European Heart Journal Advance Access originally published online on November 7, 2007
European Heart Journal 2008 29(1):45-53; doi:10.1093/eurheartj/ehm509
Alcohol and long-term prognosis after a first acute myocardial infarction: the SHEEP study
1 Department of Public Health Sciences, Karolinska Institutet, Norrbacka, 6th floor, Karolinska University Hospital SE-171 76 Stockholm, Sweden
2 Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
3 Centre for Epidemiology, The National Board of Health and Welfare, Stockholm, Sweden
4 Stockholm Centre for Public Health, Stockholm, Sweden
5 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
6 Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
Received 11 July 2007; revised 5 October 2007; accepted 11 October 2007; online publish-ahead-of-print 7 November 2007.
* Corresponding author. Tel: +46 8 73 73 894, Fax: +46 8 73 73 888, Email: imre.janszky{at}ki.se
See page 4 for the editorial comment on this article (doi:10.1093/eurheartj/ehm571)
Context: Few studies have investigated the relation between alcohol consumption, former drinking, and prognosis after an acute myocardial infarction (AMI), particularly for non-fatal outcomes.
Objective: To investigate the prognostic importance of drinking habits among patients surviving a first AMI.
Design, settings, and patients: A total of 1346 consecutive patients between 45–70 years with a first non-fatal AMI underwent a standardized clinical examination and were followed for over 8 years.
Main outcome measures: Total and cardiac mortality and hospitalization for non-fatal cardiovascular disease in relation to individual alcoholic beverage consumption at the time of AMI and 5 years before inclusion, assessed by a standardized questionnaire administered during hospitalization.
Results: We recorded 267 deaths, and 145 deaths from cardiac causes, during the follow-up period. After adjustment for several potential confounders, hazard ratios for total and cardiac mortality were 0.77 (0.51–1.15) and 0.61 (0.36–1.02) for those drinking >0–<5 g per day, 0.77 (0.50–1.18) and 0.62 (0.36–1.07) for those drinking 5–20 g per day, and 0.89 (0.56–1.40) and 0.69 (0.38–1.25) for those drinking over 20 g per day. Risk of hospitalization for recurrent non-fatal AMI, stroke, or heart failure generally showed a similar pattern to that of total and cardiac mortality. Recent quitters at the time of AMI had a hazard ratio of 4.55 (2.03–10.20) for total mortality. Measures of insulin sensitivity appeared to be the strongest mediators of this association.
Conclusions: Moderate alcohol drinking might have beneficial effects on several aspects of long-term prognosis after an AMI. Our findings also highlight that former drinkers should be examined separately from long-term abstainers. The potential mechanisms that underlie this association still need to be elucidated.
Key Words: Alcohol • Acute myocardial infarction • Prognosis
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