Copenhagen, Denmark - Both physical activity and a moderate alcohol intake are important for lowering the risk of fatal ischemic heart disease (IHD) and all-cause mortality, a new study shows [1].

The study, published online in the European Heart Journal on January 9, 2008, shows that people who drink moderate amounts of alcohol and are physically active have a lower risk of death from heart disease and other causes than people who don't drink at all and that people who neither drink alcohol nor exercise have a 30% to 49% higher risk of heart disease than those who drink, exercise, or do both.

The study, conducted by a team of Danish researchers, is said to be the first to look at the combined influence of leisure-time physical activity and weekly alcohol intake on the risk of fatal ischemic heart disease and deaths from all causes. The researchers note that both physical activity and light to moderate alcohol intake are known to have beneficial effects on the circulatory system, but whether one of these two modifiable factors may compensate for the effect of the other or whether both of them are important for cardiovascular health and health in general is not yet clarified. They therefore conducted a study to estimate the combined influence of leisure-time physical activity and weekly alcohol intake on the risk of subsequent fatal heart disease and all-cause mortality.

They examined data on 11 914 Danish men and women aged 20 years and older without CHD at baseline who were part of the Copenhagen City Heart Study. In this population study, participants completed a questionnaire regarding various health-related issues, including leisure-time physical activity and weekly alcohol intake, and underwent a physical examination.

Physical activity was divided into three categories: physically inactive; low level of activity—light physical activity for two to four hours a week (walking, cycling, light gardening, light physical exercise); or moderate to high level of physical activity—light physical activity for more than four hours a week or more vigorous activity for two or more hours a week. Alcohol intake was classified as nondrinkers (less than one drink a week), moderate drinkers (one to 14 drinks a week), and heavy drinkers (15 or more drinks a week).

During the 20 years of follow-up, 1242 cases of fatal heart disease occurred and 5901 participants died from all causes. Within both genders, being physically active was associated with lower risks of both fatal IHD and all-cause mortality than being physically inactive. Further, weekly alcohol intake was inversely associated with fatal heart disease and had a U-shaped association with all-cause mortality. Within each level of physical activity, nondrinkers had the highest risk of fatal heart disease, whereas both nondrinkers and heavy drinkers had the highest risk of all-cause mortality. Further, the physically inactive had the highest risk of both fatal heart disease and all-cause mortality within each category of weekly alcohol intake.

Senior author of the study, Dr Morten Grønbæk (National Institute of Public Health, Copenhagen), said: "Our study shows that being both physically active and drinking a moderate amount of alcohol is important for lowering the risk of both fatal IHD and death from all causes. For both men and women, being physically active was associated with a significantly lower risk for both fatal IHD and all-cause mortality than being physically inactive, and drinking alcohol was associated with a lower risk of fatal IHD than abstaining. A weekly moderate alcohol intake reduced the risk of all-cause mortality among both men and women, whereas the risk among heavy drinkers was similar to nondrinkers."

Lead author Dr Jane Østergaard Pedersen (National Institute of Public Health) commented: "Another important finding is that physical activity can reverse some of the adverse health effects associated with alcohol abstention. People who did not drink but whose physical activity was moderate or high had a lower risk of IHD than the inactive nondrinkers."

Pedersen added: "The lowest risk of death from all causes was observed among the physically active moderate drinkers and the highest risk as seen among the physically inactive non- and heavy drinkers. Thus, both moderate to high levels of physical activity and a moderate alcohol intake are important for lowering the risk of fatal IHD and deaths from all causes."