利用边缘结构模型研究饮酒与老年男性心肌梗死的关系。

Relationship between alcohol consumption and myocardial infarction among ageing men using a marginal structural model.

机构信息

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.

出版信息

Eur J Public Health. 2012 Dec;22(6):825-30. doi: 10.1093/eurpub/ckr013. Epub 2011 Mar 11.

DOI:10.1093/eurpub/ckr013

PMID:21398379

Abstract

BACKGROUND

Studies on the association between alcohol consumption and myocardial infarction (MI) have typically used baseline data on alcohol consumption and potential confounders. This study aimed at investigating the association between alcohol consumption and MI considering time-varying alcohol consumption and time-varying confounders.

METHODS

Data were available for 1030 males participating in the Kuopio Ischaemic Heart Disease Risk Factor Study (Finland). Baseline data for the present study were collected in 1991-93. MIs were ascertained from national registries until December 2005. Alcohol consumption was categorized into four groups. Data were analysed using conventional discrete-time hazard and marginal structural models (MSMs). Time-invariant covariates were age, working status, diabetes and cigarette-years. Time-varying covariates in the MSM were prior alcohol consumption, smoking, history of cardiovascular diseases, body mass index, high-density lipoprotein cholesterol, systolic blood pressure, insulin and fibrinogen.

RESULTS

An insignificant increase of MI risk among the heaviest alcohol consumers (≥168 g week(-1)) compared with the reference group (12-83 g week(-1)) was observed when using a conventional model including baseline alcohol consumption and confounders measured prior to baseline [relative risk (RR) = 1.20, 95% confidence interval (95% CI) = 0.68-2.12]. When using a conventional model with time-varying alcohol consumption and adjusting for prior confounders, an increased risk of MI among the heaviest alcohol consumers was revealed (RR = 1.71, 95% CI = 1.03-2.85). There was also a trend towards increased risk among the heaviest consumers using the MSM (RR = 1.59, 95% CI = 0.93-2.72).

CONCLUSION

Our findings suggest that standard methods using only baseline data on alcohol consumption and confounders may lead to biased estimates on the association between alcohol consumption and MI.

摘要

背景

以往关于饮酒与心肌梗死（MI）相关性的研究通常使用饮酒和潜在混杂因素的基线数据。本研究旨在通过考虑饮酒和时间变化的混杂因素，研究饮酒与 MI 之间的相关性。

方法

1030 名男性参与了芬兰库奥皮奥缺血性心脏病风险因素研究（KIHD 研究），本研究的数据可利用。本研究的基线数据收集于 1991-1993 年。心肌梗死的发生情况通过国家登记系统进行确定，直到 2005 年 12 月。将饮酒量分为四组。使用传统离散时间风险和边缘结构模型（MSM）进行数据分析。时间不变的协变量包括年龄、工作状态、糖尿病和吸烟年数。MSM 中的时间变化协变量包括既往饮酒量、吸烟、心血管疾病史、体重指数、高密度脂蛋白胆固醇、收缩压、胰岛素和纤维蛋白原。

结果

当使用包含基线饮酒量和基线前测量的混杂因素的传统模型时，与参考组（12-83g/周）相比，重度饮酒者（≥168g/周）的 MI 风险无显著增加（相对风险（RR）=1.20，95%置信区间（95%CI）=0.68-2.12）。当使用包含时间变化的饮酒量并调整先前混杂因素的传统模型时，重度饮酒者的 MI 风险增加（RR=1.71，95%CI=1.03-2.85）。使用 MSM 也显示重度饮酒者的风险呈上升趋势（RR=1.59，95%CI=0.93-2.72）。