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Alcohol and heart attack survival

 

Clinical bottom line

Moderate alcohol consumption is associated with reduced mortality after a heart attack.


Reference

KJ Mukamal et al. Prior alcohol consumption and mortality following acute myocardial infarction. JAMA 2001 285: 1965-1970.

Study

between 1989 and 1995 just under 2000 patients were interviewed about four days after having an acute myocardial infarction in 45 community and tertiary medical centres. The heart attack had to have been properly diagnosed. Those where there was no alcohol consumption information or those with a history of alcoholism were not included.

The patients were interviewed in a structured way about their consumption of alcohol in the year before their heart attack. Other information collected included demographic data, and information about other disorders, or drugs.

Deaths were discovered through indexes and state offices, and the cause of death agreed by three physicians working independently. All-cause mortality was the primary outcome, with cardiovascular mortality a secondary outcome.

Results

Nondrinkers were different from those drinking one or more drinks a day. Abstainers were less well educated, for instance, with a lower income, were more likely to be women, and had more health problems and took less exercise, but were less likely to smoke.

The crude results showed that the dying in the follow up period (up to six years, median about 3.5 years) was much more likely in abstainers than drinkers:

Figure: Crude all-cause mortality and cardiovascular mortality rates

By the time that the variables had been fully adjusted for, the hazard ratios calculated for alcohol consumption and all-cause and cardiovascular mortality showed a reduction compared with non-drinkers, but the analysis of the trend was highly significant.

Comment

This is an interesting prospective cohort study that shows an association between alcohol consumption and long-term survival after a heart attack. It does not tell us anything about whether alcohol will help us servive the heart attack in the first place, nor does it tell us anything about alcohol consumption after the heart attack and whether that helps. But it is another brick in the wall of evidence showing that moderate alcohol consumption has beneficial effects on the heart.