Center for Cohort Studies, Total Healthcare Center.
Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Int J Epidemiol. 2017 Jun 1;46(3):950-962. doi: 10.1093/ije/dyw237.
We examined whether alcohol flushing could be used as an instrumental variable (IV) and investigated the effect of alcohol consumption on coronary calcification using alcohol flushing status as an IV.
We analysed cross-sectional data from 24 681 Korean adults (20 696 men and 3985 women) who had been administered a questionnaire assessing alcohol consumption and alcohol flushing, as well as a coronary artery calcium (CAC) measurement. The associations of alcohol flushing status with potential confounders and alcohol consumption were examined. We employed two-stage predictor substitution methodology for the IV analysis.
The prevalence of alcohol flushing did not differ depending on gender, education, household income, cigarette smoking or physical activity. Balanced levels of confounders were observed between alcohol flushers and non-flushers. Alcohol flushing was closely related to alcohol consumption and levels of liver enzymes. In men, a doubling in alcohol consumption was associated with increased odds of coronary calcification in both the IV analysis [odds ratio (OR) of CAC scores of 1 or over = 1.11; 95% confidence interval (CI) = 1.03-1.20) and the multivariable regression analysis (OR = 1.04; 95% CI = 1.01-1.07). For cardiovascular risk factors, the IV analysis showed a positive association between alcohol consumption and blood pressure and high-density lipoprotein-cholesterol.
Alcohol flushing can be used as an IV in studies evaluating the health impact of alcohol consumption, especially in East Asian countries. Through such an analysis, we found that increased alcohol consumption was associated with an increased risk of subclinical coronary atherosclerosis.
本研究旨在探讨酒精性面红是否可作为工具变量（instrumental variable，IV），并通过评估饮酒与酒精性面红的关系，利用酒精性面红状态作为 IV 来研究饮酒对冠状动脉钙化的影响。
本研究纳入了 24681 名韩国成年人（男性 20696 名，女性 3985 名）的横断面数据，这些参与者接受了饮酒情况和酒精性面红情况的问卷调查，同时还进行了冠状动脉钙（coronary artery calcium，CAC）检测。我们检验了酒精性面红状态与潜在混杂因素及饮酒之间的相关性，并采用两阶段预测变量替代法进行 IV 分析。
男性和女性、受教育程度、家庭收入、吸烟和体力活动与酒精性面红状态无关。酒精性面红者与非面红者之间的混杂因素均衡性较好。酒精性面红与饮酒量及肝酶水平密切相关。在男性中，饮酒量加倍与 CAC 评分≥1 的比值比（odds ratio，OR）增加相关，在 IV 分析（OR=1.11；95%置信区间，CI=1.03-1.20）和多变量回归分析（OR=1.04；95%CI=1.01-1.07）中均如此。对于心血管危险因素，IV 分析显示饮酒与血压和高密度脂蛋白胆固醇呈正相关。
在评估饮酒对健康影响的研究中，酒精性面红可作为一种 IV，尤其在东亚国家。通过这种分析，我们发现饮酒量增加与亚临床冠状动脉粥样硬化风险增加相关。
