Philadelphia, PA - New data from the Health Professionals Follow-Up Study suggest that men with hypertension who drink moderately may not need to cut back on alcohol consumption out of concerns about CVD risk [1]. According to Dr Joline WJ Beulens (Utrecht Julius Center for Health Sciences and Primary Care, the Netherlands) and colleagues, their study is the first to look specifically at risk of MI in relation to alcohol consumption in hypertensive males.

The issue is important, the authors explain, because heavy alcohol consumption is known to increase risk of developing hypertension, which is itself a risk for cardiovascular disease. "We already knew that in the general, healthy population, moderate drinking is related to a lower risk of heart disease, but when you drink more than moderately, more than three drinks a day, blood pressure increases," Beulens explained to heartwire. "And we didn't know what the relation was to alcohol consumption and risk of heart disease in men with hypertension. Men with increased blood pressure are at increased risk of heart disease, so this was an interesting group to study in this respect."

Beulens et al examined alcohol consumption, assessed every four years, and incident cases of nonfatal MI, fatal coronary disease, and stroke between 1986 and 2002 among 11 711 men with hypertension in the Health Professionals Follow-Up Study. In all, they report, 653 patients experienced MI during the study period. Hazard ratios for MI declined with increasing alcohol consumption, as compared with people who abstained from alcohol, ranging from 1.09 in subjects who drank 0.1 to 4.9 g of alcohol per day to 0.41 in patients consuming 50 g or more of alcohol per day (p<0.001 for the trend). Risk of stroke, however, at least in patients consuming 10 to 29.9 g of alcohol per day, was no different from that of abstainers, with a hazard ratio of 1.40 and 1.55, respectively. No statistically significant differences were seen between beverage type and MI risk.

"What we found in this study was that men with hypertension who drank moderately—one to two drinks per day—had a decreased risk of having a heart attack compared with those men who did not drink," Beulens told heartwire. "We also looked at deaths due to heart disease and due to other causes, and we couldn't find any difference between those who drank moderately and those who didn't drink at all."

In an accompanying editorial, Dr Anne CM Thiebaut (National Cancer Institute, Bethesda, MD) and colleagues caution against making sweeping conclusions from "nutritional epidemiology," pointing out that few studies adequately take into account dietary exposure and other covariates [2]. "Error in measuring exposure leads to biased and inefficient estimate of the relationship of the exposure to disease," they write.

Using Beulens et al's study as an example, Thiebaut et al detail the problem of "measurement error" in nutrition studies. These, they write, "should convince the reader to exercise caution when interpreting relationships between diet and clinical outcomes. Owing to the current limitations of available procedures and reference instruments, we cannot assume that corrected estimates of diet-disease associations in any single study are definitive."

For her part, Beulens is cautious about the study findings and emphasizes that they should not be extrapolated to women, who were not included in the study, or be interpreted to mean that hypertensive men who do not drink should start.

"If men already drink moderately and they drink safely, this really shows that it is not a problem for them to continue that—they don't need to change their drinking behavior," she said. "And it doesn't really apply for men who don't drink, because they usually have a good reason for not choosing to drink. These findings really apply to men who already drink moderately."