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Low/Moderate Alcohol Drinking Trims Heart
Disease-Free Death Risk in HIV+ Swiss
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CROI 2014, March 3-6, 2014, Boston
Mark Mascolini
Compared with people who abstained from alcohol, low or moderate drinkers had a one-quarter to one-third lower risk of cardiovascular disease or death in the Swiss HIV Cohort Study (SHCS) [1]. This benefit did not extend to heavy drinkers, whose risk of cardiovascular disease-free survival was similar to abstainers' risk.
Research in the general population links low or moderate alcohol drinking to lower rates of cardiovascular disease and death than not drinking at all [2,3]. A US cross-sectional study tied low or moderate drinking to low cardiovascular disease prevalence [4], and a prospective French cohort study saw a lower risk of major cardiovascular disease with moderate drinking [5]. But no nationwide study addressed this issue in HIV-positive people until this analysis by SHCS investigators.
The study involved all SHCS members who started antiretroviral therapy (ART) and had follow-up after August 2005. The researchers divided self-reported drinking levels into abstention, low (1 to 9 g/day), moderate (10 to 29 g/day in women and 10 to 39 g/day in men), and high (above 29 g/day in women and 39 g/day in men). (Forty grams are 1.4 ounces or 0.175 cup.) Cardiovascular disease diagnoses included myocardial infarction, coronary angioplasty, coronary artery bypass grafting, carotid endarterectomy, procedures on other arteries, cerebral infarction, and cerebral hemorrhage.
The SHCS team used Cox proportional hazards models to explore associations between time-updated alcohol consumption and cardiovascular disease-free survival (a combined endpoint) and overall survival.
The study included 9764 people, 52% of them abstainers, 20% low-level drinkers, 22% moderate drinkers, and 7% heavy drinkers. Median age varied from 41 to 44 across the four groups of drinkers. Men who have sex with men made up 32% of abstainers, 54% of low-level drinkers, 51% of moderate drinkers, and 33% of heavy drinkers. Respective proportions of women were 39%, 23%, 16%, and 21%.
About 11% of study participants had a family history of cardiovascular disease, with little difference from group to group. Hypertension rates varied from 10% to 12% in abstainers, low-level drinkers, and moderate drinkers and reached 19% among heavy drinkers. About 29% of abstainers, low-level drinkers, and moderate drinkers were obese, compared with 25% of heavy drinkers. Respective median cigarette packs smoked daily were 0, 0, 0.1, and 1.0-- low smoking levels for an HIV cohort.
During 52,000 person-years of follow-up, the researchers recorded 464 cardiovascular diagnoses and 520 deaths for a combined incidence of 1.8 per 100 person-years (meaning about 2 of every 100 people had a cardiovascular diagnosis or died every year).
Compared with abstainers, low-level drinkers had about at 25% lower risk of cardiovascular disease or death (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.60 to 0.88, P = 0.001). Moderate drinkers had a one third lower risk of cardiovascular disease or death than abstainers (HR 0.67, 95% CI 0.56 to 0.80, P < 0.001). Every additional 10 g of alcohol daily lowered the cardiovascular disease/death rate almost 10% (HR 0.91, 95% CI 0.85 to 0.97, P = 0.01). Risk of cardiovascular disease or death did not differ significantly between heavy drinkers and abstainers (HR 0.9, 95% CI 0.70 to 1.14, P = 0.4). The impact of drinking on overall survival was similar to the impact on the combined cardiovascular disease/death endpoint.
Low CD4 count was also independently associated with steeper chances of cardiovascular disease or death, though the investigators did not detail the precise association. Familiar classic cardiovascular risk factors also independently raised the risk of death--family history, diabetes, smoking, obesity, and hypertension.
The SHCS team called for further study of alcohol's impact on cardiovascular disease and death, with particular attention to drinking patterns and type of alcohol consumed.
References
1. Wandeler G, Kraus D, Fehr J, et al. The J-curve in HIV: better cardiovascular-disease-free survival with moderate alcohol intake. CROI 2014. Conference on Retroviruses and Opportunistic Infections. March 3-6, 2014. Boston. Abstract 731.
2. Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 2011;342:d671.
3. Mukamal KJ, Conigrave KM, Mittleman MA, et al. Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. N Engl J Med. 2003;348:109-118. http://www.nejm.org/doi/full/10.1056/NEJMoa022095
4. Freiberg MS, McGinnis KA, Kraemer K, et al. The association between alcohol consumption and prevalent cardiovascular diseases among HIV-infected and HIV-uninfected men. J Acquir Immune Defic Syndr. 2010;53:247-253. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858978/
5. Carrieri MP, Protopopescu C, Le Moing V, et al. Impact of immunodepression and moderate alcohol consumption on coronary and other arterial disease events in an 11-year cohort of HIV-infected patients on antiretroviral therapy. BMJ Open. 2012;2:e001155. http://bmjopen.bmj.com/content/2/6/e001155.long
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