取自 http://www.medpagetoday.com/Cardiology/Prevention/64069?
xid=nl_mpt_SRCardiology2017-03-25&eun=g376507d0r Moderate alcohol intake of a couple drinks a day may be better than none for a range of cardiovascular ills, but the effects of heavier drinking on the heart presented a somewhat more nuanced picture slanted toward risk. So found a population-based study from England's CALIBER database combining primary care, inpatient, and mortality records for 1.9 million adults, ages 30 and older, initially free of cardiovascular disease with a median 6 years of follow-up. "We observed classic J shaped associations for cardiovascular disease (all and fatal) and all cause mortality, with non-drinkers, former drinkers, and heavy drinkers having an increased risk compared with moderate drinkers," Steven Bell, PhD, of the University of Cambridge, England, and colleagues reported online in BMJ. For coronary heart disease overall, non-drinkers were at 31% elevated risk but heavy drinkers showed no difference compared with moderate drinking, defined as two alcohol units (totaling one beer or one glass of wine) a day for women or three per day for men. "This has implications for counselling patients, public health communication, and clinical research, suggesting a more nuanced approach to the role of alcohol in prevention of cardiovascular disease is necessary," the researchers concluded. After separating out occasional or former drinkers, non-drinkers versus moderate drinkers had increased risk of the following: Unstable angina: HR 1.33 (95% CI 1.21-1.45) Myocardial infarction: HR 1.32 (95% CI 1.24-1.41) Unexpected coronary death: HR 1.56 (95% CI 1.38-1.76) Heart failure: HR 1.24 (95% CI 1.11-1.38) Ischemic stroke: HR 1.12 (95% CI 1.01-1.24) Peripheral arterial disease: HR 1.22 (95% CI 1.13-1.32) Abdominal aortic aneurysm: HR 1.32 (95% CI 1.17-1.49) More than moderate intake was associated with significantly elevated risk of unexpected coronary death (HR 1.21), heart failure (HR 1.22), cardiac arrest (HR 1.50), transient ischemic attack (HR 1.11), ischemic stroke (HR 1.33), intracerebral hemorrhage (HR 1.37), and peripheral arterial disease (HR 1.35). But it was also associated with lower risk of MI (HR 0.88, 95% CI 0.79-1.00) or stable angina (HR 0.93, 95% CI 0.86-1.00). "The new study does not offer a materially new view of the associations between alcohol consumed within recommended limits and risk of cardiovascular disease," according to an accompanying editorial by Kenneth Mukamal, MD, MPH, of Harvard Medical School in Boston, and Mariana Lazo, MD, PhD, of Johns Hopkins Medicine in Baltimore. "Four decades of epidemiological studies have largely found the same. "This work, however, sets the stage for ever larger and more sophisticated studies that will attempt to harness the flood of big data into a stream of useful, reliable, and unbiased findings that can inform public health, clinical care, and the direction of future research." For Bell's study, though, the editorialists pointed to a number of limitations. The use of estimates of actual alcohol consumption from clinical data, rather than from structured assessment tools, "requires creative extrapolation and will not be easy to export to settings outside the UK," they noted, although allowing a massive sample size that can overcome random misclassification of alcohol consumption. "Systematic error is more pernicious and contributed to both by intentional under-reporting by patients and by difficult choices forced by imperfect clinical information," they wrote. "For example, patients found to have alcohol on their breath by a general practitioner were classified as 'moderate drinkers,' but without formal validation, this categorization seems uncertain at best. Equally problematic are missing data. In this study, information on alcohol consumption was missing in 43% of the overall sample, with the potential for bias in any direction." The study was supported by the National Institute for Health Research, Wellcome Trust, the Medical Research Council prognosis research strategy (PROGRESS) Partnership, and awards to establish the Farr Institute of Health Informatics Research at UCLPartners from various organizations. Bell disclosed support from the European Research Council and the Medical Research Council/Alcohol Research UK. Mukamal disclosed no relevant relationships. Lazo disclosed support from the ABMRF/The Foundation for Alcohol Research, which is funded in part by industry. comments