Mukamal Kenneth J, Jensen Majken K, Grønbaek Morten, Stampfer Meir J, Manson JoAnn E, Pischon Tobias, Rimm Eric B
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Circulation. 2005 Sep 6;112(10):1406-13. doi: 10.1161/CIRCULATIONAHA.105.537704. Epub 2005 Aug 29.
The associations of drinking frequency and quantity with risk of myocardial infarction have not been studied among women, and the degree to which specific risk factors mediate the inverse association of drinking frequency with risk of myocardial infarction is uncertain.
We conducted nested case-control studies of 32,826 women enrolled in the Nurses Health Study followed up from 1990 to 1998 and 18,225 men enrolled in the Health Professionals Follow-Up Study followed up from 1994 to 2000. A total of 249 women and 266 men with incident myocardial infarction were matched on age, smoking, and date of entry to 498 female and 532 male control participants. We determined the risk of myocardial infarction related to frequency and quantity of alcohol intake and the change in risk before and after adjustment for putative cardiovascular risk factors. Among both women and men, drinking frequency tended to be associated with lower risk of myocardial infarction, with the lowest risks among those who drank 3 to 7 days per week. Further adjustment for levels of high-density lipoprotein cholesterol, hemoglobin A(1c), and fibrinogen attenuated 75% of the association of frequent drinking with risk among women and fully attenuated the association among men.
Alcohol intake at least 3 to 4 days per week is associated with a lower risk of myocardial infarction among women and men, an association apparently attributable to the relationship of alcohol with HDL cholesterol, fibrinogen, and hemoglobin A(1c). Because the effects of alcohol on HDL cholesterol, fibrinogen, and insulin sensitivity have been confirmed in randomized trials, our findings support the hypothesis that the inverse relation of alcohol use and myocardial infarction is causal.
饮酒频率和饮酒量与心肌梗死风险之间的关联在女性中尚未得到研究，并且特定风险因素介导饮酒频率与心肌梗死风险之间负相关的程度尚不确定。
我们对参加护士健康研究（从1990年至1998年随访）的32826名女性和参加卫生专业人员随访研究（从1994年至2000年随访）的18225名男性进行了巢式病例对照研究。共有249名女性和266名男性发生心肌梗死，根据年龄、吸烟情况和入组日期与498名女性和532名男性对照参与者进行匹配。我们确定了与酒精摄入量的频率和数量相关的心肌梗死风险，以及在对假定的心血管风险因素进行调整前后风险的变化。在女性和男性中，饮酒频率往往与较低的心肌梗死风险相关，每周饮酒3至7天的人风险最低。进一步对高密度脂蛋白胆固醇、糖化血红蛋白A1c和纤维蛋白原水平进行调整后，女性中频繁饮酒与风险之间的关联减弱了75%，男性中该关联则完全减弱。
每周至少饮酒3至4天与女性和男性较低的心肌梗死风险相关，这种关联显然归因于酒精与高密度脂蛋白胆固醇、纤维蛋白原和糖化血红蛋白A1c之间的关系。由于酒精对高密度脂蛋白胆固醇、纤维蛋白原和胰岛素敏感性的影响已在随机试验中得到证实，我们的研究结果支持酒精使用与心肌梗死之间的负相关是因果关系这一假设。
