Patterns of alcohol consumption and myocardial infarction risk: observations from 52 countries in the INTERHEART case-control study

Darryl P Leong; Andrew Smyth; Koon K Teo; Martin McKee; Sumathy Rangarajan; Prem Pais; Lisheng Liu; Sonia S Anand; Salim Yusuf; INTERHEART Investigators

doi:10.1161/CIRCULATIONAHA.113.007627

Patterns of alcohol consumption and myocardial infarction risk: observations from 52 countries in the INTERHEART case-control study

Circulation. 2014 Jul 29;130(5):390-8. doi: 10.1161/CIRCULATIONAHA.113.007627. Epub 2014 Jun 13.

Authors

Darryl P Leong¹, Andrew Smyth², Koon K Teo², Martin McKee², Sumathy Rangarajan², Prem Pais², Lisheng Liu², Sonia S Anand², Salim Yusuf²; INTERHEART Investigators

Collaborators

INTERHEART Investigators:
S Yusuf, S Ounpuu, P Montague, J Keys, S Rangarajan, S Hawken, A Negassa, C Wright, R Mayhew, L Westfall, P Mackie, C Cuvay, D Cunningham, K Picken, H Gerstein, M McQueen, K Hall, J Keys, R Diaz, E Paolasso, M Ciruzzi, R Nordaby, C H Sosa, H L Luciardi, E M Marzetti, J A Piasentin, M Amuchastegui, C Cuneo, G Zapata, J O Bono, E M Marxetti, A Caccavo, R A A Guerrero, R Nordaby, C Dizeo, D Hunt, J Varigos, M Sallaberger, G Aroney, P Hicks, D Campbell, J Amerena, W Walsh, G Nelson, D Careless, J Durech, K Gunawardane, A Thomson, D Owensby, A Buncle, B Watson, H Ikram, M Audeau, M Hills, D Rosen, J Rankin, A Tunesi, J Sampson, K Roberts, A Hamer, L Roberts, B Singh, C Singh, R Hendriks, G Tulloch, A Hill, D Rees, C Hall, M A Halim, M I Amin, S Haque, G M Furuque, M Hossain, H Agboton, C Onen, A Avezum, L Piegas, G Reis, J P Esteves, L C Bodanese, A R Junior, J A M Neto, R F Ramos, E S Silva, A Labrunie, A C C Carvalho, I P Filho, D C D Albuquerque, J A M Abrantes, O C E Gebara, P E Leaes, S S Xavier, R L Marino, O Dutra, W Muna, K N Blackett, K Teo, S Yusuf, S Ounpuu, Y K Chan, C Joyner, A D Kitching, A Morris, A Panju, H Lee, I Bata, B May, J G Hiscock, P V Greenwood, W Tymchak, M Natarajan, F Lanas, D Standen, A Lanas, C Santibanez, P Soto, S Potthoff, R Soto, E Mercadal, L S Liu, L X Jiang, Q Chen, N Sun, J Wang, L Zhang, X Li, H Chen, Z Li, Y Shi, J Meng, D Wang, Z Liu, J Yan, W Zhang, Z Wan, Y Xu, X Li, L Wang, Q Fu, K Zhu, Y Wang, X Wang, F Wang, R Liu, R Zhao, K Sun, S Yue, Y Zhang, X Zhao, L Zhao, C Zhou, X Meng, A Liu, X Li, R Wu, R Xiao, X Zhang, G Wan, X Chen, Z Ge, T Zhou, Y Li, X Zhou, F Zhang, L E Bautista, J P Casas, C A Morillo, C A Ardilla, I A Arenas, M Lindarte, D Aristizabal, Z Rumboldt, M Rumboldt, V Carevic, P Widimsky, M Branny, P Gregor, M S Khedr, M G Abdel-Aziz, S Abdel-Kader, M A Abdel-Moneim, F El-Demerdash, A El-Saiid, S Gharib, M Hassanin, F Abdel-Hamid Maklady, I Sadek, H J Rupprecht, T Wittlinger, P Schuster, A Schmidt, H R Ochs, N Karatzas, A Pipilis, D Symeonides, K Karidis, T H Tsaknakis, K Kyfnidis, M Luna, A M Arroyo, G Sotomora, M A Rodas, L Velasquez, A Ovando, J Sanderson, W Y Ma, S Chan, M Keltai, F Szaboki, P Karpati, K Toth, S Timar, E Kalo, A Janosi, M Rusznak, D Lehoczky, J Tarjan, E Kiss, E Sitkei, P Valyi, I Edes, P Pais, K S Reddy, P P Joshi, D Prabhakaran, D Xavier, A Roy, L Ramakrishnan, M R M Hasani, S H Mirkhani, D Halon, B Lewis, M G Franzosi, G Tognoni, E Gardinale, M Villella, M Mennuni, F Saiu, G Pettinati, S Ciricugno, S Antonaci, L Carrieri, E Balli, D Bicego, M G DelleDonne, A Ottaviano, L Moretti, C Melloni, G Melandri, E Carbonieri, A Vetrano, M Hori, H Sato, K Fujii, E N Ogola, P Wangai, M Zubaid, W Rashed, C C Lang, W A W Ahmad, A Kadirvelu, R Zambahari, M A Ramos-Corrales, A Damasceno, M R Pandey, G Baniya, A Sayami, M Kiratee, B Rawat, M Pandey, J Gurung, R Peters, D C G Basart, P N A Bronzwaer, J A Heijmeriks, H R Michels, G M A Pop, K K Akinroye, K Kazmi, N A Memon, S K Memon, S Nishtar, A Badar, M A Mattu, M Yakub, K Soomra, J Khatri, A M A Faruqui, S I Rasool, A Samad, A L Dans, F Q Punzalan, M V C Villarruz, B T Mendoza, C S Recto 3rd, B R Tamesis, V Mendoza, D J Torres, D D Morales, I Ongtengco, A Budaj, L Ceremuzynski, S Stec, J Gorny, K Prochniewska, T K Urbanek, P Wojewoda, M Pawlowski, K Religa, R Klabisz, H Latocha, M Szpajer, K Cymerman, M Laniec, H Danielewicz, M Ogorek, D Kopcik, A Baranowska, A Kozlowski, M Blachowicz, A Jedrzejowski, T Waszyrowski, Z Zielinski, K Janik, M Tomzynski, M Mytnik, A Maziarz, G Rembelska, M Piepiorka, K Debkowska, T Krynski, B S Szczeklik, W Krasowski, M Rozwodowska, P Miekus, J Surwilo, S Malinowski, J Hybel, M Michalak, P Achremczyk, J Majchrzak, W S Korombel, M Dobrowolski, J Gessek, J Morais, A A Gehani, H A Hajar, M M Almowla, A A Omer, E G Volkova, S U Levashov, O M Filatova, U I Evchenko, G S Malkiman, N N Karaulovskaya, J Panovsky, B A Johan, A Cheng, K S Ng, Y L Lim, K H Neoh, K S Tan, L N Lum, Y Cheah, P Commerford, K Steyn, B Brown, F Martiz, P Raubenheimer, A Aboo, J D Marx, E Batiste, K Sliwa, P Sareli, C Zambiakides, V Valentin, J Ferriz, A Rovira, A Rodriguez-Llorian, E Cereijo, T Monzo, N Alonso, E Gomez-Martinez, A Lopez, S Mendis, T Jayalath, A T A Hinai, M O Hassan, A Rosengren, C Sitthi-Amorn, S Chaithiraphan, K Bhuripanyo, S Srimahachota, M Anukulwutipong, P Loothavorn, P Sritara, S Tanomsup, J Tantitham, P Tatsanavivat, T Yipinsoi, W Jintapakorn, W Puavilai, B Koanantakul, P Kasemsuwan, C Supanantareauk, C Peamsomboon, B Saejueng, K Jeamsomboon, A Sukontasup, W Almahmeed, L O Abdelwareth, A Bokhari, N S Rao, S Bakir, A M Yusufali, E Hatou, Q Zaidi, K Fox, M Flather, J Probstfield, R Freeman, J Mathew, M Schweiger, W Johnson, E Ofili, J Chifamba, A J G Hakim

