Moderate Alcohol Consumption - Mortality Benefits

 

Moderate alcohol consumption before/after heart attack equals lower mortality

The Health Professionals Follow-up Study (HPFS) is a prospective cohort study of 51,529 US male health professionals. During the follow up of these men between 1986 to 2006, published in the European Heart Journal, 1,818 men were confirmed with incident non-fatal myocardial infarction (MI) – a non fatal heart attack. Among heart attack survivors, 468 deaths were documented during up to 20 years of follow up. Repeated reports were obtained on alcohol consumption every four years. Average alcohol consumption was calculated prior to and then following the MI.

The overall results show that, in comparison with no alcohol consumption, the pre-MI and the post-MI intakes of light (0.1-9.9 g/day of alcohol, or up to one small typical drink) and moderate (10.0-29.9 g/d, or up to about 2 1/2 to 3 drinks) amounts of alcohol were both associated with lower risk of all-cause mortality and cardiovascular mortality among these men.

The significant reductions in all-cause mortality risk (22% lower for 0.1-9.9 g/day and 34% lower for 10.0 – 29.9 g/day, in comparison with non-drinkers) were no longer present for those who drank more than 30 g/day; for this highest consumer group, the adjusted hazard ratio was 0.87 with 95% CI of 0.61-1.25.

There are a number of other informative and interesting results described from this study. First, there was little change in reported alcohol intake prior to and following the MI: drinkers tended to remain drinkers of similar amounts. Few non-drinkers began to drink after their heart attack; among heavier drinkers, there was a tendency to reduce drinking (but very few stopped drinking completely). Further there were no significant differences in outcome according to type of beverage consumed although, interestingly, lower hazard ratios were seen for consumers of beer and liquor than of wine. While the authors state that the effects of alcohol were stronger for the association with non-anterior MI's, the relative risk (versus non-drinkers) for all-cause mortality were little different: among the moderately drinking men the relative risks were 0.58 for anterior MI and 0.51 for other types of MI.

Even though exposures (such as alcohol) for cardiovascular events (such as MI) may be different after a person has an event than it was before the event, in this study the reductions in risk were almost the same. For example, both for alcohol intake reported prior to a MI, and that after a non-fatal MI, the risk of mortality was about 30% lower for moderate drinkers than it was for abstainers. This suggests that, in terms of reducing cardiovascular disease, alcohol may have relatively short-term effects, suggesting that frequent but moderate consumption (of under 30g a day for men) may result in the best health outcomes.

Blacks may not receive same health benefits from moderate alcohol drinking as whites

Although moderate alcohol consumption appears to lower mortality risk among whites, it may not have the same protective effect among blacks, and its potential benefits also may vary by gender, according to a nationally representative study of the U.S. population by researchers at Harvard T.H. Chan School of Public Health.

The study was published online April 23, 2015 in the American Journal of Public Health.

"Current dietary guidelines recommend moderate consumption for adult Americans who consume alcoholic beverages. Our study suggests that additional refinements based on race/ethnicity may be necessary," said Chandra Jackson, research associate in the Harvard Chan Department of Epidemiology, research associate in clinical and translational research at Harvard Medical School, and lead author of the study.

Previous research has found an association between moderate drinking and lowered risk of type 2 diabetes, heart disease, and premature mortality, but those studies were conducted among mostly white populations, and some studies have suggested that blacks may not experience similar risk reduction.

The new study looked at data from 152,180 adults--25,811 blacks and 126,369 whites--in the National Health Interview Survey from 1997-2002, with follow-up through 2006 to account for deaths. Study participants reported on how much alcohol they drank and how often; on sociodemographic characteristics such as education, employment, and income; on other health behaviors such as smoking status; and on their health. Researchers also looked at lack of "social integration" into society, such as living in poverty or being unemployed.

Consistent with prior literature, the results showed that 13% of white men and 24% of black men said they never drank. Among women, 23% of white women and 42% of black women reported never drinking.

