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Howard D. Sesso, ScD; Meir J. Stampfer, MD, DrPH; Bernard Rosner, PhD; Charles H. Hennekens, MD, DrPH; JoAnn E. Manson, MD, DrPH; J. Michael Gaziano, MD

Arch Intern Med. 2000;160:2605-2612.

Background  Few studies have examined whether changes in alcohol consumption influence future cardiovascular risk.

Objective  To examine whether 7-year changes in alcohol consumption are associated with the subsequent risk of cardiovascular disease (CVD).

Methods  We prospectively followed up 18,455 men aged 40 to 84 years from the Physicians' Health Study with no history of CVD or cancer. Alcohol consumption was reported on the baseline and the 7-year questionnaires; follow-up for this analysis began after the 7-year questionnaire (median follow-up, 5.8 years). There were 1091 CVD cases, including myocardial infarction, angina pectoris, revascularization, stroke, and CVD-related death.

Results  Among men initially consuming 1 drink per week or less (n=7360), those with moderate increases (>1 to <6 drinks per week) in alcohol consumption had a borderline significant (P=.05) 29% reduced risk of CVD compared with men with no changes (-1 to 1 drink per week). Among men initially consuming greater than 1 to 6 drinks per week (n=6612), those with moderate increases had a nonsignificant (P=.32) 15% decrease in CVD risk compared with men with no changes. Finally, among men initially consuming 1 drink per day or more (n=4483), those who increased intake had a 63% increased risk of CVD compared with men with no changes.

Conclusions  These prospective data suggest that, among men with initially low alcohol consumption (1 drink per week), a subsequent moderate increase in alcohol consumption may lower their CVD risk. The possible reduction in CVD risk from increasing alcohol intake did not extend to men initially consuming greater than 1 drink per week. Given the potential risks and benefits associated with alcohol consumption, physician counseling of patients must be individualized in the context of the primary prevention of CVD.

From the Division of Preventive Medicine (Drs Sesso, Manson, and Gaziano), the Channing Laboratory (Drs Stampfer, Rosner, and Manson), and the Cardiovascular Division (Dr Gaziano), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; the Departments of Epidemiology (Drs Sesso, Stampfer, and Manson) and Nutrition (Dr Stampfer), Harvard School of Public Health, Boston; the Department of Medicine, Epidemiology, and Public Health, University of Miami School of Medicine, Miami, Fla (Dr Hennekens); and the Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Medical Center, Brockton/West Roxbury (Dr Gaziano).

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