Prior Alcohol Consumption and Mortality Following Acute Myocardial Infarction

Mukamal, Kenneth J. MD, MPH, MA
Maclure, Malcolm ScD
Muller, James E. MD
Sherwood, Jane B. RN
Mittleman, Murray A. MD, DrPH

Author Affiliations: Divisions of General Medicine and Primary Care (Dr Mukamal) and Cardiology (Dr Mittleman), Beth Israel Deaconess Medical Center, Departments of Epidemiology (Drs Maclure and Mittleman) and Health and Social Behavior (Ms Sherwood), Harvard School of Public Health, and Division of Cardiology, Massachusetts General Hospital (Dr Muller), Boston.

Corresponding Author and Reprints: Kenneth J. Mukamal, MD, MPH, MA, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY-303, Boston, MA 02215 (e-mail: [email protected]).

JAMA: The Journal of the American Medical Association 285(15):p 1965-1970, April 18, 2001.

Context

Studies have found that individuals who consume 1 alcoholic drink every 1 to 2 days have a lower risk of a first acute myocardial infarction (AMI) than abstainers or heavy drinkers, but the effect of prior drinking on mortality after AMI is uncertain.

Objective

To determine the effect of prior alcohol consumption on long-term mortality among early survivors of AMI.

Design and Setting

Prospective inception cohort study conducted at 45 US community and tertiary care hospitals between August 1989 and September 1994, with a median follow-up of 3.8 years.

Patients

A total of 1913 adults hospitalized with AMI between 1989 and 1994.

Main Outcome Measure

All-cause mortality, compared by self-reported average weekly consumption of beer, wine, and liquor during the year prior to AMI.

Results

Of the 1913 patients, 896 (47%) abstained from alcohol, 696 (36%) consumed less than 7 alcoholic drinks/wk, and 321 (17%) consumed 7 or more alcoholic drinks/wk. Compared with abstainers, patients who consumed less than 7 drinks/wk had a lower all-cause mortality rate (3.4 vs 6.3 deaths per 100 person-years; hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.43-0.71) as did those who consumed 7 or more drinks/wk (2.4 vs 6.3 deaths per 100 person-years; HR, 0.38; 95% CI, 0.25-0.55; P<.001 for trend). After adjusting for propensity to drink and other potential confounders, increasing alcohol consumption remained predictive of lower mortality for less than 7 drinks/wk, with an adjusted HR of 0.79 (95% CI, 0.60-1.03), and for 7 or more drinks/wk, with an adjusted HR of 0.68 (95% CI, 0.45-1.05; P =.01 for trend). The association was similar for total and cardiovascular mortality, among both men and women, and among different types of alcoholic beverages.

Conclusion

Self-reported moderate alcohol consumption in the year prior to AMI is associated with reduced mortality following infarction.

JAMA.2001;285:1965-1970