Alcohol consumption, atherosclerotic progression, and prognosis among patients with coronary artery bypass grafts.
BACKGROUND
Although moderate drinking has been associated with lower mortality among patients after myocardial infarction, its relationship with prognosis and graft obstruction among patients with coronary artery bypass grafts is unknown.


METHODS
We studied 1351 patients enrolled in the Post-CABG trial, who had undergone coronary bypass surgery 1 to 11 years before entry. Participants were randomly assigned to lovastatin in low or high doses and to low-dose warfarin or placebo in a factorial design. Participants underwent coronary angiography at baseline and after a mean follow-up of 4.3 years and were followed up for a composite end point of death, myocardial infarction, stroke, bypass surgery, or angioplasty. We categorized reported weekly alcohol intake as abstention (<1 drink), light (1-6 drinks), moderate (7-13 drinks), and heavier (> or =14 drinks).


RESULTS
During follow-up, 238 participants sustained a clinical event. Moderate drinking was associated with a trend toward both fewer clinical events (hazard ratio 0.7, 95% CI 0.4-1.1) and less angiographic progression (odds ratio 0.7, 95% CI 0.5-1.1), although neither of these effects were statistically significant. High-density lipoprotein cholesterol appeared to account for one third of the trend toward lower risk among moderate drinkers.


CONCLUSIONS
We did not demonstrate statistically significant differences in prognosis according to alcohol intake in this study, although there were inverse trends between moderate drinking and both morbidity and graft progression of a magnitude similar to studies in other populations. Larger studies of alcohol intake among patients with coronary artery bypass grafts are needed.
Mukamal
Kenneth J
KJ
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. kmukamal@bidmc.harvard.edu
Girotra
Saket
S
Mittleman
Murray A
MA
D000428:Alcohol Drinking; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D008076:Cholesterol, HDL / Q000097:blood; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000097:blood / Q000209:etiology* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006083:Graft Occlusion, Vascular / Q000097:blood / Q000209:etiology*; D006801:Humans; D008148:Lovastatin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use
D000924:Anticholesteremic Agents; D000925:Anticoagulants; D008076:Cholesterol, HDL; D014859:Warfarin; D008148:Lovastatin