Wannamethee, Sasiwarang Goya; (1992) Alcohol, cardiovascular disease and all-cause mortality in middle-aged british men. Doctoral thesis (Ph.D.), Royal Free Hospital School of Medicine.

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Abstract

There has been much controversy regarding the protective effect of light or moderate drinking on overall health and on ischaemic heart disease in particular, due to the higher morbidity and mortality rates seen in non-drinkers ("the U-shaped curve"), whose characteristics are rarely examined in detail. This thesis examines the long term effects of alcohol on all-cause mortality and more specifically on ischaemic heart disease, with particular focus on the complex interrelationship between alcohol, pre-existing disease, the characteristics of nondrinkers and morbidity and mortality. It also examines the sources of bias and methodological issues in assessing the effects of alcohol on health. The data comes from the British Regional Heart Study, a large prospective study of 7735 British men aged 40-59 from 24 British towns. The relationship between alcohol intake and pre-existing disease and factors which may influence the mortality patterns eg smoking, blood lipids and blood pressure, were extensively examined. Data on alcohol intake obtained from screening and five years later were used to examine the health characteristics of non-drinkers and the dynamics of changes in drinking habits with respect to development of disease and its effect on mortality outcome. A weak U-shaped relationship was seen between alcohol and risk of all heart attacks and a strong inverse association was seen with fatal heart attacks. These relationships were only apparent in manual workers, in ex-smokers and in men with pre-existing ischaemic heart disease. No association was seen with all heart attacks after men with pre-existing ischaemic heart disease had been excluded. However, moderate drinkers (3-6 drinks/day) showed lower risks of fatal heart attacks and this was not explained by high density lipoprotein-cholesterol. For all-cause mortality, a U-shaped relationship was seen, with non-drinkers and heavy drinkers showing the highest rates, but no association was seen after exclusion of men with pre-existing cardiovascular or cardiovascular-related disease at screening. It is concluded that non-drinkers should not be used as a baseline group for comparative purposes and that the "U-shaped curve" for all cause mortality is to a large extent produced by the movement of men with ill-health into non-drinking status. Although there is evidence which suggest that moderate drinking (3-5 drinks/day) is protective against ischaemic heart disease specifically, it is only apparent at levels of drinking associated with increased morbidity and mortality from other causes and there is no benefit on overall mortality.

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