title: Alcohol and long-term prognosis after a first acute myocardial infarction: the SHEEP study.
abstract: BACKGROUND
  Few studies have investigated the relation between alcohol consumption, former drinking, and prognosis after an acute myocardial infarction (AMI), particularly for non-fatal outcomes.
  
  
  OBJECTIVE
  To investigate the prognostic importance of drinking habits among patients surviving a first AMI.
  
  
  METHODS
  A total of 1346 consecutive patients between 45-70 years with a first non-fatal AMI underwent a standardized clinical examination and were followed for over 8 years.
  
  
  METHODS
  Total and cardiac mortality and hospitalization for non-fatal cardiovascular disease in relation to individual alcoholic beverage consumption at the time of AMI and 5 years before inclusion, assessed by a standardized questionnaire administered during hospitalization.
  
  
  RESULTS
  We recorded 267 deaths, and 145 deaths from cardiac causes, during the follow-up period. After adjustment for several potential confounders, hazard ratios for total and cardiac mortality were 0.77 (0.51-1.15) and 0.61 (0.36-1.02) for those drinking >0-<5 g per day, 0.77 (0.50-1.18) and 0.62 (0.36-1.07) for those drinking 5-20 g per day, and 0.89 (0.56-1.40) and 0.69 (0.38-1.25) for those drinking over 20 g per day. Risk of hospitalization for recurrent non-fatal AMI, stroke, or heart failure generally showed a similar pattern to that of total and cardiac mortality. Recent quitters at the time of AMI had a hazard ratio of 4.55 (2.03-10.20) for total mortality. Measures of insulin sensitivity appeared to be the strongest mediators of this association.
  
  
  CONCLUSIONS
  Moderate alcohol drinking might have beneficial effects on several aspects of long-term prognosis after an AMI. Our findings also highlight that former drinkers should be examined separately from long-term abstainers. The potential mechanisms that underlie this association still need to be elucidated.
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Norrbacka, 6th floor, Karolinska University Hospital SE-171 76 Stockholm, Sweden. imre.janszky@ki.se
authors.forename: Imre
authors.initials: I
authors.lastname: Janszky
authors.forename: Rickard
authors.initials: R
authors.lastname: Ljung
authors.forename: Staffan
authors.initials: S
authors.lastname: Ahnve
authors.forename: Johan
authors.initials: J
authors.lastname: Hallqvist
authors.forename: Anna M
authors.initials: AM
authors.lastname: Bennet
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology / Q000401:mortality* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology