Journal of General Internal Medicine

, Volume 20, Issue 1, pp 14–20

The association of alcohol consumption with coronary heart disease mortality and cancer incidence varies by smoking history

  • Jon O. Ebbert
  • Carol A. Janney
  • Thomas A. Sellers
  • Aaron R. Folsom
  • James R. Cerhan
Original Article

Abstract

OBJECTIVE: To evaluate the effect of alcohol on coronary heart disease (CHD), cancer incidence, and cancer mortality by smoking history.

DESIGN/SETTING: A prospective, general community cohort was established with a baseline mailed questionnaire completed in 1986.

PARTICIPANTS: A population-based sample of 41,836 Iowa women aged 55–69 years.

MEASUREMENTS: Mortality (total, cancer, and CHD) and cancer incidence outcomes were collected through 1999. Relative hazard rates (HR) were calculated using Cox regression analyses.

MAIN RESULTS: Among never smokers, alcohol consumption (≥14 g/day vs none) was inversely associated with age-adjusted CHD mortality (HR, 0.40; 95% confidence interval [CI], 0.19 to 0.84) and total mortality (HR, 0.71; 95% CI, 0.55 to 0.92). Among former smokers. alcohol consumption was also inversely associated with CHD mortality (HR, 0.45; 95% CI, 0.23 to 0.88) and total mortality (HR, 0.78; 95% CI, 0.62 to 0.97), but was positively associated with cancer incidence (HR, 1.25; 95% CI, 1.03 to 1.51). Among current smokers, alcohol consumption was not associated with CHD mortality (HR, 1.05; 95% CI, 0.73 to 1.50) or total mortality (HR, 1.07; 95% CI, 0.92 to 1.25), but was positively associated with cancer incidence (HR, 1.30; 95% CI, 1.10 to 1.54).

CONCLUSIONS: Health behavior counseling regarding alcohol consumption for cardioprotection should include a discussion of the lack of a decreased risk of CHD mortality for current smokers and the increased cancer risk among former and current smokers.

