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【medical-news】适量饮酒降低心肌梗死后死亡率 可
11 January 2008
MedWire News: Moderate alcohol intake may have beneficial effects on fatal and nonfatal outcomes after an acute myocardial infarction (AMI), conclude researchers in a study comparing current drinking with long-term and recent abstinence separately.
Two out of three previous studies of the effects of alcohol consumption in people with established coronary heart disease (CHD) showed that individuals reporting light-to-moderate alcohol intake at the time they suffered an AMI had lower mortality after the event than those who abstained from alcohol.
But former drinkers were not systematically taken into account among current alcohol abstainers in these studies. According to the "sick quitter" hypothesis, some abstainers who quit drinking due to illness may have pre-existing disease that could explain their higher risk relative to moderate drinkers.
In the current study, Imre Janszky (Karolinska University Hospital, Stockholm, Sweden) and colleagues studied the long-term relationship between drinking alcohol and total and cardiac mortality in patients surviving a first AMI, taking into account drinking habits during the 5 years prior to, and at the time of, AMI.
A total of 1346 consecutive patients aged between 45 and 70 years were included in the study, all of whom responded to a standardized questionnaire regarding alcohol intake while they were in hospital.
During 8 years of follow-up, 267 of the patients died, with 145 dying from cardiac causes, Janszky and co-authors report in the European Heart Journal. Patients who reported drinking 5 g, 5-20 g, and over 20 g of alcohol per day had both lower all-cause mortality and cardiac mortality than long-term abstainers (those who did not drink in the previous 5 years or at the time of AMI).
Adjusted Hazard ratios (HRs) for all-cause mortality among those who drank less than 5 g, 5-20 g, and more than 20 g of alcohol per day relative to long-term abstainers were 0.77, 0.77, and 0.89, respectively. The corresponding HRs for cardiac mortality were 0.61, 0.62, and 0.69.
By contrast, patients who had recently quit drinking, based on reports of previous drinking in the past 5 years but not at the time of AMI, had significantly higher all-cause and cardiac mortality than abstainers, at HRs of 4.55 and 4.47, respectively.
Further analysis showed that the associations between alcohol intake and the risk for new nonfatal AMI, hospitalization for heart failure, and hospitalization for stroke showed similar patterns.
Grouping longer-term abstainers and recent quitters together as the reference group inflated the observed protective effect of alcohol, the authors note.
In an accompanying editorial, Michael de Lorgeril (University of Grenoble, France) and colleagues commented that moderate drinking appears to be more effective than intense cholesterol lowering at protecting the lives of high-risk and post-AMI patients.
In addition, they noted: "Cardiologists should remember that moderate drinking is a social lubricant and a major characteristic of the European lifestyle... often associated with the feeling of 'joie de vivre,' especially in southern Europe.
"They should keep in mind that the must not only protect the lives, but also preserve the quality of life of their fragile high-risk patients."
Eur Heart J 2008; 29: 45-53
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作者:admin@医学,生命科学 2011-05-24 05:14
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