1 verre d'alcool par jour serait bon pour le coeur

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1 verre d'alcool par jour serait bon pour le coeur

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• Coeur
• Boisson alcoolisée
• Verre
• VIN

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• Publié par: Fil_actu
• Publié le: 21 janvier 2015
• Nombre de lectures: 16
• Langue: Français

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European Heart Journal Advance Access published January 19, 2015
CLINICAL RESEARCHEuropean Heart Journal
doi:10.1093/eurheartj/ehu514 Prevention and epidemiology
Alcohol consumption and risk of heart failure: the
Atherosclerosis Risk in Communities Study
1,2 1 1,3 4Alexandra Gonc ¸alves , Brian Claggett , Pardeep S. Jhund , Wayne Rosamond ,
5 6 1 1 1*Anita Deswal , David Aguilar , Amil M. Shah , Susan Cheng , and Scott D. Solomon
1 2 3CardiovascularDivision,BrighamandWomen’sHospital, 75FrancisStreet, Boston,MA02115,USA; UniversityofPortoMedical School,Porto,Portugal; Institute ofCardiovascularand
4Medical Sciences, University of Glasgow, Glasgow, UK; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA;
5 6Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA; and Department of Medicine, Baylor College of Medicine, Houston, TX, USA
Received 2October 2014; revised23 November 2014;accepted 19 December 2014
Aim Alcohol is a known cardiac toxin and heavy consumption can lead to heart failure (HF). However, the relationship
between moderate alcohol consumption and risk for HF, in either men or women, remains unclear.
.....................................................................................................................................................................................
Methods We examined 14 629 participants of the Atherosclerosis Risk in Communities (ARIC) study (54+ 6 years, 55% women)
andresults without prevalent HF at baseline (1987–89) who were followed for 24+ 1 years. Self-reported alcohol consumption
was assessed as the number of drinks/week (1 drink¼ 14 g of alcohol) at baseline, and updated cumulative average
alcohol intake was calculated over 8.9+ 0.3 years. Using multivariable Cox proportional hazards models, we examined
the relation of alcohol intake with incident HF and assessed whether associations were modified by sex. Overall, most
participants were abstainers (42%) or former drinkers (19%), with 25% reporting up to 7 drinks per week, 8% reporting
≥7 to 14 drinks per week, and 3% reporting≥14–21 and≥21 drinks per week, respectively. Incident HF occurred in
1271 men and 1237 women. Men consuming up to 7 drinks/week had reduced risk of HF relative to abstainers
(hazard ratio, HR 0.80, 95% CI 0.68–0.94, P¼ 0.006); this effect was less robust in women (HR 0.84, 95% CI 0.71–
1.00, P¼ 0.05). In the higher drinking categories, the risk of HF was not significantly different from abstainers, either in
men or in women.
.....................................................................................................................................................................................
Conclusion In the community, alcohol consumption of up to 7 drinks/week at early-middle age is associated with lower risk for future
HF, with a similar but less definite association in women than in men. These findings suggest that despite the dangers of
heavy drinking, modest alcohol consumption in early-middle age may be associated with a lower risk for HF.
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-Keywords Alcohol consumption † Heart failure † Men, women, general population
8associated hypertension, coexisting nutritional deficiencies, or, rarely,Introduction
9toxic additives to alcoholic beverages. Conversely, the cardiovascular
Heart failure (HF) is a major public health problem, but data on the mechanisms of alcohol benefit in HF may involve the risk reduction
10 11relationship between community lifestyle factors, such as alcohol for coronary artery disease (CAD), neurohormonal changes or
12,13consumption and incident HF, are limited. Although heavy blood pressure lowering. Importantly, the balance of risks and ben- is associated with impairment in left ventricular func- efits is likely to differ in different populations and by gender and across
1 2,14tion and eventual alcoholic cardiomyopathy with symptomatic HF, race and age groups.
Womenareknowntodevelopalcohol-asso2,3moderate alcohol intake could, conversely, lower the risk for HF. ciated cardiomyopathy at a lower lifetime dose of alcohol compared
15However, the association between moderate alcohol intake and with men, and women have a much greater risk of heart disease
16the risk of HF is still controversial, as some studies did not find an death for the same amount of alcohol use. Nonetheless, sex-related
