Chicago, IL - An alcohol-intake level averaging one to seven drinks per week protects against death and CV events, and it does so independently of ethanol's anti-inflammatory effects and high-density lipoprotein (HDL) cholesterol levels, suggests an observational study of "well-functioning" elderly persons [1].

Adjusted risk reductions reached 26% and almost 30%, respectively, compared with outcomes among persons who drank less than once per week, including abstainers. Event rates climbed at intake above seven per week.

"Our findings provide evidence of a cardioprotective effect and survival benefit of light to moderate alcohol consumption among older people," write Dr Cinzia Maraldi (University of Florida, Gainesville) and associates in the July 24, 2006 issue of Archives of Internal Medicine.

Their study arrives in print on the heels of a Cardiovascular Health Study report with closely parallel results. As recently covered by heartwire, they showed a similar U-shaped event curve that included a significant 28% drop in the risk of heart failure associated with about the same once-a-day drinking frequency [2].

If you drink—that's the qualifier, if you drink—then drink moderately and responsibly and you can have good outcomes.

The question of whether that level of alcohol intake can be cardioprotective appears answered, according to Dr Thomas D Giles (Louisiana State University Health Sciences Center, New Orleans), a hypertension expert who studies the connection between alcohol and cardiac risk. "The strongest support for a benefit comes from observational studies," he observed. Still, "I think the data at this point are overwhelming that if you drink, and you drink responsibly and with light to moderate consumption, you are going to fare better than people who don't drink at all. That's clear," he told heartwire. "Conversely, if you drink too much, I think it's pretty apparent you're going to have bad outcomes."

Such vast observational data are sometimes enough to convince without randomized trials, according to Giles, noting that there's never been a randomized study of the health effects of cigarette smoking.

In the current study, Maraldi and associates queried 2487 participants in the community-based Health, Aging, and Body Composition Study at baseline and annually about their weekly alcohol consumption and then followed them for a mean of 5.6 years. All participants, who lived in two US metropolitan areas, were free of CVD at study entry. Cardiovascular events were defined as an overnight hospitalization for MI, angina, or HF.

The survival effect of light to moderate drinking appeared stronger among African American men, who showed a mortality hazard ratio of 0.41 (95% CI 0.22-0.77).

The two reports send "one clear message," Giles said. "If you drink—that's the qualifier, if you drink—then drink moderately and responsibly and you can have good outcomes," Giles said. But he emphasized a lot of caveats, including whether there's a family history of alcoholism and the drinker is responsible about when and where to imbibe and how much is too much.

The take is different for nondrinkers, who shouldn't be advised to start drinking, he noted. That might change "if we had a test, which I think is coming, that would predict who is going to get into trouble with alcohol abuse."