Wannamethee S G, Shaper A G
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.
Int J Epidemiol. 1997 Jun;26(3):523-31. doi: 10.1093/ije/26.3.523.
To determine the risk of all cause mortality and the incidence of major coronary heart disease (CHD) events in lifelong teetotallers and in ex-drinkers compared with occasional and regular drinkers.
A prospective study of middle-aged men drawn at random from one general practice in each of 24 British towns. Five years after the screening of 7735 men aged 40-59 years, 7167 provided further information on postal questionnaire enabling separation of non-drinkers into lifelong teetotallers and ex-drinkers.
During the follow-up period of 9.8 years after the postal questionnaire there were 929 deaths from all causes and 490 major CHD events. Ex-drinkers exhibited increased cardiovascular and non-cardiovascular mortality; lifelong teetotallers showed the lowest cardiovascular mortality but a significantly increased non-cardiovascular mortality. After adjustment for confounding factors and pre-existing disease, the two non-drinking groups did not differ significantly in all cause mortality from occasional and regular drinkers (light, moderate or heavy) but lifelong teetotallers still showed a significant increase in non-cardiovascular mortality. Adjustment considerably attenuated the risk of both cardiovascular and non-cardiovascular mortality in the ex-drinkers. In men without a diagnosis of CHD, lifelong teetotallers and ex-drinkers showed similar increased relative risk (RR) of heart attacks, with regular drinkers (combined) having a significantly decreased risk compared to occasional drinkers (RR = 0.78, 95% confidence interval [CI] : 0.64-0.96) and non-drinkers (RR = 0.69, 95% CI : 0.52-0.91). This decreased risk was small in absolute terms at around 2-3 major CHD events/1000 person-years.
Lifelong teetotallers and ex-drinkers showed a significantly increased RR of major CHD events compared with regular drinkers, although this risk is small in absolute terms. Lifelong teetotallers have a low risk of overall cardiovascular mortality and an increased risk of non-cardiovascular mortality. Non-drinkers constitute an unsuitable reference group in alcohol-related studies; occasional or even light drinkers may be more appropriate. Overall, there is no convincing evidence that light or moderate drinking has a protective effect on total or cardiovascular mortality in these middle-aged British men.
确定终生戒酒者和戒酒者与偶尔饮酒者和经常饮酒者相比，全因死亡率风险及主要冠心病（CHD）事件的发生率。
对从英国24个城镇的每个一个普通诊所随机抽取的中年男性进行前瞻性研究。在对7735名年龄在40 - 59岁的男性进行筛查五年后，7167人通过邮政问卷提供了进一步信息，从而能够将不饮酒者分为终生戒酒者和戒酒者。
在邮政问卷后的9.8年随访期内，有929例全因死亡和490例主要冠心病事件。戒酒者的心血管和非心血管死亡率均有所增加；终生戒酒者的心血管死亡率最低，但非心血管死亡率显著增加。在对混杂因素和既往疾病进行调整后，两个不饮酒组与偶尔饮酒者和经常饮酒者（轻度、中度或重度）在全因死亡率方面无显著差异，但终生戒酒者的非心血管死亡率仍显著增加。调整后显著降低了戒酒者心血管和非心血管死亡率的风险。在未诊断为冠心病的男性中，终生戒酒者和戒酒者发生心脏病发作的相对风险（RR）增加相似，与偶尔饮酒者相比，经常饮酒者（合并）的风险显著降低（RR = 0.78，95%置信区间[CI]：0.64 - 0.96），与不饮酒者相比（RR = 0.69，95% CI：0.52 - 0.91）。从绝对数值来看，这种降低的风险较小，约为每1000人年2 - 3例主要冠心病事件。
与经常饮酒者相比，终生戒酒者和戒酒者发生主要冠心病事件的RR显著增加，尽管从绝对数值来看这种风险较小。终生戒酒者总体心血管死亡率风险较低，而非心血管死亡率风险增加。在与酒精相关的研究中，不饮酒者并非合适对照组；偶尔饮酒甚至轻度饮酒者可能更合适。总体而言，没有令人信服的证据表明轻度或中度饮酒对这些英国中年男性的总死亡率或心血管死亡率有保护作用。