When the researchers looked at the relationship between drinking alcohol and mortality, they found that it varied by both race and gender. For men, the lowest risk of mortality was among white men who consumed 1-2 drinks 3-7 days per week and among black men who didn't drink at all. For women, the lowest risk of mortality was among white women consuming 1 drink per day 3-7 days per week, and among black women who consumed 1 drink on 2 or fewer days per week.

Given the findings, the authors suggested further research into other factors that might be involved in the connection between alcohol and mortality risk, such as lifestyle related to diet, physical activity, sleep, youthful experimentation vs. coping with hardships; socioeconomic status and other markers of social integration; differences in physical, chemical, and social exposures in both occupational and residential environments; genetic differences; and gender differences.

Wine may boost life expectancy by 5 years

Long-term wine consumption is related to cardiovascular mortality and life expectancy independently of moderate alcohol intake

Drinking up to half a glass of wine a day may boost life expectancy by five years—at least in men—suggests research published in the Journal of Epidemiology and Community Health.

The Dutch authors base their findings on a total of 1,373 randomly selected men whose cardiovascular health and life expectancy at age 50 were repeatedly monitored between 1960 and 2000.

The researchers looked into how much alcohol the men drank, what type it was, and over what period, in a bid to assess whether this had any impact on the risks of their dying from cardiovascular disease, cerebrovascular disease, and from all causes.

They also tracked weight and diet, whether the men smoked, and for how long, and checked for the presence of serious illness.

During the 40 years of monitoring, 1,130 of the men died. Over half the deaths were caused by cardiovascular disease.

The proportion of men who drank alcohol almost doubled from 45% in 1960 to 86% in 2000, with the proportion of those drinking wine soaring from 2% to 44% during that period.

The researchers found that light long term alcohol consumption of all types—up to 20 g a day— extended life by around two extra years compared with no alcohol at all. Extended life expectancy was slightly less for those who drank more than 20 g.

And men who drank only wine, and less than half a glass of it a day, lived around 2.5 years longer than those who drank beer and spirits, and almost five years longer than those who drank no alcohol at all.

Drinking wine was strongly associated with a lower risk of dying from coronary heart disease, cerebrovascular disease, and death from all causes.

These results held true, irrespective of socioeconomic status, dietary and other lifestyle habits, factors long thought to influence the association between wine drinking and better health.

Light wine intake = longer life expectancy in men

Drinking a little alcohol every day, especially wine, may be associated with an increase in life expectancy. That’s the conclusion of Dutch researchers who reported the findings of their study at the American Heart Association’s 47th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

The researchers found that a light intake of alcohol (on average less than one glass per day) was associated with a lower rate of cardiovascular death and death from all causes. When compared to spirits and beer, consumption of small amounts of wine, about a half a glass a day, was associated with the lowest levels of all-cause and cardiovascular deaths.

"Our study showed that long-term, light alcohol intake among middle-aged men was associated not only with lower cardiovascular and all-cause death risk, but also with longer life expectancy at age 50," said Martinette T. Streppel, lead author of the study and a Ph.D. student in the Division of Human Nutrition at Wageningen University and National Institute for Public Health and the Environment (RIVM) in Bilthoven, The Netherlands. "Furthermore, long-term light wine consumption is associated with a further protective effect when compared to that of light-to-moderate alcohol intake of other types."

Previous studies have shown that light to moderate alcohol intake is associated with a lower risk of cardiovascular death. However, it remained unclear whether a specific beverage was associated with more benefit and whether the use of long-term alcohol consumption was associated with increased life expectancy. Studies such as this cannot definitively show whether the agent being studied has a causal effect on health.

The Netherlands study — called the Zutphen Study — involved a cohort of 1,373 men born between 1900 and 1920 who were surveyed in detail about alcohol consumption seven times over 40 years. The participants, all from Zutphen, an industrial town in the eastern part of the Netherlands, were followed until death or until the final survey taken among survivors in mid-2000. The surveys included drinking habits, dietary habits, body mass index, smoking habits and the prevalence of heart attack, stroke, diabetes and cancer. The statistics on alcohol consumption were adjusted to account for other risk factors.

