Practice Update: Cardiology

EDITOR’S PICKS 10

Relationship of Alcohol Consumption to All-Cause, Cardiovascular, and Cancer- Related Mortality JACC: Journal of the American College of Cardiology Take-home message • Data from the National Health Interview Survey and the National Death Index records were analyzed to evaluate the association between alcohol consumption and the risk of all-cause, cancer-, and cardiovascular disease (CVD)-associated mortality. Light or moderate alcohol intake was significantly associated with a reduced risk for all-cause mortality and CVD-specific mortality compared with lifetime abstinence. Conversely, heavy alcohol consumption was significantly asso- ciated with an increased risk for all-cause mortality and cancer-related mortality. The risk of all-cause mortality and cancer-related mortality was also significantly increased in the setting of binge drinking ≥1 day/week. • While light and moderate alcohol consumption may have a protective effect on the risk of all-cause and CVD-specific mortality, heavy drinking and binge drinking are associated with an increased all-cause and cancer-specific mortality risk. Abstract

COMMENT By Paul D Thompson MD Picking Your Poison H ow should we advise patients regarding the risks and benefits of alcohol consumption? Many prior studies have suggested a J-shaped relationship between alcohol and health, meaning that risk is high both in those who abstain from alcohol and those who drink heavily, compared to low and mod- erate drinkers. But many prior studies did not correct for the “abstainer” effect. This refers to the possibility that some abstain- ers quit drinking but were former, perhaps heavy, drinkers. Xi and colleagues ( J Am Coll Cardiol 2017;70:913–22) used reported alcohol intake provided by 333,247 subjects in the 1997-2009 National Health Interview Surveys to examine the relationship between alco- hol consumption and all, cancer and cardiovascular (CV) deaths in the United States. Subjects were divided into lifetime abstainers (<12 drinks ever), infrequent drinkers (<12 drinks in any year), for- mer drinkers (≥12 drinks in a previous year), light (<3), moderate (>3 <15 drinks/ week for men and >3 <8 drinks/week for women; and heavy current drinkers. Binge drinking was defined as ≥5 drinks in a day during the past year. The median follow-up was 8.2 years. Compared to abstainers, light and mod- erate alcohol consumers had a 21 and 22% reduction in all-cause mortality and a 26 and 29% reduction in cardiovas- cular death. In contrast, heavy drinkers had an 11% increase in total mortality and a 27% increase in cancer mortality. Binge drinking ≥1 per week was associ- ated with a 13% increase in total and a 22% increase in cancer mortality. These results support the J-shaped rela- tionship between alcohol and health. Light tomoderate alcohol intake appears beneficial to total andCVhealthbut heavy and binge drinking increase all cause and cancer specific mortality. Patients who wish should be permitted to imbibe but discouraged from >2 daily drinks for men and >1 daily drink for women.

included. Self-reported alcohol consumption patterns were categorized into 6 groups: lifetime abstainers; lifetime infrequent drinkers; former drinkers; and current light, moderate, or heavy drinkers. Secondary exposure included partici- pants’ binge-drinking status. The main outcome was all-cause, cancer, or CVD mortality. RESULTS After a median follow-up of 8.2 years (2.7 million person-years), 34,754 participants died of all causes (including 8,947 CVD deaths and 8,427 cancer deaths). Compared with lifetime abstainers, those who were light or mod- erate alcohol consumers were at a reduced risk of mortality for all causes (light-hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.76 to 0.82; moderate-HR: 0.78; 95% CI: 0.74 to 0.82) and CVD (light-HR: 0.74; 95% CI: 0.69 to 0.80; mod- erate-HR: 0.71; 95% CI: 0.64 to 0.78), respectively. In contrast, there was a significantly increased risk of mortality for all causes (HR: 1.11; 95% CI: 1.04 to 1.19) and cancer (HR: 1.27; 95% CI: 1.13 to 1.42) in adults with heavy alcohol consumption. Binge drinking ≥1 d/week was also associated with an increased risk of mortality for all causes (HR: 1.13; 95% CI: 1.04 to 1.23) and cancer (HR: 1.22; 95% CI: 1.05 to 1.41). CONCLUSIONS Light and moderate alcohol intake might have a protective effect on all-cause and CVD-specific mortality in U.S. adults. Heavy or binge drinking was associated with increased risk of all-cause and cancer-specific mortality. Relationship of alcohol consumption to all- cause, cardiovascular, and cancer-related mortality in US adults . J Am Coll Cardiol 2017 Aug 22;70(8)913-922, B Xi, SP Veeranki, M Zhao, et al. www.practiceupdate.com/c/57186

BACKGROUND Previous studies have revealed inconsistent findings regarding the associa- tion of light to moderate alcohol consumption with cardiovascular disease (CVD) and cancer mortality. OBJECTIVES The aim of this study was to examine the association between alcohol consumption and risk of mortality from all causes, cancer, and CVD in U.S. adults. METHODS Data were obtained by linking 13 waves of the National Health Interview Surveys (1997 to 2009) to the National Death Index records through December 31, 2011. A total of 333,247 participants ≥18 years of age were

Dr Thompson is Physician Co-Director of the Hartford Healthcare Cardiovascular Institute, Hartford, and Professor of Medicine, University of Connecticut, Storrs, Connecticut.

PRACTICEUPDATE CARDIOLOGY