Alcohol consumption and risk of coronary heart disease in older adults: the Cardiovascular Health Study.
OBJECTIVE
To evaluate several aspects of the relationship between alcohol use and coronary heart disease in older adults, including beverage type, mediating factors, and type of outcome.


METHODS
Prospective cohort study.


METHODS
Four U.S. communities.


METHODS
Four thousand four hundred ten adults aged 65 and older free of cardiovascular disease at baseline.


METHODS
Risk of incident myocardial infarction or coronary death according to self-reported consumption of beer, wine, and spirits ascertained yearly.


RESULTS
During an average follow-up period of 9.2 years, 675 cases of incident myocardial infarction or coronary death occurred. Compared with long-term abstainers, multivariate relative risks of 0.90 (95% confidence interval (CI)=0.71-1.14), 0.93 (95% CI=0.73-1.20), 0.76 (95% CI=0.53-1.10), and 0.58 (95% CI=0.39-0.86) were found in consumers of less than one, one to six, seven to 13, and 14 or more drinks per week, respectively (P for trend=.007). Associations were similar for secondary coronary outcomes, including nonfatal and fatal events. No strong mediators of the association were identified, although fibrinogen appeared to account for 9% to 10% of the relationship. The associations were statistically similar for intake of wine, beer, and liquor and generally similar in subgroups, including those with and without an apolipoprotein E4 allele.


CONCLUSIONS
In this population, consumption of 14 or more drinks per week was associated with the lowest risk of coronary heart disease, although clinicians should not recommend moderate drinking to prevent coronary heart disease based on this evidence alone, because current National Institute on Alcohol Abuse and Alcoholism guidelines suggest that older adults limit alcohol intake to one drink per day.
Mukamal
Kenneth J
KJ
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. kmukamal@bidmc.harvard.edu
Chung
Hyoju
H
Jenny
Nancy S
NS
Kuller
Lewis H
LH
Longstreth
W T
WT
Mittleman
Murray A
MA
Burke
Gregory L
GL
Cushman
Mary
M
Psaty
Bruce M
BM
Siscovick
David S
DS
D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D001057:Apolipoproteins E / Q000235:genetics; D001515:Beer; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005838:Genotype; D015438:Health Behavior; D006801:Humans; D015994:Incidence; D008297:Male; D012111:Residence Characteristics; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014481:United States; D014920:Wine
D001057:Apolipoproteins E