Key Words

ethanol coronary disease neoplasms smoking mortality 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Camacho TC, Kaplan GA, Cohen RD. Alcohol consumption and mortality in Alameda County. J Chronic Dis. 1987;40:229–36.PubMedCrossRefGoogle Scholar
  2. 2.
    Colditz GA, Branch LG, Lipnick RJ, et al. Moderate alcohol and decreased cardiovascular mortality in an elderly cohort. Am Heart J. 1985;109:886–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Camargo CA Jr, Hennekens CH, Gaziano JM, Glynn RJ, Manson JE, Stampfer MJ. Prospective study of moderate alcohol consumption and mortality in US male physicians. Arch Intern Med. 1997;157:79–85.PubMedCrossRefGoogle Scholar
  4. 4.
    Cullen KJ, Knuiman MW, Ward NJ. Alcohol and mortality in Busselton, Western Australia. Am J Epidemiol. 1993;137:242–8.PubMedGoogle Scholar
  5. 5.
    Doll R, Peto R, Hall E, Wheatley K, Gray R. Mortality in relation to consumption of alcohol: 13 years’ observations on male British doctors. BMJ. 1994;309:911–8.PubMedGoogle Scholar
  6. 6.
    Dyer AR, Stamler J, Paul O, et al. Alcohol consumption, cardiovascular risk factors, and mortality in two Chicago epidemiologic studies. Circulation. 1977;56:1067–74.PubMedGoogle Scholar
  7. 7.
    Friedman LA, Kimball AW. Coronary heart disease mortality and alcohol consumption in Framingham. Am J Epidemiol. 1986;124:481–9.PubMedGoogle Scholar
  8. 8.
    de Labry LO, Glynn RJ, Levenson MR, Hermos JA, LoCastro JS, Vokonas PS. Alcohol consumption and mortality in an American male population: recovering the U-shaped curve—findings from the normative Aging Study. J Stud Alcohol. 1992;53:25–32.PubMedGoogle Scholar
  9. 9.
    Garfinkel L, Boffetta P, Stellman SD. Alcohol and breast cancer: a cohort study. Prev Med. 1988;17:686–93.PubMedCrossRefGoogle Scholar
  10. 10.
    Garg R, Wagener DK, Madans JH. Alcohol consumption and risk of ischemic heart disease in women. Arch Intern Med. 1993;153:1211–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Gordon T, Doyle JT. Drinking and mortality. The Albany Study. Am J Epidemiol. 1987;125:263–70.PubMedGoogle Scholar
  12. 12.
    Greig M, Pemberton J, Hay I, MacKenzie G. A prospective study of the development of coronary heart disease in a group of 1202 middle-aged men. J Epidemiol Community Health. 1980;34:23–30.PubMedCrossRefGoogle Scholar
  13. 13.
    Gronbaek M, Deis A, Sorensen TI, et al. Influence of sex, age, body mass index, and smoking on alcohol intake and mortality. BMJ. 1994;308:302–6.PubMedGoogle Scholar
  14. 14.
    Kittner SJ, Garcia-Palmieri MR, Costas R Jr, Cruz-Vidal M, Abbott RD, Havlik RJ. Alcohol and coronary heart disease in Puerto Rico. Am J Epidemiol. 1983;117:538–50.PubMedGoogle Scholar
  15. 15.
    Kromhout D, de Lezenne Coulander C. Diet, prevalence and 10-year mortality from coronary heart disease in 871 middle-aged men. The Zutphen Study. Am J Epidemiol. 1984;119:733–41.PubMedGoogle Scholar
  16. 16.
    Gronbaek M, Becker U, Johansen D, et al. Type of alcohol consumed and mortality from all causes, coronary heart disease, and cancer. Ann Intern Med. 2000;133:411–9.PubMedGoogle Scholar
  17. 17.
    Klatsky AL, Armstrong MA, Friedman GD. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. Am J Cardiol. 1990;66:1237–42.CrossRefGoogle Scholar
  18. 18.
    Kono S, Ikeda M, Ogata M, Tokudome S, Nishizumi M, Kuratsune M. The relationship between alcohol and mortality among Japanese physicians. Int J Epidemiol. 1983;12:437–41.PubMedCrossRefGoogle Scholar
  19. 19.
    Kozarevic D, Demirovic J, Gordon T, Kaelber CT, McGee D, Zukel WJ. Drinking habits and coronary heart disease: the Yugoslavia cardiovascular disease study. Am J Epidemiol. 1982;116:748–58.PubMedGoogle Scholar
  20. 20.
    Marmot MG, Rose G, Shipley MJ, Thomas BJ. Alcohol and mortality: a U-shaped curve. Lancet. 1981;1(pt 1):580–3.PubMedCrossRefGoogle Scholar
