Centre for Addiction and Mental Health, Public Health and Regulatory Policies Section, Toronto, Ontario, Canada M5S 2S1.
Am J Epidemiol. 2010 Mar 15;171(6):633-44. doi: 10.1093/aje/kwp451. Epub 2010 Feb 8.
Contrary to a cardioprotective effect of moderate regular alcohol consumption, accumulating evidence points to a detrimental effect of irregular heavy drinking occasions (>60 g of pure alcohol or > or =5 drinks per occasion at least monthly) on ischemic heart disease risk, even for drinkers whose average consumption is moderate. The authors systematically searched electronic databases from 1980 to 2009 for case-control or cohort studies examining the association of irregular heavy drinking occasions with ischemic heart disease risk. Studies were included if they reported either a relative risk estimate for intoxication or frequency of > or =5 drinks stratified by or adjusted for total average alcohol consumption. The search identified 14 studies (including 31 risk estimates) containing 4,718 ischemic heart disease events (morbidity and mortality). Using a standardized protocol, the authors extracted relative risk estimates and their variance, in addition to study characteristics. In a random-effects model, the pooled relative risk of irregular heavy drinking occasions compared with regular moderate drinking was 1.45 (95% confidence interval: 1.24, 1.70), with significant between-study heterogeneity (I(2) = 53.9%). Results were robust in several sensitivity analyses. The authors concluded that the cardioprotective effect of moderate alcohol consumption disappears when, on average, light to moderate drinking is mixed with irregular heavy drinking occasions.
与适量有规律的饮酒对心脏具有保护作用相反，越来越多的证据表明，不规律的重度饮酒（每月至少一次，每次摄入纯酒精 60 克以上或 5 杯以上）对缺血性心脏病的风险有不利影响，即使对于那些平均饮酒量适中的饮酒者也是如此。作者系统地检索了从 1980 年到 2009 年的电子数据库，以查找病例对照或队列研究，这些研究检查了不规律的重度饮酒与缺血性心脏病风险之间的关联。如果研究报告了按或根据总平均酒精摄入量分层的醉酒或> =5 杯的频率与风险的相对风险估计值，则将这些研究纳入。该搜索确定了 14 项研究（包括 31 项风险估计值），其中包含 4718 例缺血性心脏病事件（发病率和死亡率）。使用标准化方案，作者提取了相对风险估计值及其方差，以及研究特征。在随机效应模型中，与有规律的适度饮酒相比，不规律的重度饮酒的相对风险为 1.45（95%置信区间：1.24，1.70），存在显著的研究间异质性（I²=53.9%）。在几项敏感性分析中，结果都是稳健的。作者得出结论，当轻度到中度饮酒平均与不规律的重度饮酒相混合时，适度饮酒的心脏保护作用就会消失。