4,5association and the cardiovascular mechanisms of potential differences on the effects of alcohol consumption and risk of HF
3,6benefit of alcohol consumption in HF are uncertain. remain relatively unexplored. In the current study, we aimed to assess
Myocardial damage may occur as a consequence of direct toxic the association between alcohol intake and the risk of developing HF
7effects of alcohol or its metabolites by ethanol-induced apoptosis; in men and women, in a large biracial community-based cohort.
* Corresponding author. Tel:[phone], Fax:[phone], Email: [e-mail]
Published on behalf of the European Society of Cardiology. All rights reserved.& The Author 2015. For permissions please email: [e-mail] 2 of 8 A. Gonc ¸alves et al.
CovariatesMethods
Established definitions for hypertension, obesity, diabetes mellitus, CAD,
Study population stroke, and smoking status were used as previously described in the ARIC
21study. Anindexof physical activity wasderivedfrom the physical activityThe Atherosclerosis Risk in Communities (ARIC) Study is an ongoing,
questionnaire of Baecke et al., including physical activity at work andprospective observational study. Detailed study rationale, design, and
2217 during sports. Interviews included assessment of educational levelprocedures have been previously published. The original cohort
and high educationlevel wasdefined as college or graduate or profession-included 15 792 persons aged 45–64 years recruited between 1987
al school attendance. All covariates were ascertained at Visit 1.and 1989 (Visit 1), selected from four communities in the United
States: Forsyth County, North Carolina; Jackson, Mississippi;
MinneapStatistical methodsolis, Minnesota; and Washington County, Maryland. Three subsequent
We performed analyses for men and women, for the associationfollow-up visits occurred at 3-year intervals, with annual telephone
interbetween alcohol consumption and HF. For the six groups [former drin-views ongoing and conducted between visits. Institutional review boards
kers, abstainers, drinkers of up to 7 drinks/week (,7),≥7 to 14,≥14 tofrom each site approved the study, and informed consent was obtained
21, and≥21 drinks/week], summary statistics for covariates were calcu-from all participants.
lated as counts and percentages or means and standard deviation for cat-We restricted our analyses to self-described black or white
particiegorical and continuous data, respectively. Comparisons of baselinepants (44 exclusions by undetermined race) and excluded those with
2characteristics between the six groups were made using Pearson xprevalent or missing HF data (n¼ 1,039) and those with missing data
test and analysis of variance. The rates of incident HF were calculatedon alcohol consumption at visit 1 (n¼ 80). A total of 14 629 U.S.
and expressed as events per 100 person-years at risk.adults aged 45–64 followed prospectively through 2011 (mean of
We estimated multivariable hazard ratios for incident HF, baseline24+ 1 years) constitute the sample for the present analysis.
alcohol consumption and time-updated cumulative average alcohol
intake classification, usingted Cox proportional hazards
regression models adjusted for age, body mass index (BMI), total
cholesDefinition of heart failure terol and score of physical activity, as continuous variables, and diabetes,
Prevalent HF at visit 1 was defined by Stage 3 or manifest HF according to hypertension, CAD, education level and smoking status, as categories,
Gothenburg criteria or the use of medications for HF. The Gothenburg with incident myocardial infarction as a time-varying covariate,
comparcriteria are a validated scoring system composed of three components, ing each level of drinking with abstainers. Tests for violation of the
cardiac, pulmonary, and therapy, in which Stage 3 or manifest HF requires proportional hazards assumption were conducted through the
introduc18one point from each component. Incident HF at follow-up was defined tion of linear interaction between the time variable and the exposure of
by HF hospitalization or HF death, according to the International Classi- interest (categories of alcohol consumption).
fication of Diseases-Ninth Revision (ICD-9), code 410 in any position, for In addition to the test for linear trend from the categorical analysis, we
HF, obtained by ARIC Study retrospective surveillance of hospital dis- also tested for a curvilinear association between the continuous measure
19,20charges. Deaths were ascertained through linkage with the National of alcohol consumption (grams per week) at baseline and incident HF, via
Death Index. an adjusted Cox model using a restricted cubic spline. For the purpose
of the spline analysis, former drinkers were excluded, with abstainers
(0 g/week) as the reference group. The number of knots used in the<