Boston, MA - Moderate alcohol intake can significantly cut the risk of MI over and beyond the effects of a healthy diet, regular exercise, and other heart-protecting lifestyle choices, at least among men, according to an analysis appearing in the October 23, 2006 issue of the Archives of Internal Medicine [1].

According to data from the Health Professionals Follow-Up Study (HPFS), the cardioprotective effects of moderate drinking long observed in other studies are probably not influenced by confounding lifestyle behaviors, conclude the authors, Dr Kenneth J Mukamal (Beth Israel Deaconess Medical Center, Boston, MA) and associates. In their analysis, CV risk was lowest among men who reported daily alcohol consumption ranging from 5 g to 30 g, which corresponded to about one-half to two drinks.

The HPFS, notes the group, is a prospective study of 51 529 male health professionals who, in 1986, at age 40 to 75 years, completed a diet and medical-history questionnaire and thereafter regularly reported follow-up information on health, diet, and lifestyle.

The cohort under study consisted of 8867 HPFS participants who were initially free of CV disease, cancer, and diabetes and who reported the presence of four healthy lifestyle features or behaviors: a body mass index <25, "moderate to vigorous" exercise at least 30 minutes per day, not smoking, and a high diet score. Such high scores, according to the group, reflected an abundant intake of vegetables, fruits, "cereal fiber," fish, chicken, plant proteins, and polyunsaturated fats and a low intake of trans fats and red meats.

"We restricted our sample much more precisely than had been done in previous studies, homing in on a group of subjects who were as homogeneous as possible in as many ways as possible," Mukamal told heartwire. Even so, the relationship between moderate drinking and CV risk was "just as strong in these very carefully selected men as it had been in more general populations. In some ways [it was] even stronger," he observed.

Guidelines on CV risk reduction typically have "quite conspicuously avoided discussing alcohol consumption, and when they do, they've commonly cautioned that there are other potentially safer or more effective ways to lower risk," such as quitting smoking, staying trim, exercising, and following a healthy diet, according to Mukamal. The men in the HPFS analysis, he said, "were adhering to all of the standard recommendations that we can give to individuals, and even in that group, there was this additive lower risk of heart disease associated with moderate drinking."

Among the study's messages for clinicians, he said, "is that we need not consider our recommendations mutually exclusive, but we ought to evaluate whether we think moderate drinking is or isn't associated with lower risk based on the evidence. . . . The observational evidence that moderate drinking is associated with lower risk is strong and consistent."

Mukamal et al do mention the range of health hazards that have been associated with alcohol consumption, even at moderate levels, so "physicians and patients must weigh both the absolute health risks and benefits of alcohol when discussing alcohol intake." But their analysis, Mukamal said to heartwire, suggests that physicians do not necessarily have to view any alcohol consumption as a uniformly bad thing.

"It is certainly true that we should not view all levels of alcohol consumption equally. We and others have looked across the range of alcohol consumption, and while heavy drinking is consistently associated with a worse outcome, moderate drinking is not. So at a minimum, for people who are drinking safely and have shown themselves to be able to drink safely, there's no reason to ask those individuals to quit."