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Binge Drinking is Associated With a Higher Rate of Mortality After Acute Myocardial Infarction

January 18, 2006

By: Jennifer Tartaglia MS and Asher Kimchi MD

Boston, Mass. Among patients with coronary heart disease, moderate drinkers have been shown to have a better prognosis than abstainers or heavy drinkers. So, while moderate drinkers may have lower rates of mortality after a myocardial infarction (MI), prognosis after MI is uncertain with episodic or binge drinking. A recent study by Kenneth J. Mukamal, MD et al. from Beth Israel Deaconess Medical Center in Boston, MA published in the December 20/27, 2005 issue of Circulation investigated whether the potentially detrimental risks of even occasional binge drinking outweighed the potential benefits of moderate drinking. They showed that binge drinking was associated with a 2-fold higher mortality after MI. 

It was previously shown that average alcohol intake was inversely associated with mortality among patients with acute MI, however the detrimental effects of binge drinking on patients with coronary heart disease remains to be determined. Mukamal et al. designed a multicenter, prospective cohort study which evaluated medical charts and personal interviews of 1919 hospitalized MI patients.

The age and sex adjusted hazard risk (HR) for all-cause, cardiovascular, and non-cardiovascular mortality after acute MI was 2.0 (95% confidence interval (CI), 1.3-3.1; P= <0.001). The investigators estimated that 20% of deaths (95% CI, 7% to 33%) among the study participants who reported drinking were attributable to binge drinking. Among patients matched on propensity scores, binge drinkers were found to have significantly worse survival than other patients with an HR of 1.8 (95% CI, 1.0 to 3.3; P=0.05). In addition, there was an inverse association between alcohol intake and mortality in patients who did not report binge drinking with an HR of 0.75 (95% CI, 0.57 to 1.00; P=0.009) in light drinkers and an HR or 0.59 (95% CI 0.33 to 1.04; P=0.0009) in heavier drinkers.

The major finding of this study is the 2-fold higher mortality in early survivors of acute myocardial infarctions who admitted to binge drinking. The authors speculate that this binge drinking may be contributing to coronary heart disease by affecting cardiovascular physiology (such as increasing blood pressure and heart rate), and by increasing platelet reactivity, thromboxane B2 formation, and plasminogen activator inhibitor-1 activity (effectively prolonging clot lysis time and possibly triggering a recurrent MI). They also propose that binge drinking may lower the ventricular fibrillation threshold and increase the risk of sudden cardiac death. Thus, this study suggests that drinking habits such as binging (in addition to amount of alcohol regularly consumed) should be assessed in patients with MI risk factors or who have already undergone an MI.

Co-authors: Malcolm Maclure, ScD; James E. Muller, MD; Murray A. Mittleman, MD, DrPH.

 


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