Research Department of Epidemiology and Public Health, University College London, London, UK.
CLOSER, UCL Social Research Institute, University College London, London, UK.
Addiction. 2022 Jul;117(7):1920-1930. doi: 10.1111/add.15850. Epub 2022 Mar 3.
Research into alcohol consumption and cardiovascular disease (CVD) patients' prognosis has largely ignored the longitudinal dynamics in drinking behaviour. This study measured the association between alcohol consumption trajectories and mortality risk in CVD patients.
Prospective cohort study.
UK-based Whitehall II Study.
A total of 1306 participants with incident non-fatal CVD (coronary heart disease/stroke) events.
Up to eight repeated measures of alcohol intake were available for each patient from the most recent assessment phase pre-incident CVD and all subsequent phases post-incident CVD, spanning up to three decades. Six trajectory groups of alcohol consumption were identified using group-based trajectory modelling and related to the risk of all-cause mortality, adjusting for demographics and changes in life-style and health status.
Three hundred and eighty deaths were recorded during a median follow-up of 5 years after patients' last alcohol assessment. Compared with patients who consistently drank moderately (≤ 14 units/week), former drinkers had a greater risk of mortality (hazard ratio = 1.74, 95% confidence interval = 1.19-2.54) after adjustment for covariates. There was no significantly increased risk of mortality in long-term abstainers, reduced moderate drinkers, stable or unstable heavy drinkers. Cross-sectional analyses based only on drinking information at patients' last assessment found no significant differences in mortality risk for abstainers, former or heavy drinkers versus moderate drinkers.
Cardiovascular disease patients who consistently drink ≤ 14 units/week appear to have a similar risk of mortality to those who are long-term abstainers, which does not support a protective effect of moderate drinking on total mortality. Cardiovascular disease patients who stop drinking appear to have increased mortality risk compared with continuous moderate drinkers, but this may be linked to poor self-rated health before cardiovascular disease onset.
研究饮酒与心血管疾病（CVD）患者预后的关系时，大多忽略了饮酒行为的纵向动态变化。本研究旨在探讨 CVD 患者饮酒轨迹与死亡风险之间的关系。
前瞻性队列研究。
英国 Whitehall II 研究。
共纳入 1306 例首发非致死性 CVD（冠心病/中风）患者。
在 CVD 发病前的最近评估阶段和发病后的所有后续阶段，对每位患者的饮酒量进行了最多 8 次重复测量，时间跨度长达 30 年。采用基于群组的轨迹建模方法，识别了 6 个饮酒轨迹组，并根据人口统计学数据以及生活方式和健康状况的变化，将这些轨迹组与全因死亡率的风险相关联。
在患者最后一次饮酒评估后中位数为 5 年的随访期间，共记录了 380 例死亡事件。与持续适量饮酒（≤14 单位/周）的患者相比，既往饮酒者在调整了混杂因素后，其死亡风险更高（危险比=1.74，95%置信区间=1.19-2.54）。长期戒酒者、减少饮酒量的适度饮酒者、稳定或不稳定的重度饮酒者的死亡风险无显著增加。仅基于患者最后一次评估时的饮酒信息进行的横断面分析发现，与适度饮酒者相比，戒酒者、既往饮酒者和重度饮酒者的死亡风险无显著差异。
持续饮酒量≤14 单位/周的 CVD 患者的死亡风险似乎与长期戒酒者相似，这并不支持适度饮酒对全因死亡率有保护作用。与持续适量饮酒者相比，停止饮酒的 CVD 患者的死亡风险似乎更高，但这可能与 CVD 发病前自我报告的健康状况较差有关。
