title: Alcohol and incident heart failure among middle-aged and elderly men: cohort of Swedish men.
abstract: BACKGROUND
  Compared with no alcohol consumption, heavy alcohol intake is associated with a higher rate of heart failure (HF) whereas light-to-moderate intake may be associated with a lower rate. However, several prior studies did not exclude former drinkers, who may have changed alcohol consumption in response to diagnosis. This study aimed to investigate the association between alcohol intake and incident HF.
  
  
  RESULTS
  We conducted a prospective cohort study of 33 760 men aged 45 to 79 years with no HF, diabetes mellitus, or myocardial infarction at baseline participating in the Cohort of Swedish Men Study. We excluded former drinkers. At baseline, participants completed a food frequency questionnaire and reported other characteristics. HF was defined as hospitalization for or death from HF, ascertained by Swedish inpatient and cause-of-death records from January 1, 1998, through December 31, 2011. We constructed Cox proportional hazards models to estimate multivariable-adjusted incidence rate ratios. During follow-up, 2916 men were hospitalized for (n=2139) or died (n=777) of incident HF. There was a U-shaped relationship between total alcohol intake and incident HF (P=0.0004). There was a nadir at light-to-moderate alcohol intake: consuming 7 to <14 standard drinks per week was associated with a 19% lower multivariable-adjusted rate of HF compared with never drinking (incidence rate ratio, 0.81; 95% confidence interval, 0.69-0.96).
  
  
  CONCLUSIONS
  In this cohort of Swedish men, there was a U-shaped relationship between alcohol consumption and HF incidence, with a nadir at light-to-moderate intake. Heavy intake did not seem protective.
authors: From the Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, University of Alabama at Birmingham (E.B.L.); and Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (N.H., A.W.).
authors: Kirsten S
authors: KS
authors: Dorans
authors: From the Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, University of Alabama at Birmingham (E.B.L.); and Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (N.H., A.W.).
authors: Elizabeth
authors: E
authors: Mostofsky
authors: From the Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, University of Alabama at Birmingham (E.B.L.); and Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (N.H., A.W.).
authors: Emily B
authors: EB
authors: Levitan
authors: From the Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, University of Alabama at Birmingham (E.B.L.); and Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (N.H., A.W.).
authors: Niclas
authors: N
authors: Håkansson
authors: From the Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, University of Alabama at Birmingham (E.B.L.); and Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (N.H., A.W.).
authors: Alicja
authors: A
authors: Wolk
authors: From the Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, Harvard School of Public Health, Boston, MA (K.S.D., E.M., M.A.M.); Department of Epidemiology, University of Alabama at Birmingham (E.B.L.); and Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (N.H., A.W.). mmittlem@bidmc.harvard.edu.
authors: Murray A
authors: MA
authors: Mittleman
mesh_terms: D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D002423:Cause of Death; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
keywords: alcohol consumption; cohort studies; epidemiology; heart failure