Estudios científicos

Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women


Background: Light-to-moderate alcohol consumption has been reported to be cardio-protective among apparently healthy individuals; however, it is unclear whether this association is also present in those with disease. To examine the association between alcohol consumption and prognosis in individuals with pre-existing cardiovascular disease (CVD), we conducted a series of meta-analyses of new findings from three large-scale cohorts and existing published studies.

Methods: We assessed alcohol consumption in relation to all-cause mortality, cardiovascular mortality, and subsequent cardiovascular events via de novo analyses of 14,386 patients with a previous myocardial infarction, angina, or stroke in the UK Biobank Study (median follow-up 8.7 years, interquartile range [IQR] 8.0-9.5), involving 1640 deaths and 2950 subsequent events, and 2802 patients and 1257 deaths in 15 waves of the Health Survey for England 1994-2008 and three waves of the Scottish Health Survey 1995, 1998, and 2003 (median follow-up 9.5 years, IQR 5.7-13.0). This was augmented with findings from 12 published studies identified through a systematic review, providing data on 31,235 patients, 5095 deaths, and 1414 subsequent events. To determine the best-fitting dose-response association between alcohol and each outcome in the combined sample of 48,423 patients, models were constructed using fractional polynomial regression, adjusting at least for age, sex, and smoking status.

Results: Alcohol consumption was associated with all assessed outcomes in a J-shaped manner relative to current non-drinkers, with a risk reduction that peaked at 7 g/day (relative risk 0.79, 95% confidence interval 0.73-0.85) for all-cause mortality, 8 g/day (0.73, 0.64-0.83) for cardiovascular mortality and 6 g/day (0.50, 0.26-0.96) for cardiovascular events, and remained significant up to 62, 50, and 15 g/day, respectively. No statistically significant elevated risks were found at higher levels of drinking. In the few studies that excluded former drinkers from the non-drinking reference group, reductions in risk among light-to-moderate drinkers were attenuated.

Conclusions: For secondary prevention of CVD, current drinkers may not need to stop drinking. However, they should be informed that the lowest risk of mortality and having another cardiovascular event is likely to be associated with lower levels of drinking, that is up to approximately 105g (or equivalent to 13 UK units, with one unit equal to half a pint of beer/lager/cider, half a glass of wine, or one measure of spirits) a week.

Comentarios divulgativos:

Según los resultados de esta investigación, un consumo ligero de vino podría tener cabida en la alimentación de personas que tienen una enfermedad cardiovascular o que han sufrido un ictus o un infarto de miocardio.

El consumo bajo o moderado de vino puede ser protector para la salud cardiovascular en personas sanas, pero no está claro si esto ocurre también en los pacientes que ya tienen o han sufrido una enfermedad de este tipo.

Este artículo, en forma de metaanálisis, recoge las investigaciones realizadas hasta el momento, que evalúan la relación entre el consumo y la salud cardiovascular de personas que ya tienen o han sufrido una enfermedad cardiovascular.

El estudio, que incluyó datos de 48.423 hombres y mujeres con una enfermedad cardiovascular previa, observó que las personas que tenían el riesgo más bajo de morir por cualquier causa, de morir por enfermedad cardiovascular o de tener una recaída eran aquellas personas que bebían habitualmente una cantidad de alcohol equivalente a poco más de media copa de vino al día. Sin embargo, este efecto “protector” se perdía si los pacientes superaban los 105 gramos de alcohol a la semana, por ejemplo, si tomaban más de una copa y media de vino al día durante la semana.