Light-to-moderate alcohol consumption is believed to be protective against coronary artery disease (CAD) in many studies. However, the cardioprotective effects of alcohol intake lack epidemiologic evidence in a Chinese population. The present case–control study was designed to explore the relation between alcohol consumption and angiographically proved CAD in Chinese men. The study population consisted of 1,476 consecutive men 36 to 84 years of age who underwent coronary arteriography. Participants were categorized as nondrinkers, light drinkers, moderate drinkers, and heavy drinkers. Adjusted odds ratios for light, moderate, and heavy drinking were 1.16 (95% confidence interval 0.68 to 1.94), 1.78 (1.35 to 2.27), and 2.18 (1.46 to 3.25). Adjusted odds ratios were 1.36 (1.08 to 1.83) for drinking alcohol 2 to 3 days/week, 1.58 (1.17 to 2.26) for 4 to 5 days/week, and 2.03 (1.36 to 3.27) for 6 to 7 days/week. Compared to nondrinking, adjusted odds ratios were 1.03 (0.54 to 1.87) for drinking 0 to 15 years, 1.61 (1.28 to 2.14) for 16 to 30 years, and 1.98 (1.23 to 3.05) for >30 years. In conclusion, moderate-to-heavy alcohol consumption increased the risk of CAD in Chinese men. CAD risk tended to increase with an increase in frequency and duration of drinking.
There have not been any studies that have evaluated the relation between alcohol consumption and angiographically proved coronary artery disease (CAD) in China. Therefore, the present case–control study was designed to explore the relation between alcohol consumption and CAD in Chinese men undergoing coronary arteriography.
Methods
In total 1,476 consecutive men patients 36 to 84 years of age who underwent coronary arteriography at 2 hospitals (The First Affiliated Hospital of Nanjing Medical University and Nanjing Chest Hospital) from June 2009 to March 2010 in Nanjing, China, participated in the present study. All patients underwent coronary arteriography because of typical or atypical chest pain or abnormal ST-T changes. The First Affiliated Hospital of Nanjing Medical University is the largest comprehensive hospital in Nanjing and Nanjing Chest Hospital is a hospital that specializes in the treatment of cardiopulmonary disease. These are also appointed hospitals for coronary arteriography under medical insurance and most patients who need coronary arteriography in Nanjing attend these 2 hospitals. Of the 1,476 patients, those with CAD (n = 738) were defined as having significant stenosis in ≥1 major coronary artery and patients (n = 738) who did not have significant stenosis of all arteries were defined as controls. The study was assessed and approved by the institutional ethics committees of the First Affiliated Hospital of Nanjing Medical University and Nanjing Chest Hospital.
Coronary arteriography was carried out in all patients using a standard Judkins technique through the femoral artery or brachial artery. Severity of coronary obstruction was evaluated in the worst-view projection. All evaluations were based on the American Heart Association method. CAD was defined as diameter stenosis ≥50% in the left main, left anterior descending, left circumflex, and/or right coronary artery.
We obtained information on alcohol consumption using a quantitative questionnaire.
The participants were required to answer the following questions: (1) What was the amount of alcohol you consumed each week? (2) How often did you drink each week? (3) How long had you been drinking? The most commonly consumed alcoholic beverages in China are beer, wine, and hard liquor. Participants were then categorized into 4 groups: <1 drink/week (nondrinkers), 1 drink to 6 drinks/week (light drinkers), 7 to 13 drinks/week (moderate drinkers), and >13 drinks/week (heavy drinkers). A standard drink was defined as a glass of wine, a bottle of beer, or a shot of spirits, approximating 10 to 12 g of ethanol.
In the present study, patients were regarded as physically active if they engaged in aerobic activities for >30 minutes (walking, bicycling, running, swimming, etc.) ≥3 times/week. Weight and height measurements were taken after patients removed their shoes and upper garments and put on an examination gown. Height was measured to the nearest 0.1 cm using a wall-mounted stadiometer. Weight was measured to the nearest 0.1 kg using a hospital balance beam scale. Body mass index (BMI) was calculated as weight (kilograms) divided by height (meters) squared. Biochemical data, including total cholesterol concentration, triglyceride concentration, and fasting blood glucose concentration, were collected from patients’ most recent medical records. Hyperlipidemia was defined as a serum total cholesterol concentration >220 mg/dl (5.698 mmol/L) or triglyceride concentration >150 mg/dl (1.695 mmol/L) or use of lipid-lowering therapy. Patients were considered to have diabetes mellitus if they were under hypoglucose treatment or if their fasting blood glucose concentration was >110 mg/dl (6.1 mmol/L). Blood pressure was measured in the right arm with the participant seated and the arm bare using an automatic sphygmomanometer. Two readings were recorded for each subject and the average was recorded. Hypertension was defined as a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg or receiving antihypertensive treatment.
In the present study, age and BMI data were treated as continuous variables. Hypertension, diabetes mellitus, hyperlipidemia, smoking, and physical activity were treated as categorical variables. Odds ratios and 95% confidence intervals were calculated to indicate the relation between alcohol consumption and CAD. Multiple logistic regression analysis was used to adjust for age, BMI, hypertension, diabetes mellitus, hyperlipidemia, smoking, and physical activity. A p value <0.05 was considered statistically significant. All statistical analyses were carried out using SPSS 13.0 (SPSS, Inc., Chicago, Illinois).
Results
Characteristics of patients with and without CAD are presented in Table 1 . In the present study, age, obesity, hypertension, diabetes mellitus, hyperlipidemia, smoking, and physical inactivity were confirmed to be risk factors for CAD.
| CAD | ||
|---|---|---|
| Yes (n = 738) | No (n = 738) | |
| Age (years) | 64.6 ± 8.5 | 53.2 ± 9.4 |
| Body mass index (kg/m 2 ) | 25.7 ± 2.8 | 22.4 ± 2.3 |
| Hypertension | 496 (67.2%) | 345 (46.7%) |
| Diabetes mellitus | 187 (25.3%) | 124 (16.8%) |
| Hyperlipidemia ⁎ | 361 (48.9%) | 302 (40.9%) |
| Smoker | 508 (68.8%) | 314 (42.5%) |
| Physically active | 323 (43.8%) | 385 (52.2%) |
⁎ Defined as serum cholesterol concentration >220 mg/dl or triglyceride concentration >150 mg/dl or use of lipid-lowering therapy.
The relation between amount of alcohol intake and CAD risk is presented in Table 2 . Our findings revealed that the risk of CAD tended to increase with an increase in alcohol intake. The relation between drinking frequency and CAD risk are presented in Table 3 . We found that risk of CAD tended to increase with an increase in drinking frequency. The relation between duration of drinking and CAD risk is presented in Table 4 . The findings indicated that risk of CAD tended to increase with an increase in duration of drinking.
| Number of Alcoholic Drinks/Week | CAD | Adjusted OR ⁎ (95% CI) | |
|---|---|---|---|
| Yes | No | ||
| (n = 738) | (n = 738) | ||
| <1 | 56 (7.6%) | 83 (11.2%) | 1 |
| 1–6 | 293 (39.7%) | 354 (48.0%) | 1.16 (0.68–1.94) |
| 7–13 | 324 (43.9%) | 259 (35.1%) | 1.78 (1.35–2.27) |
| >13 | 65 (8.8%) | 42 (5.7%) | 2.18 (1.46–3.25) |
| p value for trend | <0.001 | ||
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
