Alcohol consumption and prognosis in patients with left ventricular systolic dysfunction after a myocardial infarction.
OBJECTIVE
We assessed the influence of alcohol intake on the development of symptomatic heart failure (HF) in patients with left ventricular (LV) dysfunction after a myocardial infarction (MI).


BACKGROUND
In contrast to protection from coronary heart disease, alcohol consumption has been linked to cardiodepressant effects and has been considered contraindicated in patients with HF.


METHODS
The Survival And Ventricular Enlargement (SAVE) trial randomized 2231 patients with a LV ejection fraction (EF) <40% following MI to an angiotensin-converting enzyme inhibitor or placebo. Patients were classified as nondrinkers, light-to-moderate drinkers (1 to 10 drinks/week), or heavy drinkers (>10 drinks/week) based on alcohol consumption reported at baseline. The primary outcome was hospitalization for HF or need for an open-label angiotensin-converting enzyme inhibitor. Analyses were repeated using alcohol consumption reported three months after MI.


RESULTS
Nondrinkers were older and had more comorbidities than light-to-moderate and heavy drinkers. In univariate analyses, baseline light-to-moderate alcohol intake was associated with a lower incidence of HF compared with nondrinkers (hazard ratio [HR] 0.71; 95% confidence interval [CI] 0.57 to 0.87), whereas heavy drinking was not (HR 0.91; 95% CI 0.67 to 1.23). After adjustment for baseline differences, light-to-moderate baseline alcohol consumption no longer significantly influenced the development of HF (light-to-moderate drinkers HR 0.93; 95% CI 0.75 to 1.17; heavy drinkers HR 1.25; 95% CI 0.91 to 1.72). Alcohol consumption reported three months after the MI similarly did not modify the risk of adverse outcome.


CONCLUSIONS
In patients with LV dysfunction after an MI, light-to-moderate alcohol intake either at baseline or following MI did not alter the risk for the development of HF requiring hospitalization or an open-label angiotensin-converting enzyme inhibitor.
Aguilar
David
D
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. david.aguilar@uth.tmc.edu
Skali
Hicham
H
Moyé
Lemuel A
LA
Lewis
Eldrin F
EF
Gaziano
J Michael
JM
Rutherford
John D
JD
Hartley
L Howard
LH
Randall
Otelio S
OS
Geltman
Edward M
EM
Lamas
Gervasio A
GA
Rouleau
Jean L
JL
Pfeffer
Marc A
MA
Solomon
Scott D
SD
D000428:Alcohol Drinking / Q000009:adverse effects*; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D014481:United States; D018487:Ventricular Dysfunction, Left