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TOPLINE:

Among those with high alcohol intakes, lowering alcohol consumption to mild to moderate levels is associated with a 23% reduction in the risk for major adverse cardiovascular events (MACEs), a large cohort study suggests.

METHODOLOGY:

• Researchers analyzed data from 21,011 adults in the Korean National Health Insurance Service-Health Screening database with heavy alcohol consumption at baseline (90.39%, men; mean age, 56.08 years); heavy drinking was defined as more than four drinks per day or more than 14 drinks per week for men and more than three daily drinks or more than seven drinks per week for women.
• Participants underwent health examinations over two consecutive periods, 2005-2008 and 2009-2012, and completed self-report questionnaires.
• People who drank heavily at baseline were categorized into two groups according to changes in alcohol consumption after their second health examination: Sustained heavy drinking or reduced drinking.
• Potential confounders included, among others, age; sex; body mass index; obesity; systolic blood pressure; smoking status; level of physical activity; medical comorbidities of hypertension, diabetes, dyslipidemia, heart failure, chronic kidney disease, and atrial fibrillation; and laboratory results, including total cholesterol, low-density lipoprotein cholesterol, hemoglobin, glucose, serum creatinine, and alanine aminotransferase.
• The primary outcome was the occurrence of MACEs — ie, a composite of nonfatal myocardial infarction or angina undergoing revascularization, any stroke accompanied by hospitalization, and all-cause death.

TAKEAWAY:

• During a follow-up of 162,378 person-years, the group that continued heavy drinking experienced a significantly higher incidence of MACEs than the group that reduced drinking (817 vs 675 per 100,000 person-years).
• Reduced alcohol consumption was associated with a 23% lower risk for MACEs than sustained heavy drinking (propensity score matching hazard ratio [PSM HR], 0.77).
• Secondary analyses suggested that the cardiovascular benefits of reduced alcohol consumption varied according to specific cardiovascular disease subtypes, with significant reductions in the risks for coronary artery disease (PSM HR, 0.71), angina (PSM HR, 0.70), any stroke (PSM HR, 0.72), ischemic stroke (PSM HR, 0.66), and all-cause death (PSM HR, 0.79).
• The preventive benefits of reduced alcohol intake were consistent across various subgroups of participants.

IN PRACTICE:

"Reduced alcohol consumption among people who drink heavily was associated with a lower risk of future cardiovascular events [and] habitual changes in heavy alcohol consumption...over the subsequent...10 years," the authors wrote. Benefits became increasingly evident approximately 3 years after the initiation of alcohol-related behavioral change, they noted.

SOURCE:

Jin-Man Jung, MD, PhD, Chungbuk National University College of Medicine, Chungju-si, Republic of Korea, was principal investigator of the study, which was published online on March 28 in JAMA Network Open.

LIMITATIONS:

The study used self-reported alcohol intake, which could result in misclassification. Alcohol-related behavioral changes could not be assessed before the first health exam and after the second. The study population was exclusively South Koreans, potentially limiting the generalizability of the findings.

DISCLOSURES:

The study was supported by the K-Brain Project of the National Research Foundation of Korea, which is funded by the Korean government, and by Korea University and Korea University Guro Hospital. No conflicts of interest were reported.