Current issues of ACP Journal Club are published in Annals of Internal Medicine


Etiology

Moderate consumption of wine and beer, but not spirits, reduced mortality

ACP J Club. 1995 Nov-Dec;123:81. doi:10.7326/ACPJC-1995-123-3-081


Source Citation

Grønbaek M, Deis A, Sørensen TI, et al. Mortality associated with moderate intakes of wine, beer, or spirits. BMJ. 1995 May 6;310;1165-9.


Abstract

Objective

To determine the association between the consumption of different types of alcohol (wine, beer, and spirits) and death.

Design

Cohort analytic study with minimum follow-up of 10 years (Copenhagen City Heart Study).

Setting

Community-based study in Denmark.

Participants

13 285 adults (7234 women) who were ≥ 30 years of age at baseline (1976 to 1978) and consumed ≤ 5 drinks of any type of alcohol/d. Participants were followed until 1988. Follow-up was > 99%.

Assessment of risk factors

At baseline, height and weight were measured and participants reported by self-administered questionnaire their drinking habits (beer, wine, and spirits), smoking habits, education, and income.

Main outcome measure

Death from vascular (cardiovascular and cerebrovascular) diseases and from other causes.

Main results

During follow-up, 831 women and 1398 men died; 354 women and 765 men died of vascular causes. The relative risk (RR) for death from vascular causes among wine drinkers (compared with never-drinkers) decreased with increasing consumption (RR 0.69, 95% CI 0.62 to 0.77 for monthly consumption; RR 0.53, CI 0.45 to 0.63 for weekly consumption; RR 0.47, CI 0.35 to 0.62 for 1 to 2 glasses/d; RR 0.44, CI 0.24 to 0.80 for 3 to 5 glasses/d). Wine also decreased the risk for death from other causes. Beer consumption was associated with a reduced risk for death from vascular causes (RR 0.79, CI 0.69 to 0.91 for monthly consumption; RR 0.87, CI 0.75 to 0.99 for weekly consumption; RR 0.79, CI 0.68 to 0.91 for 1 to 2 bottles/d; RR 0.72, CI 0.61 to 0.88 for 3 to 5 bottles/d). For death from other causes, only monthly consumption of beer showed a decreased risk (RR 0.82, CI 0.71 to 0.95). Spirit consumption did not decrease the risk for death from vascular causes; death from other causes was reduced with moderate consumption of spirits (RR 0.80, CI 0.71 to 0.91) and with 1 to 2 drinks/d (RR 0.81, CI 0.65 to 0.99). Adults who consumed 3 to 5 drinks of spirits/d had an increased risk for death from vascular causes (RR 1.35, CI 1.00 to 1.83) and for death from other causes (RR 1.36, CI 1.01 to 1.84).

Conclusions

Wine consumption was associated with a decreased risk for death from vascular causes and death from other causes; beer consumption was associated with a decreased risk for death; spirit consumption of 3 to 5 drinks/d increased the risk for death from vascular causes and death from other causes.

Source of funding: Danish National Board of Health.

For article reprint: Dr. M. Grønbaek, Institute of Preventive Medicine, Kommunehospitalet, DK-1399 Copenhagen, Denmark. FAX 45-3391-3244.


Commentary

Light to moderate alcohol consumption reduced mortality in women

Many studies done during the past 15 years have shown that light to moderate alcohol intake decreases mortality from ischemic heart disease and CVD. Even when former heavy drinkers are excluded and only persons who do not drink are considered, the mortality rate for nondrinkers is higher than that for light to moderate drinkers.

The studies by Fuchs and Grønbaek and their colleagues highlight 2 remaining controversies: 1) Can the benefit primarily observed in middle-aged men be extrapolated to women, particularly in light of findings that moderate to heavy alcohol consumption increases the risk for breast cancer (1)? and 2) Does the type of alcohol consumed make a difference?

Fuchs and colleagues did find that light to moderate alcohol consumption reduced death from CVD and overall mortality. This analysis, with its large sample size and wide geographic and ethnic distribution, should be generalizable to most women in the United States. On the basis of their results, we conclude that the health care provider and the woman need to weigh the individual risks for coronary heart disease, breast cancer, and alcoholism to determine whether moderate alcohol consumption is beneficial. A woman at high risk for breast cancer and low risk for coronary heart disease may well decide that drinking is not safe for her. In most cases, however, light to moderate consumption of alcohol should be safe, even beneficial, and should result in a 10% to 20% decrease in overall mortality rates.

A more difficult question to answer concerns the extent to which the type of alcohol consumed makes a difference. Grønbaek and colleagues found that, in a population-based sample in Denmark, drinking wine was protective but the heavy consumption of spirits had an adverse effect. No evidence was found for a U-shaped curve with wine because heavy drinkers received the same benefit as moderate drinkers.

Unfortunately, 2 problems make the results of the study by Grønbaek and colleagues difficult to accept. First, the prevalence of recovering alcoholics—persons with a history of drinking who are currently sober—was unbelievably low (17 of 13 285, or 0.01%), which suggests a strong reporting bias. The article by Fuchs and colleagues supports previous studies showing that former heavy drinkers have an increased mortality rate; therefore, including these former drinkers would increase the RR for nondrinkers. Second, and more important, Grønbaek and colleagues controlled for a very limited number of potential confounders. They did not adjust for physical activity level; aspirin use; or the presence of hypertension, hyperlipidemia, or diabetes mellitus. These factors—all of which are strongly associated with death from CVD and total mortality—could also be associated with the type of alcohol consumed. This is a serious concern because the observed findings could be caused by differences in these factors rather than the type of alcohol consumed. Many studies have looked at this important issue, but the answer is still unclear. This study adds to the data favoring wine, but, unfortunately, its limitations prevent it from being definitive.

Scott E. Sherman, MD, MPH
Donald S. Chang, MDVA/UCLA/RAND Center for the Study of Healthcare Provider BehaviorSepulveda, California, USA


Reference

1. Willett WC, Stampfer MJ, Colditz GA, et al. Moderate alcohol consumption and the risk of breast cancer. N Engl J Med. 1987;316:1174-80.