Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Family Medicine, Chungbuk National University Hospital, Chungju, Republic of Korea.
JAMA Netw Open. 2024 Mar 4;7(3):e244013. doi: 10.1001/jamanetworkopen.2024.4013.
Cardiovascular benefits of mild to moderate alcohol consumption need to be validated in the context of behavioral changes. The benefits of reduced alcohol consumption among people who drink heavily across different subtypes of cardiovascular disease (CVD) are unclear.
To investigate the association between reduced alcohol consumption and risk of major adverse cardiovascular events (MACEs) in individuals who drink heavily across different CVD subtypes.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data from the Korean National Health Insurance Service-Health Screening database and self-reported questionnaires. The nationally representative cohort comprised Korean citizens aged 40 to 79 years who had national health insurance coverage on December 31, 2002, and were included in the 2002 to 2003 National Health Screening Program. People who drank heavily who underwent serial health examinations over 2 consecutive periods (first period: 2005-2008; second period: 2009-2012) were included and analyzed between February and May 2023. Heavy drinking was defined as more than 4 drinks (56 g) per day or more than 14 drinks (196 g) per week for males and more than 3 drinks (42 g) per day or more than 7 drinks (98 g) per week for females.
Habitual change in heavy alcohol consumption during the second health examination period. People who drank heavily at baseline were categorized into 2 groups according to changes in alcohol consumption during the second health examination period as sustained heavy drinking or reduced drinking.
The primary outcome was the occurrence of MACEs, a composite of nonfatal myocardial infarction or angina undergoing revascularization, any stroke accompanied by hospitalization, and all-cause death.
Of the 21 011 participants with heavy alcohol consumption at baseline (18 963 males [90.3%]; mean [SD] age, 56.08 [6.16] years) included in the study, 14 220 (67.7%) sustained heavy drinking, whereas 6791 (32.2%) shifted to mild to moderate drinking. During the follow-up of 162 378 person-years, the sustained heavy drinking group experienced a significantly higher incidence of MACEs than the reduced drinking group (817 vs 675 per 100 000 person-years; log-rank P = .003). Reduced alcohol consumption was associated with a 23% lower risk of MACEs compared with sustained heavy drinking (propensity score matching hazard ratio [PSM HR], 0.77; 95% CI, 0.67-0.88). These benefits were mostly accounted for by a significant reduction in the incidence of angina (PSM HR, 0.70; 95% CI, 0.51-0.97) and ischemic stroke (PSM HR, 0.66; 95% CI, 0.51-0.86). The preventive attributes of reduced alcohol intake were consistently observed across various subgroups of participants.
Results of this cohort study suggest that reducing alcohol consumption is associated with a decreased risk of future CVD, with the most pronounced benefits expected for angina and ischemic stroke.
需要在行为改变的背景下验证轻度至中度饮酒对心血管的益处。重度饮酒者不同心血管疾病（CVD）亚型中减少饮酒的益处尚不清楚。
研究重度饮酒者减少饮酒与主要不良心血管事件（MACE）风险之间的关联，在不同 CVD 亚型中。
设计、地点和参与者：本队列研究分析了来自韩国国家健康保险服务-健康筛查数据库和自我报告问卷的数据。全国代表性队列由年龄在 40 至 79 岁之间的韩国公民组成，他们在 2002 年 12 月 31 日拥有国家健康保险，并参加了 2002 年至 2003 年的全国健康筛查计划。在连续两个时期（第一期：2005-2008 年；第二期：2009-2012 年）进行了连续健康检查的重度饮酒者被纳入并分析。重度饮酒定义为男性每天超过 4 杯（56 克）或每周超过 14 杯（196 克），女性每天超过 3 杯（42 克）或每周超过 7 杯（98 克）。
第二健康检查期重度饮酒习惯的变化。基线时饮酒量较大的人群根据第二健康检查期饮酒量的变化分为两组：持续大量饮酒或减少饮酒。
主要结局是 MACE 的发生，包括非致死性心肌梗死或血管重建后的心绞痛、任何伴有住院的中风以及全因死亡。
在基线时饮酒量较大的 21011 名参与者（18963 名男性[90.3%]；平均[SD]年龄为 56.08[6.16]岁）中，14220 名（67.7%）持续大量饮酒，而 6791 名（32.2%）转为轻度至中度饮酒。在 162378 人年的随访中，持续大量饮酒组的 MACE 发生率明显高于减少饮酒组（每 100000 人年分别为 817 例和 675 例；对数秩 P=0.003）。与持续大量饮酒相比，减少饮酒与 MACE 风险降低 23%相关（倾向评分匹配风险比[PSM HR]，0.77；95%CI，0.67-0.88）。这些益处主要归因于心绞痛（PSM HR，0.70；95%CI，0.51-0.97）和缺血性中风（PSM HR，0.66；95%CI，0.51-0.86）发生率的显著降低。减少饮酒的预防作用在各种亚组参与者中均一致观察到。
本队列研究结果表明，减少饮酒与未来 CVD 风险降低相关，对心绞痛和缺血性中风的益处最为明显。
