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THE RENAUD SOCIETY MEMBER BULLETIN BOARD
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| Subject: January, 2009: Journal Watch: Alcohol & Healt |
Author: R. Curtis Ellison, MD
Date: 1/11/2009 7:27 am MST
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Article: McClelland RL, Bild DE, Burke GL, Mukamal KJ, Lima JA, Kronmal RA. Alcohol and coronary artery calcium prevalence, incidence, and progression: results from the Multi-Ethnic Study of Atherosclerosis (MESA).
Am J Clin Nutr 2008;88:1593–1601.
Summary: The authors state that alcohol use has been consistently found to have a J-shaped association with coronary heart disease, with moderate drinkers exhibiting a decreased risk compared with both heavy drinkers and nondrinkers. However, results of studies of the association between alcohol use and subclinical coronary artery disease are conflicting. The objective was to determine whether alcohol is associated with the presence, amount, or progression of coronary calcium over a 2- to 4-y period. The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective community-based cohort study of subclinical cardiovascular disease in a multi-ethnic cohort. In 2000–2002, 6,814 participants free of clinical cardiovascular disease were enrolled at 6 participating centers.
The subjects consisted of 3,766 (55.5%) current drinkers, 1,635 (24.1%) former drinkers, and 1,390 (20.5%) never drinkers. Although light-to-moderate alcohol consumption was associated with lower coronary heart disease risk, the investigators found no evidence of a protective or J-shaped association of alcohol and coronary artery calcium (CAC). In fact, there was evidence that heavy consumption of hard liquor was associated with greater CAC accumulation. Other alcoholic beverages were not associated with CAC prevalence, incidence, or progression. The authors conclude that this was the first large study to evaluate the association of alcohol with CAC in 4 racial-ethnic groups and to evaluate the progression of calcification. These results suggest that the cardiovascular benefits that may be derived from light-to-moderate alcohol consumption are not mediated through reduced CAC accumulation.
Comments: Our group carried out an analysis of alcohol and CAC in the Family Heart Study a few years ago and found no association; the present study supports these findings. While moderate drinkers in MESA showed a strong inverse association with the occurrence of coronary heart disease (approximately 60% lower risk for consumers of 1 - 2 drinks/day in comparison with life-time abstainers), the authors found that alcohol intake did not lower measured levels of CAC or progression of the degree of CAC over time. There was a suggestion that higher intake of alcohol, especially of spirits, could lead to an increase in calcification.
Lay Summary: Moderate drinkers (versus abstainers) are almost always found to be at lower risk of coronary heart disease events (such as myocardial infarction or cardiac death). Data are inconsistent, however, as to the effects of alcohol consumption on one measure of what is known as "subclinical coronary artery disease," based on the level of calcification in the coronary arteries (CAC) as shown on CT scans. The present study found that drinking did not decrease such calcification, nor did it reduce the risk of progression of such calcification, even though moderate drinking was associated with considerably lower occurrence of coronary events.
In conjunction with previous research, the new findings suggest that the potential protection against myocardial infarction from moderate alcohol intake may be related more to clotting mechanisms, or to direct effects on the blood vessel lining (the endothelium), than to the development of calcification within the coronary arteries.
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R. Curtis Ellison, MD |
11/23/2008 7:29 am MST |
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R. Curtis Ellison, MD |
11/23/2008 7:30 am MST |
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R. Curtis Ellison, MD |
11/23/2008 7:32 am MST |
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R. Curtis Ellison, MD |
12/12/2008 4:07 pm MST |
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January, 2009: Journal Watch: Alcohol & Healt |
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R. Curtis Ellison, MD |
1/11/2009 7:27 am MST |
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R. Curtis Ellison, MD |
1/11/2009 7:13 am MST |
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