The researchers found that long-term, light alcohol intake of less than or equal to 20 grams per day (1 glass of alcoholic beverage contains 10 grams of alcohol, 1 ounce = ~30 mL of alcoholic beverage) compared to no alcohol intake was associated with a 36 percent lower relative risk of all-cause death and a 34 lower relative risk of cardiovascular death. The average long-term daily intake of the men throughout the 40-year study was six grams based on any alcohol intake of more than zero and up to 20 grams. The long-term average intake of six grams of alcohol is equal to one four-ounce beer, one two-ounce glass of wine or one one-ounce glass of spirits, daily.

When the researchers looked independently at wine consumption, the associated risk reduction was greater. Participants who drank on average half a glass, or 1.5 ounces, of wine per day, over a long period, had a 40 percent lower rate of all-cause death and a 48 percent lower incidence of cardiovascular death, compared to the non-wine drinkers.

Researchers said life expectancy was 3.8 years higher in those men who drank wine compared to those who did not drink alcoholic beverages. Life expectancy of wine users was more than two years longer than users of other alcoholic beverages. Men with a long-term alcohol intake less than or equal to 20 grams per day had a 1.6-year-higher life expectancy, compared to those who consumed no alcohol.

Most of the previous studies assessed alcohol intake at baseline; however, in this study researchers collected detailed information seven times over 40 years. "Consumption patterns usually change during life," Streppel said. "This enabled us to study the effects of long-term alcohol intake on mortality." Researchers found that the number of alcohol users nearly doubled from 45 percent in 1960 to 85 percent in the 2000 survey. Average alcohol consumption rose and then fell at various points during the study. Users’ consumption was eight grams a day in 1960, then survivors’ consumption was 18 grams a day in 1985, dropping to 13 grams per day in 2000. The percentage of wine users increased during follow-up from 2 percent in 1960 to more than 40 percent among the survivors in 2000. "One can speculate that a protective effect of light alcohol intake could be due to an increase in high-density lipoprotein (HDL) cholesterol, or to a reduction in blood clotting, due to an inhibition of platelet aggregation," Streppel said.

Furthermore, red wine consumption may have an additional health benefit because the polyphenolic compounds contained in wine have been seen in animal to interfere with the formation, progression and rupture of atherosclerotic plaques — the build-up of fatty tissue in the arteries that can result in stroke or heart attack.

"Those people who already consume alcoholic beverages should do so lightly (1 to 2 glasses per day) and preferably drink wine," Streppel said. "The cardio-protective effects of alcohol and wine only held up for light alcohol consumption in middle-aged men. Heavy alcohol consumption may cause accidents and diseases such as cancer and cirrhosis of the liver, even though this was not observed in our study. Since alcohol consumption can be addictive, starting to drink alcohol because of its positive health benefits is not advised."

How alcohol or wine might affect cardiovascular risk merits further research, but right now the American Heart Association does not recommend beginning to drink wine or any other form of alcohol to gain these potential benefits. The association does recommend that to reduce your risk you should talk to your doctor about lowering your cholesterol and blood pressure, controlling your weight, getting enough physical activity and following a healthy diet and quit smoking, if you smoke. There is no scientific proof that drinking wine or any other alcoholic beverage can replace these conventional measures.

Moderate Drinking May Help Older Women Live Longer

A study published in Journal of the American Geriatrics Society finds that moderate alcohol intake (1-2 drinks/day for 3-6 days/week, depending on alcoholic content) may lead to increased quality of life and survival in older women. The Australian Longitudinal Study on Women’s Health followed nearly 12,000 women in their 70’s over a 6 year period. The group was comprised of non-drinkers, occasional drinkers and moderate drinkers.

The study found that non-drinkers and women who rarely drank had a significantly higher risk of dying during the survey period than did women who drank moderately. Of those who survived, the women who drank the least reported the lowest health-related quality of life. Previous studies have shown that women who have at least one drink per day stand at a lower risk for cardiovascular disease and ischemic stroke than non-drinkers.

“The results of this study indicate that moderate alcohol intake in keeping with current guidelines may carry some health benefits for older women,” says Dr. Julie Ellen Byles, author of the study. This contrasts previous studies which have suggested that moderate alcohol intake can be detrimental to older women and may lead to accidents, cancers, even dementia.

