Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri.
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
JAMA Netw Open. 2018 Dec 7;1(8):e186383. doi: 10.1001/jamanetworkopen.2018.6383.
More than 1 million older adults develop heart failure annually. The association of alcohol consumption with survival among these individuals after diagnosis is unknown.
To determine whether alcohol use is associated with increased survival among older adults with incident heart failure.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included 5888 community-dwelling adults aged 65 years or older who were recruited to participate in the Cardiovascular Health Study between June 12, 1989, and June 1993, from 4 US sites. Of the total participants, 393 individuals had a new diagnosis of heart failure within the first 9 years of follow-up through June 2013. The study analysis was performed between January 19, 2016, and September 22, 2016.
Alcohol consumption was divided into 4 categories: abstainers (never drinkers), former drinkers, 7 or fewer alcoholic drinks per week, and more than 7 drinks per week.
Participant survival after the diagnosis of incident heart failure.
Among the 393 adults diagnosed with incident heart failure, 213 (54.2%) were female, 339 (86.3%) were white, and the mean (SD) age was 78.7 (6.0) years. Alcohol consumption after diagnosis was reported in 129 (32.8%) of the participants. Across alcohol consumption categories of long-term abstainers, former drinkers, consumers of 1-7 drinks weekly and consumers of more than 7 drinks weekly, the percentage of men (32.1%, 49.0%, 58.0%, and 82.4%, respectively; P < .001 for trend), white individuals (78.0%, 92.7%, 92.0%, and 94.1%, respectively, P <. 001 for trend), and high-income participants (22.0%, 43.8%, 47.3%, and 64.7%, respectively; P < .001 for trend) increased with increasing alcohol consumption. Across the 4 categories, participants who consumed more alcohol had more years of education (mean, 12 years [interquartile range (IQR), 8.0-10.0 years], 12 years [IQR, 11.0-14.0 years], 13 years [IQR, 12.0-15.0 years], and 13 years [IQR, 12.0-14.0 years]; P < .001 for trend). Diabetes was less common across the alcohol consumption categories (32.1%, 26.0%, 22.3%, and 5.9%, respectively; P = .01 for trend). Across alcohol consumption categories, there were fewer never smokers (58.3%, 44.8%, 35.7%, and 29.4%, respectively; P < .001 for trend) and more former smokers (34.5%, 38.5%, 50.0%, and 52.9%, respectively; P = .006 for trend). After controlling for other factors, consumption of 7 or fewer alcoholic drinks per week was associated with additional mean survival of 383 days (95% CI, 17-748 days; P = .04) compared with abstinence from alcohol. Although the robustness was limited by the small number of individuals who consumed more than 7 drinks per week, a significant inverted U-shaped association between alcohol consumption and survival was observed. Multivariable model estimates of mean time from heart failure diagnosis to death were 2640 days (95% CI, 1967-3313 days) for never drinkers, 3046 days (95% CI, 2372-3719 days) for consumers of 0 to 7 drinks per week, and 2806 (95% CI, 1879-3734 days) for consumers of more than 7 drinks per week (P = .02). Consumption of 10 drinks per week was associated with the longest survival, a mean of 3381 days (95% CI, 2806-3956 days) after heart failure diagnosis.
These findings suggest that limited alcohol consumption among older adults with incident heart failure is associated with survival benefit compared with long-term abstinence. These findings suggest that older adults who develop heart failure may not need to abstain from moderate levels of alcohol consumption.
每年有超过 100 万老年人患心力衰竭。目前尚不清楚这些人在确诊后饮酒与生存之间的关系。
确定酒精使用是否与老年心力衰竭患者的生存增加有关。
设计、地点和参与者：这项前瞻性队列研究纳入了 5888 名年龄在 65 岁及以上、居住在社区的成年人，他们于 1989 年 6 月 12 日至 1993 年 6 月 19 日从美国 4 个地点被招募参加心血管健康研究。在随访的前 9 年中，总计参与者中有 393 人被诊断患有新发心力衰竭。研究分析于 2016 年 1 月 19 日至 2016 年 9 月 22 日进行。
酒精摄入量分为 4 类：从不饮酒者（从不饮酒者）、以前饮酒者、每周饮酒 7 杯或以下、每周饮酒超过 7 杯。
心力衰竭确诊后患者的生存情况。
在被诊断为心力衰竭的 393 名成年人中，213 名（54.2%）为女性，339 名（86.3%）为白人，平均（SD）年龄为 78.7（6.0）岁。在 129 名（32.8%）参与者中报告了确诊后饮酒情况。在长期禁酒者、以前饮酒者、每周饮用 1-7 杯酒者和每周饮用超过 7 杯酒者的 4 个饮酒量类别中，男性（32.1%、49.0%、58.0%和 82.4%；趋势 P<0.001）、白人（78.0%、92.7%、92.0%和 94.1%；趋势 P<0.001）和高收入参与者（22.0%、43.8%、47.3%和 64.7%；趋势 P<0.001）的比例随着饮酒量的增加而增加。在这 4 个类别中，饮酒量较多的参与者接受了更多的教育（平均为 12 年[四分位数间距（IQR），8.0-10.0 年]、12 年[IQR，11.0-14.0 年]、13 年[IQR，12.0-15.0 年]和 13 年[IQR，12.0-14.0 年]；趋势 P<0.001）。糖尿病在饮酒量类别中也较少见（32.1%、26.0%、22.3%和 5.9%；趋势 P=0.01）。在饮酒量类别中，从不吸烟者（58.3%、44.8%、35.7%和 29.4%；趋势 P<0.001）的比例较低，而以前吸烟者（34.5%、38.5%、50.0%和 52.9%；趋势 P=0.006）的比例较高。在控制了其他因素后，每周饮用 7 杯或以下的酒精摄入量与无饮酒者相比，平均额外生存 383 天（95%CI，17-748 天；P=0.04）相关。尽管由于每周饮用超过 7 杯酒的人数较少，稳健性受到限制，但观察到饮酒量与生存之间存在显著的倒 U 型关联。心力衰竭诊断后至死亡的平均时间的多变量模型估计值为从不饮酒者 2640 天（95%CI，1967-3313 天）、每周饮用 0-7 杯者 3046 天（95%CI，2372-3719 天）和每周饮用超过 7 杯者 2806 天（95%CI，1879-3734 天）（P=0.02）。每周饮用 10 杯酒与最长的生存时间相关，心力衰竭诊断后平均生存 3381 天（95%CI，2806-3956 天）。
这些发现表明，与长期戒酒相比，老年心力衰竭患者的有限饮酒与生存获益有关。这些发现表明，患心力衰竭的老年人可能不需要完全戒酒。
