[Alcohol consumption, S-LDL-cholesterol and risk of ischemic heart disease. 6-year follow-up in The Copenhagen Male Study].

A high intake of saturated fat is associated with an increase in serum low density lipoprotein cholesterol (LDL) and an increase in risk of ischaemic heart disease (IHD). In some parts of France a high intake of fat is not associated with increased risk of IHD, an apparent discrepancy named the French paradox. It has been suggested, but never tested prospectively, that regular use of alcohol might explain this low risk. We investigated the interplay between use of alcohol, LDL and risk of IHD in a prospective study controlling for a number of relevant confounders including other lipid fraction, including 2,826 males aged 53-74 years without overt IHD. The incidence of IHD during a six year follow-up period was registered. One hundred and seventy-two men (6.1%) had a first IHD event. There was an overall inverse association between alcohol intake and risk of IHD. The association was highly dependent on LDL. In men with a high LDL (> or = 5.25 mmol/l), cumulative incidence rates of IHD were 16.4% for abstainers, 8.7% for those who drank 1-21 beverages/week and 4.4% for those who drank 22+. Using abstainers as reference, adjusted for confounders, corresponding relative risks (95% CI) were 0.4 (0.2-1.0), p < 0.05, and 0.2 (0.1-0.8), p < 0.01. In men with a low LDL (< 3.63 mmol/l) use of alcohol was not associated with risk. The attributable risk (AR) of IHD among men with LDL > or = 3.63 mmol/l who abstained from drinking alcohol was calculated; AR with 95% confidence limits was 43% (10-64%). To conclude, in middleaged and elderly men the inverse association between alcohol consumption and risk of IHD was highly dependent on the level of LDL. These results support the suggestion that alcohol intake may at least in part explain the French paradox.