title: Patterns of alcohol consumption and myocardial infarction risk: observations from 52 countries in the INTERHEART case-control study.
abstract: BACKGROUND
  Although moderate alcohol use is associated with protection against myocardial infarction (MI), it is not known whether this effect is generalizable to populations worldwide. It is also uncertain whether differences in the pattern of alcohol use (and in particular heavy episodic consumption) between different regions negate any beneficial effect.
  
  
  RESULTS
  We included 12 195 cases of first MI and 15 583 age- and sex-matched controls from 52 countries. Current alcohol use was associated with a reduced risk of MI (compared with nonusers: adjusted odds ratio, 0.87; 95% confidence interval, 0.80-0.94; P=0.001); however, the strength of this association was not uniform across different regions (region-alcohol interaction P<0.001). Heavy episodic drinking (≥6 drinks) within the preceding 24 hours was associated with an increased risk of MI (odds ratio, 1.4; 95% confidence interval, 1.1-1.9; P=0.01). This risk was particularly elevated in older individuals (for age >65 years: odds ratio, 5.3; 95% confidence interval, 1.6-18; P=0.008).
  
  
  CONCLUSIONS
  In most participants, low levels of alcohol use are associated with a moderate reduction in the risk of MI; however, the strength of this association may not be uniform across different countries. An episode of heavy drinking is associated with an increased risk of acute MI in the subsequent 24 hours, particularly in older individuals.
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (D.P.L., A.S., K.K.T., S.R., S.S.A., S.Y.); London School of Hygiene and Tropical Medicine, London, UK (M.M.); St. John's Medical College, Bangalore, India (P.P.); and Fu Wai Hospital, Beijing, China (L.L.). leongd@phri.ca.
authors.forename: Darryl P
authors.initials: DP
authors.lastname: Leong
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (D.P.L., A.S., K.K.T., S.R., S.S.A., S.Y.); London School of Hygiene and Tropical Medicine, London, UK (M.M.); St. John's Medical College, Bangalore, India (P.P.); and Fu Wai Hospital, Beijing, China (L.L.).
authors.forename: Andrew
authors.initials: A
authors.lastname: Smyth
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (D.P.L., A.S., K.K.T., S.R., S.S.A., S.Y.); London School of Hygiene and Tropical Medicine, London, UK (M.M.); St. John's Medical College, Bangalore, India (P.P.); and Fu Wai Hospital, Beijing, China (L.L.).
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (D.P.L., A.S., K.K.T., S.R., S.S.A., S.Y.); London School of Hygiene and Tropical Medicine, London, UK (M.M.); St. John's Medical College, Bangalore, India (P.P.); and Fu Wai Hospital, Beijing, China (L.L.).
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (D.P.L., A.S., K.K.T., S.R., S.S.A., S.Y.); London School of Hygiene and Tropical Medicine, London, UK (M.M.); St. John's Medical College, Bangalore, India (P.P.); and Fu Wai Hospital, Beijing, China (L.L.).
authors.forename: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (D.P.L., A.S., K.K.T., S.R., S.S.A., S.Y.); London School of Hygiene and Tropical Medicine, London, UK (M.M.); St. John's Medical College, Bangalore, India (P.P.); and Fu Wai Hospital, Beijing, China (L.L.).
authors.forename: Prem
authors.initials: P
authors.lastname: Pais
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (D.P.L., A.S., K.K.T., S.R., S.S.A., S.Y.); London School of Hygiene and Tropical Medicine, London, UK (M.M.); St. John's Medical College, Bangalore, India (P.P.); and Fu Wai Hospital, Beijing, China (L.L.).
authors.forename: Lisheng
authors.initials: L
authors.lastname: Liu
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (D.P.L., A.S., K.K.T., S.R., S.S.A., S.Y.); London School of Hygiene and Tropical Medicine, London, UK (M.M.); St. John's Medical College, Bangalore, India (P.P.); and Fu Wai Hospital, Beijing, China (L.L.).
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Anand
authors.affiliation: From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (D.P.L., A.S., K.K.T., S.R., S.S.A., S.Y.); London School of Hygiene and Tropical Medicine, London, UK (M.M.); St. John's Medical College, Bangalore, India (P.P.); and Fu Wai Hospital, Beijing, China (L.L.).
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D063425:Binge Drinking / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D016017:Odds Ratio; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data; D012307:Risk Factors; D040242:Risk Reduction Behavior; D017678:Sex Distribution
keywords: alcohol drinking; epidemiology; myocardial infarction; risk factors