Mukamal Kenneth J, Chung Hyoju, Jenny Nancy S, Kuller Lewis H, Longstreth W T, Mittleman Murray A, Burke Gregory L, Cushman Mary, Psaty Bruce M, Siscovick David S
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
J Am Geriatr Soc. 2006 Jan;54(1):30-7. doi: 10.1111/j.1532-5415.2005.00561.x.
To evaluate several aspects of the relationship between alcohol use and coronary heart disease in older adults, including beverage type, mediating factors, and type of outcome.
Prospective cohort study.
Four U.S. communities.
Four thousand four hundred ten adults aged 65 and older free of cardiovascular disease at baseline.
Risk of incident myocardial infarction or coronary death according to self-reported consumption of beer, wine, and spirits ascertained yearly.
During an average follow-up period of 9.2 years, 675 cases of incident myocardial infarction or coronary death occurred. Compared with long-term abstainers, multivariate relative risks of 0.90 (95% confidence interval (CI)=0.71-1.14), 0.93 (95% CI=0.73-1.20), 0.76 (95% CI=0.53-1.10), and 0.58 (95% CI=0.39-0.86) were found in consumers of less than one, one to six, seven to 13, and 14 or more drinks per week, respectively (P for trend=.007). Associations were similar for secondary coronary outcomes, including nonfatal and fatal events. No strong mediators of the association were identified, although fibrinogen appeared to account for 9% to 10% of the relationship. The associations were statistically similar for intake of wine, beer, and liquor and generally similar in subgroups, including those with and without an apolipoprotein E4 allele.
In this population, consumption of 14 or more drinks per week was associated with the lowest risk of coronary heart disease, although clinicians should not recommend moderate drinking to prevent coronary heart disease based on this evidence alone, because current National Institute on Alcohol Abuse and Alcoholism guidelines suggest that older adults limit alcohol intake to one drink per day.
评估老年人饮酒与冠心病之间关系的多个方面，包括饮料类型、中介因素和结局类型。
前瞻性队列研究。
美国四个社区。
4410名65岁及以上的成年人，基线时无心血管疾病。
根据每年自我报告的啤酒、葡萄酒和烈酒消费量，计算发生心肌梗死或冠心病死亡的风险。
在平均9.2年的随访期内，发生了675例心肌梗死或冠心病死亡事件。与长期戒酒者相比，每周饮酒少于1杯、1至6杯、7至13杯以及14杯及以上者的多变量相对风险分别为0.90（95%置信区间[CI]=0.71-1.14）、0.93（95%CI=0.73-1.20）、0.76（95%CI=0.53-1.10）和0.58（95%CI=0.39-0.86）（趋势P值=0.007）。二级冠心病结局（包括非致命和致命事件）的关联相似。未发现该关联的强中介因素，尽管纤维蛋白原似乎占该关系的9%至10%。葡萄酒、啤酒和烈酒的摄入量之间的关联在统计学上相似，且在各亚组中通常也相似，包括有和没有载脂蛋白E4等位基因的亚组。
在该人群中，每周饮用14杯及以上饮料与冠心病风险最低相关，尽管临床医生不应仅基于此证据就推荐适度饮酒来预防冠心病，因为美国国立酒精滥用与酒精中毒研究所目前的指南建议老年人将酒精摄入量限制在每天1杯。
