Alcohol Consumption and Coronary Artery Bypass Grafts
Alcohol Consumption and Coronary Artery Bypass Grafts
Background: Although moderate drinking has been associated with lower mortality among patients after myocardial infarction, its relationship with prognosis and graft obstruction among patients with coronary artery bypass grafts is unknown.
Methods: We studied 1351 patients enrolled in the Post-CABG trial, who had undergone coronary bypass surgery 1 to 11 years before entry. Participants were randomly assigned to lovastatin in low or high doses and to low-dose warfarin or placebo in a factorial design. Participants underwent coronary angiography at baseline and after a mean follow-up of 4.3 years and were followed up for a composite end point of death, myocardial infarction, stroke, bypass surgery, or angioplasty. We categorized reported weekly alcohol intake as abstention (<1 drink), light (1-6 drinks), moderate (7-13 drinks), and heavier (≥14 drinks).
Results: During follow-up, 238 participants sustained a clinical event. Moderate drinking was associated with a trend toward both fewer clinical events (hazard ratio 0.7, 95% CI 0.4-1.1) and less angiographic progression (odds ratio 0.7, 95% CI 0.5-1.1), although neither of these effects were statistically significant. High-density lipoprotein cholesterol appeared to account for one third of the trend toward lower risk among moderate drinkers.
Conclusion: We did not demonstrate statistically significant differences in prognosis according to alcohol intake in this study, although there were inverse trends between moderate drinking and both morbidity and graft progression of a magnitude similar to studies in other populations. Larger studies of alcohol intake among patients with coronary artery bypass grafts are needed.
Moderate alcohol consumption has been associated with a lower risk of coronary heart disease (CHD) in observational studies, an association supported by the established effects of alcohol intake on cardiovascular risk factors in short-term trials. More recent studies have also found an association between moderate drinking and lower morbidity and mortality among patients with recent or remote myocardial infarction (MI).
Surprisingly, little information exists regarding the relationship of alcohol consumption with prognosis among patients with CHD other than those who survive MI. In a retrospective series of 225 German men undergoing stent implantation, consumption of ≥50 g (approximately 4 drinks) per week was associated with lower rates of restenosis and repeat angioplasty. In a population-based cohort study, moderate drinking was also associated with a lower rate of coronary atherosclerotic progression among Swedish women who survived acute coronary syndromes. We know of no studies that have addressed the relationship of alcohol consumption with progression of graft atherosclerosis or with prognosis among patients who survive coronary artery bypass graft (CABG) surgery.
To determine whether moderate alcohol intake was associated with prognosis or with progression of graft obstruction among patients with patent bypass grafts, we studied patients enrolled in the Post-CABG trial. This trial randomly assigned patients with previous CABG surgery in a factorial design to high-dose or low-dose lovastatin and to low-dose warfarin or placebo, with coronary angiography at baseline and at the conclusion of follow-up.
Abstract and Introduction
Abstract
Background: Although moderate drinking has been associated with lower mortality among patients after myocardial infarction, its relationship with prognosis and graft obstruction among patients with coronary artery bypass grafts is unknown.
Methods: We studied 1351 patients enrolled in the Post-CABG trial, who had undergone coronary bypass surgery 1 to 11 years before entry. Participants were randomly assigned to lovastatin in low or high doses and to low-dose warfarin or placebo in a factorial design. Participants underwent coronary angiography at baseline and after a mean follow-up of 4.3 years and were followed up for a composite end point of death, myocardial infarction, stroke, bypass surgery, or angioplasty. We categorized reported weekly alcohol intake as abstention (<1 drink), light (1-6 drinks), moderate (7-13 drinks), and heavier (≥14 drinks).
Results: During follow-up, 238 participants sustained a clinical event. Moderate drinking was associated with a trend toward both fewer clinical events (hazard ratio 0.7, 95% CI 0.4-1.1) and less angiographic progression (odds ratio 0.7, 95% CI 0.5-1.1), although neither of these effects were statistically significant. High-density lipoprotein cholesterol appeared to account for one third of the trend toward lower risk among moderate drinkers.
Conclusion: We did not demonstrate statistically significant differences in prognosis according to alcohol intake in this study, although there were inverse trends between moderate drinking and both morbidity and graft progression of a magnitude similar to studies in other populations. Larger studies of alcohol intake among patients with coronary artery bypass grafts are needed.
Introduction
Moderate alcohol consumption has been associated with a lower risk of coronary heart disease (CHD) in observational studies, an association supported by the established effects of alcohol intake on cardiovascular risk factors in short-term trials. More recent studies have also found an association between moderate drinking and lower morbidity and mortality among patients with recent or remote myocardial infarction (MI).
Surprisingly, little information exists regarding the relationship of alcohol consumption with prognosis among patients with CHD other than those who survive MI. In a retrospective series of 225 German men undergoing stent implantation, consumption of ≥50 g (approximately 4 drinks) per week was associated with lower rates of restenosis and repeat angioplasty. In a population-based cohort study, moderate drinking was also associated with a lower rate of coronary atherosclerotic progression among Swedish women who survived acute coronary syndromes. We know of no studies that have addressed the relationship of alcohol consumption with progression of graft atherosclerosis or with prognosis among patients who survive coronary artery bypass graft (CABG) surgery.
To determine whether moderate alcohol intake was associated with prognosis or with progression of graft obstruction among patients with patent bypass grafts, we studied patients enrolled in the Post-CABG trial. This trial randomly assigned patients with previous CABG surgery in a factorial design to high-dose or low-dose lovastatin and to low-dose warfarin or placebo, with coronary angiography at baseline and at the conclusion of follow-up.
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