  21. 21.
    Rimm EB, Giovannucci EL, Willett WC, et al. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet. 1991;338:464–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Salonen JT, Puska P, Nissinen A. Intake of spirits and beer and risk of myocardial infarction and death—a longitudinal study in Eastern Finland. J Chronic Dis. 1983;36:533–43.PubMedCrossRefGoogle Scholar
  23. 23.
    Shaten BJ, Kuller LH, Neaton JD. Association between baseline risk factors, cigarette smoking, and CHD mortality after 10.5 years. MRFIT Research Group. Prev Med. 1991;20:655–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Stampfer MJ, Colditz GA, Willett WC, Speizer FE, Hennekens CH. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N Engl J Med. 1988;319:267–73.PubMedCrossRefGoogle Scholar
  25. 25.
    Yano K, Rhoads GG, Kagan A. Coffee, alcohol and risk of coronary heart disease among Japanese men living in Hawaii. N Engl J Med. 1977;297:405–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Criqui MH, Cowan LD, Tyroler HA, et al. Lipoproteins as mediators for the effects of alcohol consumption and cigarette smoking on cardiovascular mortality: results from the Lipid Research Clinics Follow-up Study. Am J Epidemiol. 1987;126:629–37.PubMedGoogle Scholar
  27. 27.
    Miller GJ, Beckles GL, Maude GH, Carson DC. Alcohol consumption: protection against coronary heart disease and risks to health. Int J Epidemiol. 1990;19:923–30.CrossRefGoogle Scholar
  28. 28.
    Suhonen O, Aromaa A, Reunanen A, Knekt P. Alcohol consumption and sudden coronary death in middle-aged Finnish men. Acta Med Scand. 1987;221:335–41.PubMedCrossRefGoogle Scholar
  29. 29.
    Semenciw RM, Morrison HI, Mao Y, Johansen H, Davies JW, Wigle DT. Major risk factors for cardiovascular disease mortality in adults: results from the Nutrition Canada Survey cohort. Int J Epidemiol. 1988;17:317–24.PubMedCrossRefGoogle Scholar
  30. 30.
    Shaper AG, Wannamethee G, Walker M. Alcohol and mortality in British men: explaining the U-shaped curve. Lancet. 1988;2:1267–73.PubMedCrossRefGoogle Scholar
  31. 31.
    Kivela SL, Nissinen A, Ketola A, Punsar S, Puska P, Karvonen M. Alcohol consumption and mortality in aging or aged Finnish men. J Clin Epidemiol. 1989;42:61–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Scherr PA, LaCroix AZ, Wallace RB, et al. Light to moderate alcohol consumption and mortality in the elderly. J Am Geriatr Soc. 1992;40:651–7.PubMedGoogle Scholar
  33. 33.
    Farchi G, Fidanza F, Mariotti S, Menotti A. Alcohol and mortality in the Italian rural cohorts of the Seven Countries Study. Int J Epidemiol. 1992;21:74–81.PubMedCrossRefGoogle Scholar
  34. 34.
    Simons LA, McCallum J, Friedlander Y, Ortiz M, Simons J. Moderate alcohol intake is associated with survival in the elderly: the Dubbo Study. Med J Aust. 2000;173:121–4.PubMedGoogle Scholar
  35. 35.
    Renaud S, Criqui MH, Farchi G, Veenstra J. Alcohol drinking and coronary heart disease. In: Verschuren P, ed. Health Issues Related to Alcohol Consumption. Washington, DC: ILSI Press; 1993:81–123.Google Scholar
  36. 36.
    Bovet P, Paccaud F. Commentary: alcohol, coronary heart disease and public health: which evidence-based policy. Int J Epidemiol. 2001;30:734–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Fuchs CS, Stampfer MJ, Colditz GA, et al. Alcohol consumption and mortality among women. N Engl J Med. 1995;332:1245–50.PubMedCrossRefGoogle Scholar
  38. 38.
    Klatsky AL, Armstrong MA, Friedman GD. Alcohol and mortality. Ann Intern Med. 1992;117:646–54.PubMedGoogle Scholar
  39. 39.
    Kivela SL, Nissinen A, Ketola A, Punsar S, Puska P, Karvonen M. Alcohol consumption and mortality in aging or aged Finnish men. J Clin Epidemiol. 1989;42:61–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Klatsky AL, Friedman GD, Siegelaub AB. Alcohol and mortality. A ten-year Kaiser-Permanente experience. Ann Intern Med. 1981;95:139–45.PubMedGoogle Scholar
