- The Washington Times - Wednesday, January 8, 2003

BOSTON, Jan. 8 (UPI) — Daily consumption of beer, wine or liquor lowers the risk of a heart attack in men, suggesting frequent intake of alcohol, rather than a particular type of beverage, is key to providing heart benefits, a study released Wednesday reveals.

The study found men who had an alcohol-containing drink five to seven days a week had a 35 percent lower risk of a heart attack than men who did not drink, Kenneth Mukamal, lead author and an associate physician at Beth Israel Deaconess Medical Center, told United Press International.

Alcohol previously had been associated with reduced risk of heart problems, but it was not clear whether the amount or type of alcohol consumed had much of an impact. The new study, which appears in the Jan. 9 issue of The New England Journal of Medicine, suggests daily consumption is more important than the amount or type of beverage, Mukamal said.

"It looked like it didn't really matter how much they drank each day, so long as they drank frequently enough," he said, adding there appeared to be little difference whether the men consumed beer, liquor or wine. "The type of alcohol and the amount of alcohol consumed on a given day doesn't have a large role to play," he said.

Mukamal's team analyzed data about alcohol use from the Health Professionals Follow-up Study, which has tracked more than 38,000 male doctors, dentists and veterinarians, ages 40 to 75, for 12 years. After adjusting for age, smoking, cholesterol levels and other factors, men who consumed alcohol three or more times per week, regardless of amount, had the lowest risk of heart disease.

In addition, men who increased their alcohol intake by one drink per day had a 22 percent lower risk of heart attack than men who maintained their intake levels over the 12-year period.

"This should not be taken as some sort of invitation to drink to excess, but for those people who drink this may provide some reassurance that doing so certainly doesn't hurt their heart," Mukamal said.

Alcohol might lower the risk of heart attack by preventing the formation of blood clots that can lead to a lack of blood flow to the heart, the researchers said. Alcohol raises levels of HDL, or "good," cholesterol and it has positive effects on clotting factors, both of which could lower heart attack risk.

Ira Goldberg, chief of the division of preventive medicine and nutrition at Columbia University in New York City, who wrote an accompanying editorial, recommended caution to people who might use the findings to justify drinking.

Alcohol has many negative effects associated with it, including being the No. 1 cause of liver disease in America and a major cause of vehicle crashes and neurological problems, Goldberg told UPI.

In addition, he cautioned, this was only an observational study, not a controlled clinical trial. Therefore it is difficult to draw any firm conclusions about whether people actually receive a heart benefit from drinking, he said.

"People need a stronger indication that this is really true," Goldberg said, noting clinical trials of hormone replacement therapy for postmenopausal women showed the drugs increased the risk of heart disease, rather than lowering it as many medical experts expected.

A safer approach to lowering heart disease risk would be to eat nuts, drink tea or eat fish — all of which have been associated with a reduced risk of heart problems, Goldberg said.

Claude Lenfant, director of the National Heart, Lung, and Blood Institute in Bethesda, Md., agreed with Goldberg.

"There are well-proven ways to prevent cardiovascular disease and reduce its risks, including lowering cholesterol levels and blood pressure, maintaining a healthy weight, being physically active, and stopping smoking," Lenfant said in a written statement. "These preventive measures do not have the risks associated with alcohol consumption. Therefore, we do not advise the public to begin drinking alcohol to prevent heart disease."

However, he noted, "those who already drink alcohol should be aware that current evidence suggests that moderate drinking may reduce the risk of heart disease in some individuals."

Mukamal agreed the negative consequences of alcohol should be considered.

"This is just a look at one disease," he said. "Alcohol has a host of other effects that people need to consider when deciding how much to drink and how much not to drink, and the best way to make that decision is in consultation with one's physicians."

With regard to adopting healthier lifestyle habits instead of drinking, Mukamal said the two do not have to be mutually exclusive.

"We don't need to tell people they should eat healthy and exercise and pretend that alcohol doesn't exist," he said. "I would certainly not recommend that we favor alcohol over other ways of lowering cardiovascular risk, but I think we need to place it in the context that alcohol can have a benefit."

Goldberg said now might be a good time to do a controlled clinical trial of the effects of alcohol in people at high-risk or who already have heart disease to determine once and for all whether it really lowers risk.

"We might find that it adds benefit over the usual therapies for treating heart disease … or we might find that when we add the alcohol" there are deleterious effects, he said.

Mukamal agreed a controlled trial would be ideal, but added it would be difficult to do such a trial and the results would not be available for several years.

"We still have to advise our patients in the interim," and the current evidence suggests "there may be some benefits to drinking moderately," he said.

(Reported by Steve Mitchell, UPI Medical Correspondent, in Washington)

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