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CLINICAL RESEARCH: HEART FAILURE

The Association of Alcohol Consumption and Incident Heart Failure

The Cardiovascular Health Study

Chris L. Bryson, MD, MS^_*,, Kenneth J. Mukamal, MD, MPH, MA^,_*, Murray A. Mittleman, DrPH, MD, Linda P. Fried, MD, MPH, Calvin H. Hirsch, MD^||, Dalane W. Kitzman, MD^¶ and David S. Siscovick, MD, MPH^_*

^_* Cardiovascular Health Research Unit, University of Washington, Seattle, Washington
VA Puget Sound HSR&D, Seattle, Washington
Department of Medicine, Beth Israel-Deaconess Medical Center, Boston, Massachusetts
Department of Medicine, Johns Hopkins, Baltimore, Maryland
^|| Division of Internal Medicine, UC Davis, Davis, California
^¶ Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina

Manuscript received December 2, 2005; revised manuscript received January 5, 2006, accepted February 17, 2006.

^_* Reprint requests and correspondence: Dr. Kenneth J. Mukamal, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RO-114, Boston, Massachusetts 02215. (Email: kmukamal{at}bidmc.harvard.edu).

OBJECTIVES: We investigated the association between alcohol consumption and incident congestive heart failure (CHF) both overall and after adjusting for incident myocardial infarction (MI).

BACKGROUND: Moderate alcohol consumption has been associated with lower risk of CHF and MI.

METHODS: The Cardiovascular Health study, a prospective cohort study of cardiovascular disease risk factors and outcomes, followed 5,888 subjects 65 years old for 7 to 10 years. Cox models were used to estimate the adjusted risk of CHF by reported alcohol consumption.

RESULTS: There were 5,595 subjects at baseline at risk for incident CHF with alcohol data and 1,056 events during follow-up. Compared with abstainers, the adjusted risk of CHF was lower among subjects who reported consuming 1 to 6 drinks per week (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.67 to 1.00, p = 0.05) and 7 to 13 drinks per week (HR 0.66, 95% CI 0.47 to 0.91, p = 0.01). Time-dependent adjustment for incident MI altered only slightly the association between moderate alcohol consumption and CHF (for 1 to 6 drinks per week, HR 0.84, 95% CI 0.65 to 1.04; for 7 to 13 drinks per week, HR 0.69, 95% CI 0.49 to 0.99). Baseline former drinkers had a higher risk of CHF than abstainers (HR 1.51, p < 0.01), but those who quit during the study did not have a higher risk (HR 0.83, 95% CI 0.66 to 1.03).

CONCLUSIONS: Moderate alcohol use is associated with a lower risk of incident CHF among older adults, even after accounting for incident MI and other factors.

Abbreviations and Acronyms   CHF = congestive heart failure   CHS = Cardiovascular Health Study   CI = confidence interval   ECG = electrocardiogram   HR = hazard ratio   LV = left ventricle/ventricular   MI = myocardial infarction

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