  41. 41.
    Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Hennekens CH, Speizer FE. Moderate alcohol consumption and the risk of breast cancer. N Engl J Med. 1987;316:1174–80.PubMedCrossRefGoogle Scholar
  42. 42.
    Jain MG, Ferrenc RG, Rehm JT, et al. Alcohol and breast cancer mortality in a cohort study. Breast Cancer Res Treat. 2000;64:201–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Feigelson HS, Calle EE, Robertson AS, Wingo PA, Thun MJ. Alcohol consumption increases the risk of fatal breast cancer (United States). Cancer Causes Control. 2001;12:895–902.PubMedCrossRefGoogle Scholar
  44. 44.
    Ellison RC, Zhang Y, McLennan CE, Rothman KJ. Exploring the relation of alcohol consumption to risk of breast cancer. Am J Epidemiol. 2001;154:740–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Garland M, Hunter DJ, Colditz GA, et al. Alcohol consumption in relation to breast cancer risk in a cohort of United States women 25–42 years of age. Cancer Epidemiol Biomarkers Prev. 1999;8:1017–21.PubMedGoogle Scholar
  46. 46.
    Rohan TE, Jain M, Howe GR, Miller AB. Alcohol consumption and risk of breast cancer: a cohort study. Cancer Causes Control. 2000;11:239–47.PubMedCrossRefGoogle Scholar
  47. 47.
    American Institute for Cancer Research. Food, Nutrition and the Prevention of Cancer: A Global Perspective. Menasha, WI: BANTA Book Group; 1997.Google Scholar
  48. 48.
    Smith-Warner SA, Spiegelman D, Yaun SS, et al. Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA. 1998;279:535–40.PubMedCrossRefGoogle Scholar
  49. 49.
    International Agency for Research on Cancer. IARC Monographs on the Evaluation of the Carcinogenic Risks to Humans. Alcohol Drinking, Vol 44. Lyon, France: IARC; 1988.Google Scholar
  50. 50.
    Pearson TA. Alcohol and heart disease. Circulation. 1996;94:3023–5.PubMedGoogle Scholar
  51. 51.
    Kushi LH, Fee RM, Folsom AR, Mink PJ, Anderson KE, Sellers TA. Physical activity and mortality in postmenopausal women. JAMA. 1997;277:1287–92.PubMedCrossRefGoogle Scholar
  52. 52.
    Folsom AR, Kaye SA, Prineas RJ, Potter JD, Gapstur SM, Wallace RB. Increased incidence of carcinoma of the breast associated with abdominal adiposity in postmenopausal women. Am J Epidemiol. 1990;131:794–803.Google Scholar
  53. 53.
    Bisgard KM, Folsom AR, Hong CP, Sellers TA. Mortality and cancer rates in nonrespondents to a prospective cohort study of older women: 5-year follow-up. Am J Epidemiol. 1994;139:990–1000.PubMedGoogle Scholar
  54. 54.
    Willett WC, Sampson L, Stampfer MJ, et al. Reproductibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. 1985;122:51–65.PubMedGoogle Scholar
  55. 55.
    Willett WC, Sampson L, Browne ML, et al. The use of a self-administered questionnaire to assess diet four years in the past. Am J Epidemiol. 1988;127:188–99.PubMedGoogle Scholar
  56. 56.
    Munger RG, Folsom AR, Kushi LH, Kaye SA, Sellers TA. Dietary assessment of older Iowa women with a food frequency questionnaire: nutrient intake, reproducibility, and comparison with 24-hour dietary recall interviews. Am J Epidemiol. 1992;136:192–200.PubMedGoogle Scholar
  57. 57.
    Ries LG, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review, 1973–1998. Bethesda, MD: National Cancer Institute; 2001.Google Scholar
  58. 58.
    World Health Organization. International Classification of Disease, Ninth Revision (ICD-9). Geneva, Switzerland: World Health Organization; 1977.Google Scholar
  59. 59.
    Korn EL, Graubard BI, Midthune D. Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol. 1997;145:72–80.PubMedGoogle Scholar
  60. 60.
    Therneau TM, Grambsch PM. Modeling Survival Data: Extending the Cox Model. New York, NY: Springer-Verlag; 2000:142–7.Google Scholar
  61. 61.
