Transcript Journal Club Alcohol, Other Drugs, and Health: Current Evidence November–December 2010 www.aodhealth.org Featured Article Patterns of Alcohol Consumption and Ischaemic Heart Disease in Culturally Divergent Countries The.

Journal Club
Alcohol, Other Drugs, and Health: Current Evidence
November–December 2010
www.aodhealth.org
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Featured Article
Patterns of Alcohol Consumption and
Ischaemic Heart Disease in Culturally
Divergent Countries
The Prospective Epidemiological Study of Myocardial
Infarction (PRIME)
Ruidavets JB, et al. BMJ. 2010:23;341:c6077.
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Study Objective
• To investigate the effect of alcohol intake
patterns on ischemic heart disease in 2
countries with contrasting lifestyles
(Northern Ireland and France).
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Study Design
• Analysis of cohort data from the Prospective
Epidemiological Study of Myocardial Infarction
(PRIME) from 1 center in Belfast and 3 centers in
France.
• The sample included 9778 men aged 50–59 and
free of ischemic heart disease at baseline.
• Participants were assessed at baseline for:
– weekly alcohol consumption
– incidence of binge drinking*
– incidence of regular drinking†
– frequency of consumption
– type of beverage consumed
*Consumption of >50 g alcohol at least 1 day per week.
†Consumption at least 1 day a week, alcohol <50 g if on only 1 occasion.
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Study Design (cont’d)
• The relationship between baseline characteristics,
coronary events (myocardial infarction [MI] and
coronary death), and angina events over 10-year
follow-up was assessed using Cox’s proportional
hazards regression analysis.
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Assessing Validity of an
Article About Harm
• Are the results valid?
• What are the results?
• How can I apply the results to
patient care?
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Are the Results Valid?
• Did the investigators demonstrate similarity in all
known determinants of outcomes? Did they
adjust for differences in the analysis?
• Were exposed patients equally likely to be
identified in the two groups?
• Were the outcomes measured in the same way in
the groups being compared?
• Was follow-up sufficiently complete?
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Did the investigators demonstrate
similarity in all known determinants of
outcomes? Did they adjust for differences
in the analysis?
• The sample included men only, similar in age and
with no baseline history of ischemic heart disease.
• Analyses were adjusted for the following factors
known to be predictive of ischemic heart disease:
−
−
−
−
−
age
education
waist circumference
systolic blood pressure
diabetes, dyslipidemia,
or hypertension
− physical activity
− tobacco consumption, pack years
− apolipoprotein A-1
concentration
− apolipoprotein B concentration
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Were exposed patients equally likely
to be identified in the groups?
 Although this study addressed drinking
pattern, self-reported alcohol consumption
on a typical week in the year prior to
baseline examination was the exposure.
 Follow-up did not assess for changes in
consumption over time.
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Were the outcomes measured in the
same way in the groups being compared?
 Extensive clinical information was gathered for
any patient who reported a possible clinical event
over the 10-year follow-up period:
−
hospital and physician notes; hospital admissions;
electrocardiograms; MI biomarkers; surgical
procedures; angioplasty; myocardial perfusion
scintigraphy; echocardiography; postmortem
information on participants who died.
 A committee comprised of 1 PRIME researcher, 1
member of the PRIME coordinating center, and 3
independent cardiologists reviewed all collected
medical data.
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Was follow-up sufficiently complete?
• Of the overall sample (N=9778),
– 317 men (3%) were lost to follow-up.
– 215 (2%) refused continued participation.
– 653 (6.1%) died.
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What are the Results?
• How strong is the association between
exposure and outcomes?
• How precise is the estimate of the risk?
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How strong is the association between
exposure and outcome?
How precise is the estimate of the risk?
– The hazard ratio (HR) for coronary events in binge drinkers*
compared with regular drinkers† was 1.81 (95% CI, 1.05–
3.11) in Belfast and 1.93 (95% CI, 0.46–7.40) in France.
– Combining all sites, the HR for coronary events compared
with regular drinkers was 2.03 (95% CI, 1.41–2.94) in never
drinkers and 1.97 (95% CI, 1.21–3.22) in binge drinkers. The
HR for former drinkers compared with regular drinkers was
1.57 (95% CI, 1.11–2.21).
– Alcohol intake was not associated with incidence of anginal
events.
*Consuming ≥50 g alcohol at least 1 day per week. †Consuming <50 g alcohol at least 1 day
per week.
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How Can I Apply the Results to
Patient Care?
• Were the study patients similar to the patients
in my practice?
• Was the duration of follow-up adequate?
• What was the magnitude of the risk?
• Should I attempt to stop the exposure?
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Were the study patients similar to the
patients in my practice?
• Subjects were Irish and French men aged
50–59 at baseline. Further race/ethnicity
data were not provided.
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Was the duration of follow-up adequate?
• Yes. Follow-up was at 10 years.
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What was the magnitude of the risk?
• Compared with regular drinkers, the HR for
coronary events was 2.03 in never drinkers
and 1.97 in binge drinkers. The HR for
former drinkers compared with regular
drinkers was 1.57.
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Should I attempt to stop the exposure?
• The results suggest a cardiovascular benefit
with consumption of <50 g alcohol at least 1
day per week.
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