Affiliations

¹ From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (D.P.L., A.S., K.K.T., S.R., S.S.A., S.Y.); London School of Hygiene and Tropical Medicine, London, UK (M.M.); St. John's Medical College, Bangalore, India (P.P.); and Fu Wai Hospital, Beijing, China (L.L.). [email protected].
² From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada (D.P.L., A.S., K.K.T., S.R., S.S.A., S.Y.); London School of Hygiene and Tropical Medicine, London, UK (M.M.); St. John's Medical College, Bangalore, India (P.P.); and Fu Wai Hospital, Beijing, China (L.L.).

PMID: 24928682
DOI: 10.1161/CIRCULATIONAHA.113.007627

Abstract

Background: Although moderate alcohol use is associated with protection against myocardial infarction (MI), it is not known whether this effect is generalizable to populations worldwide. It is also uncertain whether differences in the pattern of alcohol use (and in particular heavy episodic consumption) between different regions negate any beneficial effect.

Methods and results: We included 12 195 cases of first MI and 15 583 age- and sex-matched controls from 52 countries. Current alcohol use was associated with a reduced risk of MI (compared with nonusers: adjusted odds ratio, 0.87; 95% confidence interval, 0.80-0.94; P=0.001); however, the strength of this association was not uniform across different regions (region-alcohol interaction P<0.001). Heavy episodic drinking (≥6 drinks) within the preceding 24 hours was associated with an increased risk of MI (odds ratio, 1.4; 95% confidence interval, 1.1-1.9; P=0.01). This risk was particularly elevated in older individuals (for age >65 years: odds ratio, 5.3; 95% confidence interval, 1.6-18; P=0.008).

Conclusions: In most participants, low levels of alcohol use are associated with a moderate reduction in the risk of MI; however, the strength of this association may not be uniform across different countries. An episode of heavy drinking is associated with an increased risk of acute MI in the subsequent 24 hours, particularly in older individuals.

Keywords: alcohol drinking; epidemiology; myocardial infarction; risk factors.

MeSH terms

Age Distribution
Aged
Alcohol Drinking / epidemiology*
Binge Drinking / epidemiology
Case-Control Studies
Female
Global Health / statistics & numerical data
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction / epidemiology*
Odds Ratio
Prevalence
Racial Groups / statistics & numerical data
Risk Factors
Risk Reduction Behavior*
Sex Distribution