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.
|