Alcohol Consumption and Risk of Coronary Heart Disease in Older Adults: The Cardiovascular Health Study

Authors

  • Kenneth J. Mukamal MD, MPH,

    1. From the *Divisions of General Medicine and Primary CareCardiology, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartments of Biostatistics, §Neurology, Epidemiology, Medicine, and #Health Services, University of Washington, Seattle, Washington**Departments of Pathology††Medicine, College of Medicine, University of Vermont, Burlington, Vermont‡‡Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§§Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts∥∥Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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  • Hyoju Chung MS,

    1. From the *Divisions of General Medicine and Primary CareCardiology, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartments of Biostatistics, §Neurology, Epidemiology, Medicine, and #Health Services, University of Washington, Seattle, Washington**Departments of Pathology††Medicine, College of Medicine, University of Vermont, Burlington, Vermont‡‡Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§§Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts∥∥Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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  • Nancy S. Jenny PhD,

    1. From the *Divisions of General Medicine and Primary CareCardiology, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartments of Biostatistics, §Neurology, Epidemiology, Medicine, and #Health Services, University of Washington, Seattle, Washington**Departments of Pathology††Medicine, College of Medicine, University of Vermont, Burlington, Vermont‡‡Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§§Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts∥∥Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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  • Lewis H. Kuller MD, DrPH,

    1. From the *Divisions of General Medicine and Primary CareCardiology, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartments of Biostatistics, §Neurology, Epidemiology, Medicine, and #Health Services, University of Washington, Seattle, Washington**Departments of Pathology††Medicine, College of Medicine, University of Vermont, Burlington, Vermont‡‡Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§§Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts∥∥Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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  • W.T. Longstreth Jr. MD, MPH,

    1. From the *Divisions of General Medicine and Primary CareCardiology, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartments of Biostatistics, §Neurology, Epidemiology, Medicine, and #Health Services, University of Washington, Seattle, Washington**Departments of Pathology††Medicine, College of Medicine, University of Vermont, Burlington, Vermont‡‡Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§§Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts∥∥Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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  • Murray A. Mittleman MD, DrPH,

    1. From the *Divisions of General Medicine and Primary CareCardiology, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartments of Biostatistics, §Neurology, Epidemiology, Medicine, and #Health Services, University of Washington, Seattle, Washington**Departments of Pathology††Medicine, College of Medicine, University of Vermont, Burlington, Vermont‡‡Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§§Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts∥∥Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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  • Gregory L. Burke MD, MS,

    1. From the *Divisions of General Medicine and Primary CareCardiology, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartments of Biostatistics, §Neurology, Epidemiology, Medicine, and #Health Services, University of Washington, Seattle, Washington**Departments of Pathology††Medicine, College of Medicine, University of Vermont, Burlington, Vermont‡‡Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§§Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts∥∥Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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  • Mary Cushman MD, Msc,

    1. From the *Divisions of General Medicine and Primary CareCardiology, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartments of Biostatistics, §Neurology, Epidemiology, Medicine, and #Health Services, University of Washington, Seattle, Washington**Departments of Pathology††Medicine, College of Medicine, University of Vermont, Burlington, Vermont‡‡Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§§Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts∥∥Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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  • Bruce M. Psaty MD, PhD, MPH,

    1. From the *Divisions of General Medicine and Primary CareCardiology, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartments of Biostatistics, §Neurology, Epidemiology, Medicine, and #Health Services, University of Washington, Seattle, Washington**Departments of Pathology††Medicine, College of Medicine, University of Vermont, Burlington, Vermont‡‡Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§§Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts∥∥Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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  • David S. Siscovick MD, MPH

    1. From the *Divisions of General Medicine and Primary CareCardiology, Beth Israel Deaconess Medical Center, Boston, MassachusettsDepartments of Biostatistics, §Neurology, Epidemiology, Medicine, and #Health Services, University of Washington, Seattle, Washington**Departments of Pathology††Medicine, College of Medicine, University of Vermont, Burlington, Vermont‡‡Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§§Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts∥∥Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Address correspondence to Kenneth J. Mukamal, MD, MPH, MA, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RO-114, Boston, MA 02215. E-mail: kmukamal@bidmc.harvard.edu

Abstract

OBJECTIVES: 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.

DESIGN: Prospective cohort study.

SETTING: Four U.S. communities.

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

MEASUREMENTS: 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.

CONCLUSION: 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.

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