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 disease (CVD). Little is known about alcohol and long-term mortality risk after myocardial infarction (MI).

Objectives: 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.

Methods: The analysis comprised 4365 patients (60-80 years; 79% male) with an MI ≤ 10 years before study enrolment. We used a 203-item FFQ to assess alcohol (total ethanol) and dietary intakes over the past month. Patients were classified as nondrinkers (0 g/d; n = 956) or very light (>0 to 2 g/d; n = 385), light (M: >2 to 10 g/d; F: >2 to 5 g/d; n = 1125), moderate (M: >10 to 30 g/d; F: >5 to 15 g/d; n = 1207), or heavy drinkers (M: >30 g/d; F: >15 g/d; n = 692). 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 years of follow-up, 2035 deaths occurred, of which 903 were from CVD and 558 were from IHD. Compared to the (combined) reference group of nondrinkers and very light drinkers, HRs for all-cause mortality were 0.87 (95% CI, 0.78-0.98), 0.85 (95% CI, 0.75-0.96), and 0.91 (95% CI, 0.79-1.04) for light, moderate, and heavy drinkers, respectively. For CVD mortality, corresponding HRs were 0.80 (95% CI, 0.67-0.96), 0.82 (95% CI, 0.69-0.98), and 0.87 (95% CI, 0.70-1.08) for light, moderate, and heavy drinkers, respectively. Findings for IHD mortality were similar. HRs did not materially change when nondrinkers 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.

Conclusions: Light and moderate alcohol intakes 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. The Alpha Omega Cohort is registered at clinicaltrials.gov as NCT03192410.

Keywords: Alpha Omega Cohort; alcohol; cardiovascular disease; ischemic heart disease; mortality; myocardial infarction; patients; prospective cohort study.

© The Author(s) 2021. Published by Oxford University Press.

Figures

FIGURE 1

Associations of alcohol intake with all-cause, CVD, and IHD mortality in 4365 patients from the Alpha Omega Cohort. Lines are restricted cubic splines, showing continuous associations, with 3 knots located at the 5th, 50th, and 95th percentiles. The y-axis shows the predicted HRs for mortality for any value of alcohol intake, compared to the reference value set at 0 g/d. HRs are adjusted for age; sex; obesity; smoking; physical activity; education level; energy intake, excluding energy from alcohol; and intakes of sugar-sweetened beverages, red and processed meat, whole grains, fruits, vegetables, coffee, tea, milk, fish, and salt from foods. CVD, cardiovascular disease; IHD, ischemic heart disease.