The potential causes of increased health and survival may be ingredients found in wine or ethanol, the social and pleasurable benefits of drinking or the improved appetite and nutrition that often accompanies modest alcohol intake. The author notes that the study does not advocate non-drinkers to begin drinking. Changes in diet need to be determined through consultation with a doctor due to the potential complications of mixing alcohol and medication.

Drinking in moderation reduces all-cause mortality

A study provides further evidence that alcohol, when consumed in moderation, reduces the risk of death, and not just that due to cardiovascular disease

A study performed by the Research Laboratories of the Catholic University of Campobasso (Italy) confirms the beneficial effects that moderate consumption of alcohol has on our health. But this time it is not just cardiovascular disease that gets advantage from this: drinking in moderation reduces all-cause mortality.

The research, published in the American journal Archives of Internal Medicine, assembled 34 scientific studies conducted during the last years worldwide using the statistic procedure of meta-analysis, that al-lows to match different studies to achieve general results. In this way it has been possible to examine data concerning over a million of people, for which alcohol drinking habits were associated with all-cause mortality.

The conclusions researchers from the Catholic University of Campobasso came to clearly show that drinking in moderation (a couple of wine or beer glasses a day) has beneficial effects on health. But that is not all: while the greatest part of the studies conducted on this issue have looked at cardiovascular disease, a term that includes clinical events of various severity, the study published in the Archives of Internal Medicine shows a positive effect of alcohol on an unquestionably hard parameter as overall mortality.

"Our data" says Augusto Di Castelnuovo, lead author of the study, "show that consumption of little amounts of alcohol leads to a reduction of mortality up to 18%. But after a certain number of glasses things radically change: who drinks too much not only looses this advantage, but increases his own risk of death in relation to the amount of alcohol consumed".

The study shows very important differences between men and women. Whereas men report a beneficial effect after consuming 2-4 doses maximum (a dose refers to one glass of wine or beer), women should be aware: for them, the protection guaranteed from alcohol consumption disappears just after two glasses a day.

"It might be- says Licia Iacoviello, Head of the Laboratory of Genetic and Environmental Epidemiology, where the research has been performed- "a fact linked to the metabolism. We know that women metabolize alcohol in a different way and the blood concentration reaches higher levels. Therefore, consuming more than two doses might lead to several harmful effects, such as liver diseases or increased risk of certain forms of tumour".

The meta- analysis conducted by the Catholic University found that the protection given by a moderate consumption of alcohol for American men is lower than the one observed for Europeans. For women, instead, the situation is substantially the same both in USA and Europe. An explanation might be found in the different ways in consuming alcohol. Europeans are more inclined to drink wine rather than other beverages and use to do it while having meals. Two habits different from Americans’. In relation to women, the way they consume alcohol is roughly the same in both continents, thus they respond identically. However, the debate is still open and more research is needed.

Another significant data emerging from the study is related to the so called "confounding factors". During the past years, it has been thought that the protecting effect of alcohol might be ascribed to other factors. It might be, in fact, that people enjoying alcohol drinks in moderation are more concerned about their own health: it may turn out that they are more likely to do sport or to consume healthier food.

In other words it might be that they have a better lifestyle and this could be the cause, not necessarily alcohol, that keeps them in good health.

"We’ve carefully examined this aspect," Di Castelnuovo continues. "Our data suggest that, even considering all main confounding factors (as dietary habits, physical activity or the health of people studied), a moderate consumption of alcoholic beverages keeps on showing a real positive effect".

"The core of this study is not just about alcohol"- says Giovanni de Gaetano, director of the Research Laboratories at the Catholic University- "it is also the way we drink that makes the difference: little amounts, preferably during meals, this appears to be the right way. This is another feature of the Mediterranean diet, where alcohol, wine above all, is the ideal partner of a dinner or lunch, but that’s all: the rest of the day must be absolutely alcohol- free. The message carried by scientific studies like ours is simple: alcohol can be a respectful guest on our table, but it is good just when it goes with a healthy lifestyle, where moderation leads us toward a consumption inspired by quality not by quantity".