Drinking Frequency, Mediating Biomarkers, and Risk of Myocardial Infarction in Women and Men

TLDR

The inverse association between alcohol consumption and myocardial infarction risk has not been examined in women, and the extent to which cardiovascular risk factors mediate this relationship remains unclear, prompting nested case‑control studies of 32,826 women in the Nurses’ Health Study and 18,225 men in the Health Professionals Follow‑Up Study. The study aimed to quantify the risk of myocardial infarction associated with alcohol drinking frequency and quantity and to assess how this risk changes after adjusting for potential cardiovascular risk factors. Researchers conducted nested case‑control analyses, matching 249 women and 266 men with incident MI to 498 female and 532 male controls on age, smoking status, and entry date, and evaluated alcohol exposure and cardiovascular biomarkers. Frequent drinking (3–7 days per week) was linked to a lower risk of myocardial infarction in both sexes; adjustment for HDL cholesterol, fibrinogen, and hemoglobin A1c attenuated 75 % of the association in women and fully explained it in men, supporting a causal inverse relationship mediated by these biomarkers.

Abstract

The associations of drinking frequency and quantity with risk of myocardial infarction have not been studied among women, and the degree to which specific risk factors mediate the inverse association of drinking frequency with risk of myocardial infarction is uncertain.We conducted nested case-control studies of 32,826 women enrolled in the Nurses Health Study followed up from 1990 to 1998 and 18,225 men enrolled in the Health Professionals Follow-Up Study followed up from 1994 to 2000. A total of 249 women and 266 men with incident myocardial infarction were matched on age, smoking, and date of entry to 498 female and 532 male control participants. We determined the risk of myocardial infarction related to frequency and quantity of alcohol intake and the change in risk before and after adjustment for putative cardiovascular risk factors. Among both women and men, drinking frequency tended to be associated with lower risk of myocardial infarction, with the lowest risks among those who drank 3 to 7 days per week. Further adjustment for levels of high-density lipoprotein cholesterol, hemoglobin A(1c), and fibrinogen attenuated 75% of the association of frequent drinking with risk among women and fully attenuated the association among men.Alcohol intake at least 3 to 4 days per week is associated with a lower risk of myocardial infarction among women and men, an association apparently attributable to the relationship of alcohol with HDL cholesterol, fibrinogen, and hemoglobin A(1c). Because the effects of alcohol on HDL cholesterol, fibrinogen, and insulin sensitivity have been confirmed in randomized trials, our findings support the hypothesis that the inverse relation of alcohol use and myocardial infarction is causal.