    Maclure M. Demonstration of deductive meta-analysis: ethanol intake and risk of myocardial infarction. Epidemiol Rev. 1993;15:328–51.PubMedGoogle Scholar
  62. 62.
    Corrao G, Rubbiati L, Bagnardi V, Zambon A, Poikolainen K. Alcohol and coronary heart disease: a meta-analysis. Addiction. 2000;95:1505–23.PubMedCrossRefGoogle Scholar
  63. 63.
    Marmot MG. Alcohol and coronary heart disease. Int J Epidemiol. 2001;30:724–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Moore RD, Pearson TA. Moderate alcohol consumption and coronary artery disease. A review. Medicine (Baltimore). 1986;65:242–67.Google Scholar
  65. 65.
    Rimm EB, Williams P, Fosher K, Criqui M, Stampfer MJ. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. BMJ. 1999;319:1523–8.PubMedGoogle Scholar
  66. 66.
    Kiechl S, Willeit J, Poewe W, et al. Insulin sensitivity and regular alcohol consumption: large, prospective, cross sectional population study (Bruneck study). BMJ. 1996;313:1040–4.PubMedGoogle Scholar
  67. 67.
    Criqui MH, Wallace RB, Heiss G, Mishkel M, Schonfeld G, Jones GT. Cigarette smoking and plasma high-density lipoprotein cholesterol. The Lipid Research Clinics Program Prevalence Study. Circulation. 1980;62(pt 2):IV70-IV76.PubMedGoogle Scholar
  68. 68.
    Imamura H, Miyamoto N, Uchida K, Teshima K, Masuda Y, Kobata D. Cigarette smoking, blood pressure and serum lipids and lipoproteins in middle-aged women. J Physiol Anthropol Appl Human Sci. 2001;20:1–6.PubMedCrossRefGoogle Scholar
  69. 69.
    Winkelmann BR, Boehm BO, Nauck M, et al. Cigarette smoking is independently associated with markers of endothelial dysfunction and hyperinsulinaemia in nondiabetic individuals with coronary artery disease. Curr Med Res Opin. 2001;17:132–41.PubMedCrossRefGoogle Scholar
  70. 70.
    Eliasson B, Mero N, Taskinen MR, Smith U. The insulin resistance syndrome and postprandial lipid intolerance in smokers. Atherosclerosis. 1997;129:79–88.PubMedCrossRefGoogle Scholar
  71. 71.
    Fusegawa Y, Handa S. Platelet aggregation induced by ADP or epinephrine is enhanced in habitual smokers. Thromb Res. 2000;97:287–95.PubMedCrossRefGoogle Scholar
  72. 72.
    Simpson AJ, Gray RS, Moore NR, Booth NA. The effects of chronic smoking on the fibrinolytic potential of plasma and platelets. Br J Haematol. 1997;97:208–13.PubMedCrossRefGoogle Scholar
  73. 73.
    Andreassi MG, Botto N. DNA damage as a new emerging risk factor in atherosclerosis. Trends Cardiovasc Med. 2003;13:270–5.PubMedCrossRefGoogle Scholar
  74. 74.
    Cullen K, Stenhouse NS, Wearne KL. Alcohol and mortality in the Busselton study. Int J Epidemiol. 1982;11:67–70.PubMedCrossRefGoogle Scholar
  75. 75.
    O’Donnell CJ, Glynn RJ, Field TS, et al. Misclassification and underreporting of acute myocardial infarction by elderly persons: implications for community-based observational studies and clinical trials. J Clin Epidemiol. 1999;52:745–51.PubMedCrossRefGoogle Scholar
  76. 76.
    Kerr WC, Fillmore KM, Bostrom A. Stability of alcohol consumption over time: evidence from three longitudinal surveys from the United States. J Stud Alcohol. 2002;63:325–33.PubMedGoogle Scholar
  77. 77.
    World Health Organization. Tobacco or Health: A World Global Status Report. United States of America. Available at: http://www.cdc.gov/tobacco/who/usa.htm. Accessed July 1, 2002.Google Scholar
  78. 78.
    Simon HB. Patient-directed, nonprescription approaches to cardiovascular disease. Arch Intern Med. 1994;154:2283–96.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2005

Authors and Affiliations

  • Jon O. Ebbert
    • 1
  • Carol A. Janney
    • 2
  • Thomas A. Sellers
    • 2
  • Aaron R. Folsom
    • 3
  • James R. Cerhan
    • 2
  1. 1.Nicotine Research CenterDivision of Community Internal MedicineRochesterUSA
  2. 2.Mayo Clinic Cancer CenterRochesterUSA
  3. 3.Division of EpidemiologyUniversity of MinnesotaMinneapolisUSA

Personalised recommendations