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饮酒与心肌梗死后心血管事件风险:GISSI-Prevenzione 试验结果。

Wine consumption and risk of cardiovascular events after myocardial infarction: results from the GISSI-Prevenzione trial.

机构信息

Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy.

Departments of Medicine, Epidemiology, and Nutrition, Harvard Medical School and Harvard School of Public Health, Boston, MA, United States.

出版信息

Int J Cardiol. 2013 Mar 10;163(3):282-287. doi: 10.1016/j.ijcard.2011.06.053. Epub 2011 Jul 6.

Abstract

BACKGROUND

To evaluate the association of wine intake with incident cardiovascular events (CVE) and total mortality after myocardial infarction (MI).

METHODS

We used prospectively ascertained information among 11,248 Italian patients with recent MI enrolled in the GISSI-Prevenzione Trial. Usual wine consumption has been categorised as never/almost never, up to 0.5L/day, and >0.5L/day. Multiple imputation was used for missing values at baseline and during follow-up. We assessed adjudicated cumulative incidence of major CVE during 3.5years of follow-up and total mortality at long-term follow-up (7.3years), respectively. Multivariate Cox proportional hazards models were fitted to estimate hazard ratios (HR) first using data at baseline and then updated using time-varying covariates.

RESULTS

During 37,021 person-years of follow-up, 1168 CVE occurred. Moderate wine intake at baseline was associated with significantly reduced risk of CVE (adjusted HR 0.87; 95% CI 0.76-0.99) as compared with non-drinkers. In time-updated analyses, results were virtually the same, though they were barely statistically not significant (adjusted HR 0.88; 95% CI 0.77-1.00). Wine intake was associated with lower risk of total mortality. In time-updated adjusted analyses, patients with wine consumption up to 0.5L/day (HR 0.83; 95% CI 0.74-0.92) and >0.5L/day (HR 0.77; 95% CI 0.63-0.94) had lower mortality compared with non-drinkers (P for trend=0.0003).

CONCLUSIONS

Among patients with established heart disease, moderate consumption of wine seems to be associated with lower incidence of CVE and total mortality as compared with non drinkers.

摘要

背景

评估饮酒与心肌梗死后新发心血管事件(CVE)和总死亡率的相关性。

方法

我们使用最近在 GISSI-Prevenzione 试验中登记的 11248 例意大利心肌梗死后患者的前瞻性确定信息。习惯性饮酒分为从不/几乎从不饮酒、每天 0.5 升以下和每天 0.5 升以上。对于基线和随访期间的缺失值,我们使用了多重插补。我们评估了 3.5 年随访期间主要 CVE 的累积发生率和长期随访(7.3 年)的总死亡率。使用基线时的数据首先拟合多变量 Cox 比例风险模型,然后使用时变协变量进行更新。

结果

在 37021 人年的随访期间,发生了 1168 例 CVE。与不饮酒者相比,基线时适度饮酒与 CVE 风险显著降低相关(调整后的 HR 0.87;95%CI 0.76-0.99)。在时间更新分析中,结果几乎相同,尽管在统计学上没有显著意义(调整后的 HR 0.88;95%CI 0.77-1.00)。饮酒与总死亡率降低相关。在时间更新调整分析中,与不饮酒者相比,每天饮酒 0.5 升以下(HR 0.83;95%CI 0.74-0.92)和每天饮酒 0.5 升以上(HR 0.77;95%CI 0.63-0.94)的患者死亡率较低(趋势 P 值=0.0003)。

结论

在有明确心脏病的患者中,与不饮酒者相比,适度饮酒似乎与较低的 CVE 发生率和总死亡率相关。

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