Patterns of Alcohol Consumption and Myocardial Infarction Risk

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. Methods and 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.

The relationship between different dimensions of alcohol use and the burden of disease—an update

“…Clearly, chronic heavy drinking is detrimental (for blood pressure/hypertension 241, 242; ischaemic heart disease 243; cardiomyopathy 244; atrial fibrillation and flutter 245; all types of stroke 246), but there is also evidence for an increased risk associated with irregular heavy drinking, even in people who are on average light to moderate drinkers (ischaemic heart disease 247, 248, 249; ischaemic stroke 250; all types of stroke 251; different cardiovascular outcomes 252). For the effects of irregular heavy drinking occasions on cardiovascular disease, there are potentially four main mechanisms 253.…”

“…However, the situation may be more complex, as there are indications that the beneficial effect on ischaemic outcomes cannot be found in certain countries such as India 263, 264. It remains to be seen if this reflects different drinking patterns among those who are, on average, light to moderate drinkers, or if there are genetic influences on the biological pathways leading to cardioprotection of light to moderate alcohol use (see also 249). …”

Complex Association Between Alcohol Consumption and Myocardial Infarction

“…Strictly speaking, however, the bulk of studies supporting this knowledge operate in high-income countries with little evidence available from South America, Africa, or Asia, except China and Japan. 2 In this regard, the study by Leong et al 5 in the current issue of Circulation delivers unique and, to some extent, surprising results. Alcohol consumers living in South Asia and the Middle East, in contrast to the rest of the world, do not enjoy protection against myocardial infarction.…”

“…Inhabitants of the South Asian countries Sri Lanka, Pakistan, India, and Bangladesh (1.644 million people; 23.04% of the world population as of 2013) even faced a significantly elevated risk after adjusting for body composition, physical activity, smoking, quality of diet, and classic vascular risk factors, as well as socioeconomic and sociocultural factors. 5 INTERHEART is among the pioneer initiatives aimed at scrutinizing effects of lifestyle on human diseases on a large scale and around the globe. 6 It involves more than 27 000 individuals from 52 countries and uses rigorous methodologic standards.…”

Effects of Repeated Binge Drinking on Blood Pressure Levels and Other Cardiovascular Health Metrics in Young Adults: National Health and Nutrition Examination Survey, 2011‐2014

“…In middle‐aged and older adults, binge drinking is associated with an increased risk of myocardial infarction, stroke, and hypertension 1, 2, 3, 4, 5. Binge drinking is also associated with an increased likelihood of developing prehypertension, previously defined as systolic blood pressure (SBP) between 120 and 140 mm Hg and diastolic blood pressure (DBP) between 70 and 90 mm Hg 6.…”