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Jerome L. Abramson, PhD; Setareh A. Williams, PhD; Harlan M. Krumholz, MD,MPH; Viola Vaccarino, MD,PhD

JAMA. 2001;285:1971-1977.

Context  Heavy consumption of alcohol can lead to heart failure, but the relationship between moderate alcohol consumption and risk of heart failure is largely unknown.

Objective  To determine whether moderate alcohol consumption predicts heart failure risk among older persons, independent of the association of moderate alcohol consumption with lower risk of myocardial infarction (MI).

Design  Prospective cohort study conducted from 1982 through 1996, with a maximum follow-up of 14 years.

Setting and Participants  Population-based sample of 2235 noninstitutionalized elderly persons (mean age, 73.7 years; 41.2% male; 21.3% nonwhite) residing in New Haven, Conn, who were free of heart failure at baseline. Persons who reported alcohol consumption of more than 70 oz in the month prior to baseline were excluded.

Main Outcome Measure  Time to first fatal or nonfatal heart failure event, according to the amount of alcohol consumed in the month prior to baseline.

Results  Increasing alcohol consumption in the moderate range was associated with decreasing heart failure rates. For persons consuming no alcohol (50.0%), 1 to 20 oz (40.2%), and 21 to 70 oz (9.8%) in the month prior to baseline, crude heart failure rates per 1000 years of follow-up were 16.1, 12.2, and 9.2, respectively. After adjustment for age, sex, race, education, angina, history of MI and diabetes, MI during follow-up, hypertension, pulse pressure, body mass index, and current smoking, the relative risks of heart failure for those consuming no alcohol, 1 to 20 oz, and 21 to 70 oz in the month prior to baseline were 1.00 (referent), 0.79 (95% confidence interval [CI], 0.60-1.02), and 0.53 (95% CI, 0.32-0.88) (P for trend = .02).

Conclusions  Increasing levels of moderate alcohol consumption are associated with a decreasing risk of heart failure among older persons. This association is independent of a number of confounding factors and does not appear to be entirely mediated by a reduction in MI risk.

Author Affiliations: Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga (Drs Abramson and Vaccarino); AstraZeneca Pharmaceuticals, Wayne, Pa (Dr Williams); Department of Epidemiology and Public Health and the Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Conn (Dr Krumholz).

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