Alcohol intake and mortality in middle aged men with diagnosed coronary heart disease

Objective-To examine the effects of alcohol on risk of mortality from coron ary heart disease (CHD), cardiovascular disease, and all causes in men with established CHD. Methods and results-In a population based prospective study of 7169 men age d 45-65 years followed for a mean of 12.8 years 655 men (9.1%) had a physic ian diagnosis of CHD (myocardial infarction 455, angina only 200). In these 655 men, there were 294 deaths from all causes including 175 CHD deaths. E x-drinkers had the highest risk of CHD, cardiovascular mortality, and all c ause mortality even after adjustment for lifestyle characteristics and pre- existing disease. Using occasional drinkers as the reference group, lifelon g teetotallers, occasional drinkers, and light drinkers all showed similar risks of mortality from CHD, cardiovascular disease, and all causes. Modera te/heavy drinkers showed increased risk of mortality from CHD, cardiovascul ar disease, and all causes compared to occasional drinkers. The adverse eff ect of moderate/heavy drinking was confined to the 455 men with previous my ocardial infarction (adjusted relative risk for all cause mortality 1.50, 9 5% confidence interval 1.01 to 2.23). In contrast to lighter drinking, givi ng up smoking within five years of the start of follow up was associated wi th a considerable reduction in risk of all cause and cardiovascular mortali ty compared to those who continued to smoke. Conclusion-Compared to occasional drinking, regular light alcohol consumpti on (1-14 units per week) in men with established coronary heart disease is not associated with any significant benefit or deleterious effect for CHD, cardiovascular disease or all cause mortality. Higher levels of intake (gre ater than or equal to 3 drinks per day) are associated with increased morta lity in men with previous myocardial infarction. In contrast, smoking cessa tion in men with established CHD substantially reduces the risk of mortalit y.