ALCOHOL AND CORONARY HEART-DISEASE - THE ROLES OF HDL-CHOLESTEROL ANDSMOKING

Objectives. To study the role of HDL-cholesterol (HDLc) in the causal pathway mediating the effect of alcohol on coronary heart disease (CHD ). Design. Cox proportional hazard models were used to compare the rel ative CHD risks in various HDLc-smoking categories. Setting. A prospec tive, multicentre, placebo-controlled, double-blind CHD primary preven tion trial with gemfibrozil in primary (occupational) health care unit s, the Helsinki Heart Study. Subjects. Dyslipidaemic middle-aged men w ith available alcohol consumption data (1924 of 2035) in the placebo a rm of the 5-year study. Main outcome measures. Seventy-seven (of 84) c ases of nonfatal myocardial infarction or cardiac death. Results. A U- shaped association was detected between alcohol consumption and CHD. T he protection was found both in subjects with low (mean 0.94 mmol L(-1 )) and normal (mean 1.25 mmol L(-1)) HDLc with corresponding reduction s of 23% and 36% in relative risks. In contrast to previous data, alco hol offered virtually no protection against CHD in non-smokers. In sub jects consuming more than 800 g pure ethanol annually, the CHD inciden ce was 6/1000 in subjects with more than three weekly drinking occasio ns, compared to 11/1000 in 'weekend' drinkers. Conclusions. Our result s confirm the protective effect of alcohol against CHD. However, in co ntrast to previous data the effect in our population is restricted to smokers and the role of HDLc in mediating the effect is less central t han suggested previously.