Study suggests lower risk of coronary heart disease from alcohol, even with hazardous drinking

The analysis assesses the 12-month prevalence of coronary heart disease (CHD) in individuals according to their category of alcohol use. The 2001 National Epidemiologic Survey on Alcohol and Related Conditions study (the NESARC study, n = 43,093) identified 16,147 abstinent individuals, 15,884 moderate consumers, 9,578 hazardous drinkers - defined as exceeding sex-specific weekly limits established by the World Health Organization, and 1,484 alcohol-dependent subjects. Diagnoses were generated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. Both moderate and hazardous drinking were associated with decreased odds of CHD when compared with abstinence, whereas odds of CHD were not significantly different between alcohol-dependent and abstinent participants. A moderate or even a hazardous consumption of alcohol was associated with a decreased likelihood of CHD after controlling for socio-demographic, psychiatric, and addictive risk factors. Our study shows that alcohol may have cardio-protective effects not only in moderate drinkers, but also in individuals with patterns of use traditionally considered as hazardous.

International Scientific Forum on Alcohol Research Comments

There were adequate numbers of subjects in most analysis groups, in that 36% of subjects were abstinent in the last year and almost one quarter of subjects were in the group classified as "hazardous drinking." One Forum reviewer commented: "This exhibition of a rightward extension of the revered J-shaped curve for coronary heart disease (CHD) has been reported before. I find the results acceptable. I wonder, however, what happens to the rates of cirrhosis and other directly alcohol-related disorders and what might be the long-term total mortality experience in this group." An interesting finding in this study is that participants with CHD were more likely to have lifetime mood disorder, lifetime anxiety disorder, and personality disorder than those without CHD.

If indeed the risk of coronary disease does not increase despite consuming alcohol at a level often classified as "hazardous," it is possible that the increase in cardiovascular disease from heavy drinking reported in many studies may be due to arrhythmias, cardiomyopathy, or other heart conditions that are not actually coronary artery disease.

Limitations to paper: Appropriate socio-economic variables were available for adjustment for confounding, with good assessments for alcohol intake, tobacco use, and drug abuse. However, sick quitters and unhealthy hazardous drinkers dying earlier than the healthy ones may have confounded the results. Further, unmeasured factors such as exercise and diet that were not adjusted for may have led to further confounding.

A key concern of Forum reviewers related to the method used to diagnose CHD in this analysis. Not only was it self-reported, but only 1.0% of cases stated that they had had a myocardial infarction, the primary "hard" criterion for CHD. Most reported angina pectoris, a "softer" criterion for coronary disease. Further, "arteriosclerosis" is a vague term and not one generally used in normal communication with patients. It could have referred to conditions other than CHD.