title: Alcohol consumption and prognosis in patients with left ventricular systolic dysfunction after a myocardial infarction.
abstract: 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.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. david.aguilar@uth.tmc.edu
authors.forename: David
authors.initials: D
authors.lastname: Aguilar
authors.forename: Hicham
authors.initials: H
authors.lastname: Skali
authors.forename: Lemuel A
authors.initials: LA
authors.lastname: Moyé
authors.forename: Eldrin F
authors.initials: EF
authors.lastname: Lewis
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
authors.forename: John D
authors.initials: JD
authors.lastname: Rutherford
authors.forename: L Howard
authors.initials: LH
authors.lastname: Hartley
authors.forename: Otelio S
authors.initials: OS
authors.lastname: Randall
authors.forename: Edward M
authors.initials: EM
authors.lastname: Geltman
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Jean L
authors.initials: JL
authors.lastname: Rouleau
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: 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