title: The association of alcohol consumption with coronary heart disease mortality and cancer incidence varies by smoking history.
abstract: OBJECTIVE
  To evaluate the effect of alcohol on coronary heart disease (CHD), cancer incidence, and cancer mortality by smoking history.
  
  
  METHODS
  A prospective, general community cohort was established with a baseline mailed questionnaire completed in 1986.
  
  
  METHODS
  A population-based sample of 41,836 Iowa women aged 55-69 years.
  
  
  METHODS
  Mortality (total, cancer, and CHD) and cancer incidence outcomes were collected through 1999. Relative hazard rates (HR) were calculated using Cox regression analyses.
  
  
  RESULTS
  Among never smokers, alcohol consumption (> or =14 g/day vs none) was inversely associated with age-adjusted CHD mortality (HR, 0.40; 95% confidence interval [CI], 0.19 to 0.84) and total mortality (HR, 0.71; 95% CI, 0.55 to 0.92). Among former smokers, alcohol consumption was also inversely associated with CHD mortality (HR, 0.45; 95% CI, 0.23 to 0.88) and total mortality (HR, 0.78; 95% CI, 0.62 to 0.97), but was positively associated with cancer incidence (HR, 1.25; 95% CI, 1.03 to 1.51). Among current smokers, alcohol consumption was not associated with CHD mortality (HR, 1.05; 95% CI, 0.73 to 1.50) or total mortality (HR, 1.07; 95% CI, 0.92 to 1.25), but was positively associated with cancer incidence (HR, 1.30; 95% CI, 1.10 to 1.54).
  
  
  CONCLUSIONS
  Health behavior counseling regarding alcohol consumption for cardioprotection should include a discussion of the lack of a decreased risk of CHD mortality for current smokers and the increased cancer risk among former and current smokers.
authors.affiliation: Nicotine Research Center, Division of Community Internal Medicine, Rochester, MN 55905, USA. ebbert.jon@mayo.edu
authors.forename: Jon O
authors.initials: JO
authors.lastname: Ebbert
authors.forename: Carol A
authors.initials: CA
authors.lastname: Janney
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Sellers
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.forename: James R
authors.initials: JR
authors.lastname: Cerhan
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D003327:Coronary Disease / Q000401:mortality*; D005260:Female; D015438:Health Behavior; D006801:Humans; D015994:Incidence; D007484:Iowa / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology*