Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus.

CONTEXT Despite nutrition information and guidelines that advise against depriving diabetic patients of the potential benefit of moderate alcohol intake against cardiovascular events, the association between alcohol consumption and risk of cardiovascular outcomes in diabetic individuals has not been determined. OBJECTIVE To examine the relationship between alcohol intake and coronary heart disease (CHD) mortality in persons with older-onset diabetes. DESIGN Population-based, prospective cohort study conducted from 1984 through 1996, with a follow-up of up to 12.3 years. SETTING AND PARTICIPANTS A total of 983 older-onset diabetic individuals (mean [SD] age, 68.6 [11.0] years; 45.2% male; 98.5% white) were interviewed about their past-year intake of alcoholic beverages during the 1984-1986 follow-up examination of a population-based study of diabetic persons in southern Wisconsin. MAIN OUTCOME MEASURE Time to mortality from CHD by category alcohol intake. RESULTS Alcohol use was inversely associated with risk of CHD mortality in older-onset diabetic subjects. The CHD mortality rates for never and former drinkers were 43.9 and 38.5 per 1000 person-years, respectively, while the rates for those with alcohol intakes of less than 2, 2 to 13, and 14 or more g/d were 25.3, 20.8, and 10.0 per 1000 person-years, respectively. Compared with never drinkers and controlling for age, sex, cigarette smoking, glycosylated hemoglobin level, insulin use, plasma C-peptide level, history of angina or myocardial infarction, digoxin use, and the presence and severity of diabetic retinopathy, former drinkers had a relative risk (RR) of 0.69 (95% confidence interval [CI], 0.43-1.12); for those who drank less than 2 g/d (less frequent than 1 drink a week), the RR was 0.54 (95% CI, 0.33-0.90); for 2 to 13 g/d, it was 0.44 (95% CI, 0.23-0.84); and for 14 or more g/d (about 1 drink or more a day), it was 0.21 (95% CI, 0.09-0.48). Further adjustments for blood pressure, body mass index, education, physical activity, diabetes duration, hypertension history, overt nephropathy, peripheral neuropathy, lipid measures, or intake of medications such as aspirin and antihypertensive agents did not change the associations observed. CONCLUSION Our results suggest an overall beneficial effect of alcohol consumption in decreasing the risk of death due to CHD in people with older-onset diabetes.

[1]  D. Schottenfeld,et al.  The autopsy as a measure of accuracy of the death certificate. , 1982, Bulletin of the New York Academy of Medicine.

[2]  H. Kuzuya,et al.  Characterization of Seven C-peptide Antisera , 1978, Diabetes.

[3]  H. Iso,et al.  Alcohol intake and premature coronary heart disease in urban Japanese men. , 1998, American journal of epidemiology.

[4]  R. Guéguen,et al.  Alcohol and Mortality in Middle‐Aged Men from Eastern France , 1998, Epidemiology.

[5]  W. Poewe,et al.  Insulin sensitivity and regular alcohol consumption: large, prospective, cross sectional population study (Bruneck study) , 1996, BMJ.

[6]  A. G. Shaper,et al.  ALCOHOL AND MORTALITY IN BRITISH MEN: EXPLAINING THE U-SHAPED CURVE , 1988, The Lancet.

[7]  S. Hulley,et al.  Alcohol and High‐density Lipoprotein Cholesterol: Causal Inference From Diverse Study Designs , 1981, Circulation.

[8]  L. Chambless,et al.  The Relation of Alcohol Intake to Coronary Heart Disease and All‐Cause Mortality in a Beer‐Drinking Population , 1997, Epidemiology.

[9]  M. Lopes-Virella,et al.  Cholesterol determination in high-density lipoproteins separated by three different methods. , 1977, Clinical chemistry.

[10]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[11]  H. Hein,et al.  Alcohol consumption, serum low density lipoprotein cholesterol concentration, and risk of ischaemic heart disease: six year follow up in the Copenhagen male study , 1996, BMJ.

[12]  D L DeMets,et al.  The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. , 1984, Archives of ophthalmology.

[13]  S. Hulley,et al.  Alcohol and high-density lipoprotein cholesterol: causal inference from diverse study designs. , 1981, Circulation.

[14]  J. Manson,et al.  Moderate Alcohol Consumption and Risk for Angina Pectoris or Myocardial Infarction in U.S. Male Physicians , 1997, Annals of Internal Medicine.

[15]  M. Marmot,et al.  Alcohol and cardiovascular disease: the status of the U shaped curve. , 1991, BMJ.

[16]  J. Manson,et al.  Prospective study of moderate alcohol consumption and mortality in US male physicians. , 1997, Archives of internal medicine.

[17]  R. Klein,et al.  Cause-specific mortality in a population-based study of diabetes. , 1991, American journal of public health.

[18]  J. Peto,et al.  Asymptotically Efficient Rank Invariant Test Procedures , 1972 .

[19]  D L DeMets,et al.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy. IX. Four-year incidence and progression of diabetic retinopathy when age at diagnosis is less than 30 years. , 1989, Archives of ophthalmology.

[20]  D. Bell,et al.  Alcohol and the NIDDM Patient , 1996, Diabetes Care.

[21]  M. Maclure Demonstration of deductive meta-analysis: ethanol intake and risk of myocardial infarction. , 1993, Epidemiologic reviews.

[22]  R. Rubin,et al.  Alcohol and platelet function. , 1994, Alcoholism, clinical and experimental research.

[23]  H. Hendriks,et al.  Effect of moderate dose of alcohol with evening meal on fibrinolytic factors , 1994, BMJ.

[24]  D.,et al.  Regression Models and Life-Tables , 2022 .

[25]  C M Burchfiel,et al.  A Prospective Study of the Health Effects of Alcohol Consumption in Middle‐Aged and Elderly Men: The Honolulu Heart Program , 1994, Circulation.

[26]  G. Friedman,et al.  Red wine, white wine, liquor, beer, and risk for coronary artery disease hospitalization. , 1997, The American journal of cardiology.

[27]  R. Klein,et al.  The association of glycemia and cause-specific mortality in a diabetic population. , 1994, Archives of internal medicine.

[28]  B. Brodie,et al.  A simplified method for the estimation of total cholesterol in serum and demonstration of its specificity. , 1952, The Journal of biological chemistry.

[29]  R. Doll,et al.  Mortality in relation to consumption of alcohol: 13 years' observations on male British doctors , 1994, BMJ.

[30]  P. Ridker,et al.  Association of moderate alcohol consumption and plasma concentration of endogenous tissue-type plasminogen activator. , 1994, JAMA.

[31]  Alan D. Lopez,et al.  Alcohol consumption and mortality among middle-aged and elderly U.S. adults. , 1997, The New England journal of medicine.

[32]  R. Klein,et al.  The Wisconsin Epidemiologic Study of diabetic retinopathy. XIV. Ten-year incidence and progression of diabetic retinopathy. , 1994, Archives of ophthalmology.

[33]  D L DeMets,et al.  Prevalence of diabetes mellitus in southern Wisconsin. , 1984, American journal of epidemiology.

[34]  R. Lazarus,et al.  Alcohol intake and insulin levels. The Normative Aging Study. , 1997, American journal of epidemiology.

[35]  R. Klein,et al.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XIII. Relationship of serum cholesterol to retinopathy and hard exudate. , 1991, Ophthalmology.

[36]  Y. Ida Chen,et al.  Light-to-Moderate Alcohol Intake Is Associated With Enhanced Insulin Sensitivity , 1994, Diabetes Care.

[37]  R. Klein,et al.  Methodologic considerations in measuring glycosylated hemoglobin in epidemiologic studies. , 1988, Journal of clinical epidemiology.

[38]  D. DeMets,et al.  The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. , 1984, Archives of ophthalmology.

[39]  K. Kupka,et al.  International classification of diseases: ninth revision. , 1978, WHO chronicle.

[40]  Langford Hg The hypertension detection and follow-up program. , 1984 .

[41]  C. Sempos,et al.  Alcohol consumption and coronary heart disease morbidity and mortality. , 1997, American journal of epidemiology.

[42]  S. Wannamethee,et al.  Lifelong teetotallers, ex-drinkers and drinkers: mortality and the incidence of major coronary heart disease events in middle-aged British men. , 1997, International journal of epidemiology.

[43]  D L DeMets,et al.  The Wisconsin Epidemiologic Study of Diabetic Retinopathy. X. Four-year incidence and progression of diabetic retinopathy when age at diagnosis is 30 years or more. , 1989, Archives of ophthalmology.

[44]  A. Folsom,et al.  Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: methods and initial two years' experience. , 1996, Journal of clinical epidemiology.

[45]  G. Friedman,et al.  Alcohol Consumption and Insulin Concentrations Role of Insulin in Associations of Alcohol Intake With High‐Density Lipoprotein Cholesterol and Triglycerides , 1993, Circulation.