Alcohol intake and long-term mortality risk after myocardial infarction in the Alpha Omega Cohort

Abstract

Background Population-based studies generally show J-shaped associations between alcohol intake and mortality from cardiovascular diseases (CVD). Little is known about alcohol and long-term mortality risk after myocardial infarction (MI). Objective We examined alcohol intake in relation to all-cause, CVD and ischemic heart disease (IHD) mortality in Dutch post-MI patients of the Alpha Omega Cohort. Design The analysis comprised 4,365 patients (60-80 y, 79% male) with an MI ≤10 y before study enrolment. We used a 203-item food-frequency questionnaire to assess alcohol (total ethanol) and dietary intakes over the past month. Patients were classified as non-drinkers (0 g/d, n = 956) or very light (>0-2 g/d, n = 385), light (M: >2-10, F: >2-5 g/d, n = 1125), moderate (M: >10-30, F: >5-15 g/d, n = 1207) or heavy drinkers (M: >30, F: >15 g/d, n = 692). Hazard ratios (HRs) of mortality for alcohol intake were obtained from Cox models, adjusting for age, sex, education, smoking, BMI, physical activity and dietary factors. Results Alcohol was consumed by 83% of males and 61% of females. During ∼12 y of follow-up, 2,035 deaths occurred of which 903 from CVD and 558 from IHD. Compared to the (combined) reference group of non-drinkers and very light drinkers, HRs (95% CI) for all-cause mortality were 0.87 (0.78, 0.98), 0.85 (0.75, 0.96) and 0.91 (0.79, 1.04) in consecutive drinking categories. For CVD mortality, corresponding HRs were 0.80 (0.67, 0.96), 0.82 (0.69, 0.98) and 0.87 (0.70, 1.08). Findings for IHD mortality were similar. HRs did not materially change when non-drinkers or very light drinkers were taken as the reference, or after exclusion of former drinkers or patients with diabetes or poor/moderate self-rated health. Conclusion Light and moderate alcohol intake were inversely associated with mortality risk in stable post-MI patients. These observational findings should be cautiously interpreted in light of the total evidence on alcohol and health. Registration: The Alpha Omega Cohort is registered at Clinicaltrials.gov as NCT03192410.

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