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From the Harvard School of Public Health, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts; the Wageningen University, Wageningen, The Netherlands; and TNO Quality of Life, Zeist, The Netherlands.
Acknowledgments: The authors thank Meir J. Stampfer for his valuable comments on the editing of the manuscript.
Grant Support: By National Institutes of Health Grants AA11181, HL35464, and CA55075; a travel grant from the Dutch Heart Association; and a research exchange award from European Research Advisory Board.
Potential Financial Conflicts of Interest: Dr. Rimm has an annual speaking engagement at an academic conference for which the trip is sponsored by Distilled Spirits Council of the United States.
Requests for Single Reprints: Joline W.J. Beulens, MSc, University Medical Center, Utrecht Julius Center for Health Sciences and Primary Care, PO Box 85500, 3508 GA Utrecht, The Netherlands; e-mail, J.Beulens@umcutrecht.nl.
Current Author Addresses: Dr. Beulens: University Medical Center Utrecht Julius Center for Health Sciences and Primary Care, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Drs. Rimm and Ascherio: Department of Nutrition, Harvard School of Public Health, Building II, 655 Huntington Avenue, Boston, MA 02115.
Dr. Spiegelman: Department of Biostatistics, Kresge Building, Room 806, 677 Huntington Avenue, Boston, MA 02115.
Dr. Hendriks: Business Unit Biosciences, TNO Quality of Life, PO Box 360, 3700 AJ Zeist, The Netherlands.
Dr. Mukamal: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RO-114, Boston, MA 02215.
Author Contributions: Conception and design: J.W.J. Beulens, E.B. Rimm, A. Ascherio, H.F.J. Hendriks, K.J. Mukamal.
Analysis and interpretation of the data: J.W.J. Beulens, A. Ascherio, D. Spiegelman, K.J. Mukamal.
Critical revision of the article for important intellectual content: J.W.J. Beulens, E.B. Rimm, A. Ascherio, D. Spiegelman, H.F.J. Hendriks, K.J. Mukamal.
Final approval of the article: J.W.J. Beulens, E.B. Rimm, A. Ascherio, H.F.J. Hendriks, K.J. Mukamal.
Provision of study materials or patients: E.B. Rimm, D. Spiegelman.
Statistical expertise: D. Spiegelman.
Obtaining of funding: J.W.J. Beulens, E.B. Rimm, D. Spiegelman, H.F.J. Hendriks, K.J. Mukamal.
Collection and assembly of data: E.B. Rimm, D. Spiegelman.
The HPFS enrolled 51 529 male dentists, veterinarians, optometrists, pharmacists, osteopathic physicians, and podiatrists from the United States who were 40 to 75 years of age and who returned a mailed questionnaire about diet and medical history in 1986. Follow-up questionnaires were sent biennially to update information on exposures and newly diagnosed illnesses.
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The authors are to be commended to have carried out a thorough study documenting a progressively lower risk of myocardial infarction with increasing alcohol intake. (1) Surprisingly, they failed to comment on their observation that smoking also increased in parallel with alcohol intake. In fact, though there was a 307% increase in the incidence of smoking in the group with the highest alcohol consumption, the risk of myocardial infarction was reduced by 57% in this group compared with non-drinkers. Could this apparent "paradox" possibly indicate that alcohol consumption, by mechanisms that authors described (increase in high-density lipoprotein cholesterol, decrease of inflammatory factors, improved insulin sensitivity, and change of thrombogenic markers), antagonizes the detrimental effects of smoking on coronary artery disease as has been suggested also by other observational studies? (2-5) If so, should we not perhaps advise our patients who are unable or unwilling to give up smoking to at least have a drink or 2 in order to protect their coronaries? And if so, does it matter whether these two drinks are red wine, as French authors recommend, or liquor, as present paper seems to entail?
1. Beulens JW, Rimm EB, Ascherio A, Spiegelman D, Hendriks HF, Mukamal KJ. Alcohol consumption and risk for coronary heart disease among men with hypertension. Ann Intern Med. 2007;146(1):10-9.
2. Goldberg RJ, Burchfiel CM, Reed DM, Wergowske G, Chiu D. A prospective study of the health effects of alcohol consumption in middle-aged and elderly men. The Honolulu Heart Program. Circulation. 1994;89(2):651-9.
3. Solomon CG, Hu FB, Stampfer MJ, et al. Moderate alcohol consumption and risk of coronary heart disease among women with type 2 diabetes mellitus. Circulation. 2000;102(5):494-9.
4. Tanasescu M, Hu FB, Willett WC, Stampfer MJ, Rimm EB. Alcohol consumption and risk of coronary heart disease among men with type 2 diabetes mellitus. J Am Coll Cardiol. 2001;38(7):1836-42.
5. Valmadrid CT, Klein R, Moss SE, Klein BE, Cruickshanks KJ. Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus. Jama. 1999;282(3):239-46.
In the article written by Beulens et al (1), published in the Annals, the authors affirm that moderate alcohol consumption is associated with a decreased risk of myocardial infarction (MI) in hypertensive men. However, some considerations must be made.
The hazard ratio of drinking 15 to 29.9g of alcohol per day was statistically significant in the multivariate analysis only for total MI (CI for fatal coronary heart disease - CHD - is 0.50-1.25; and for non- fatal MI, 0.46-1.03). People in this range of alcohol consumption had the highest physical activity index and the largest absolute number of former smokers. These two characteristics are indicators of a healthier lifestyle, reflecting actions capable of lowering the cardiovascular risk per se.
Fuchs et al (2) found a positive relationship between alcohol consumption and incident CHD for African-american men, but not for Caucasians. In that study there were a higher prevalence of hypertension and lower socio-economic status in non-whites, suggesting moderate to abusive alcohol consumption as a behavioral marker of lifestyle characteristics that would put these individuals in greater cardiovascular risk.
These conflicting data keep the discussion about actual cardioprotective properties of alcohol and the possibility to quantify it. Until a consent about this subject is achieved, physicians should concentrate efforts in lowering cardiovascular risk with the known and well-established strategies, as controlling blood pressure and other risk factors for CHD and stroke.
1- Beulens JWJ; Rimm EB; Ascherio A; et al. Alcohol Consumption and Risk for Coronary Heart Disease among Men with Hypertension. Ann Intern Med. 2007;146:10-19.
2- Fuchs FD, Chambless LE, Folsom AR, et al. Association between alcoholic beverage and incidence of coronary heart disease in whites and blacks. The Atherosclerosis Risk in Communities Study. Am J Epidemiol 2004; 160(5):466-74
Alcohol Consumption and Risk for Coronary Heart Disease among Men with Hypertension
The summary below is from the full report titled “Alcohol Consumption and Risk for Coronary Heart Disease among Men with Hypertension.” It is in the 2 January 2007 issue of Annals of Internal Medicine (volume 146, pages 10-19). The authors are J.W.J. Beulens, E.B. Rimm, A. Ascherio, D. Spiegelman, H.F.J. Hendriks, and K. J. Mukamal.
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