Objective-Moderate alcohol consumption is associated with reduced cardiovascular disease (CVD) risk. Whether this protection is based on a lesser degree of coronary atherosclerosis has not been established. Methods and Results-We studied 1676 men and 465 women consecutively undergoing coronary angiography. A score (ATS) was calculated by summing the percent lumen narrowing of all main vessels; alcohol consumption was quantitated by questionnaire. In univariate analysis, ATS was significantly (PՅ0.001) associated with male sex, age, familial CVD, smoking, diabetes, hypertension, and serum cholesterol levels; alcohol consumption was associated with less frequent diabetes (PϽ0.001) and lower ATS (Pϭ0.02 1 In a recent analysis of the modifiable risk factors for acute myocardial infarction in 52 countries, 2 regular alcohol consumption was independently associated with reduced incident myocardial infarction in both sexes, at all ages and in all regions. A number of mechanisms have been postulated to explain this association, including an increase in serum high-density lipoprotein (HDL) and apolipoprotein-A 1 levels, 3 anticoagulant effects-by either direct platelet inhibition or inhibition of the fibrinolytic system 4 -6 -a reduction in inflammation, 7 and an enhancement of insulin sensitivity. 8 The physiological basis for the protective effect of alcohol is, however, less certain. The 6 angiographic studies in the English literature 9 -14 (Table I, please see http://atvb. ahajournals.org) have included only men (nϭ4) or only women (nϭ1), are of limited size, have used variable adjustment for relevant CVD risk factors, and mostly (5 of 6) lack follow-up data. This prompted the present study, in which the association of alcohol consumption with angiographically quantified coronary atherosclerosis was analyzed in a large cohort of men and women, in whom information on classical CVD risk factors and clinical outcome was available.
Materials and Methods
PatientsFrom 1983 to 1992, 2141 of the 4754 patients admitted to our coronary division underwent coronary angiography as part of the clinical work-up of symptoms or signs of heart disease. The indications for angiography were: acute myocardial infarction (nϭ43), previous myocardial infarction (nϭ213), cardiomyopathy (nϭ118), valvular disease (nϭ105), arrhythmias (nϭ30), unstable angina (nϭ34), acute pulmonary edema (nϭ6); the remainder of the patients had signs or symptoms of myocardial ischemia. Clinically, 52% of men and 56% of women presented with angina on effort, whereas 75% of men and 26% of women presented with resting angina; 56% of the cases presented with both. Since 1983, the relevant clinical data of each patient have been transferred immediately after discharge to a database created for this purpose. Each patient record consisted of the following blocks of information: (1) demographic data (sex, age, height, weight, years of school education); (2) clinical data (history of resting or effort angina, myocardial infarction, acute cerebrovascular events, coro...