International Journal of Epidemiology, Vol 26, 523-531, Copyright © 1997 by International Epidemiological Association
SG Wannamethee and AG Shaper
BACKGROUND: To determine the risk of all cause mortality and the incidence
of major coronary heart disease (CHD) events in lifelong teetotallers and
in ex-drinkers compared with occasional and regular drinkers. METHODS: A
prospective study of middle-aged men drawn at random from one general
practice in each of 24 British towns. Five years after the screening of
7735 men aged 40-59 years, 7167 provided further information on postal
questionnaire enabling separation of non- drinkers into lifelong
teetotallers and ex-drinkers. RESULTS: During the follow-up period of 9.8
years after the postal questionnaire there were 929 deaths from all causes
and 490 major CHD events. Ex-drinkers exhibited increased cardiovascular
and non-cardiovascular mortality; lifelong teetotallers showed the lowest
cardiovascular mortality but a significantly increased non-cardiovascular
mortality. After adjustment for confounding factors and pre-existing
disease, the two non-drinking groups did not differ significantly in all
cause mortality from occasional and regular drinkers (light, moderate or
heavy) but lifelong teetotallers still showed a significant increase in
non-cardiovascular mortality. Adjustment considerably attenuated the risk
of both cardiovascular and non-cardiovascular mortality in the ex-drinkers.
In men without a diagnosis of CHD, lifelong teetotallers and ex-drinkers
showed similar increased relative risk (RR) of heart attacks, with regular
drinkers (combined) having a significantly decreased risk compared to
occasional drinkers (RR = 0.78, 95% confidence interval [CI] : 0.64-0.96)
and non-drinkers (RR = 0.69, 95% CI : 0.52-0.91). This decreased risk was
small in absolute terms at around 2-3 major CHD events/1000 person-years.
CONCLUSIONS: Lifelong teetotallers and ex- drinkers showed a significantly
increased RR of major CHD events compared with regular drinkers, although
this risk is small in absolute terms. Lifelong teetotallers have a low risk
of overall cardiovascular mortality and an increased risk of
non-cardiovascular mortality. Non- drinkers constitute an unsuitable
reference group in alcohol-related studies; occasional or even light
drinkers may be more appropriate. Overall, there is no convincing evidence
that light or moderate drinking has a protective effect on total or
cardiovascular mortality in these middle-aged British men.
ARTICLES
Lifelong teetotallers, ex-drinkers and drinkers: mortality and the incidence of major coronary heart disease events in middle-aged British men
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.
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