Low to Moderate Alcohol Consumption and Myocardial Ischemia on Exercise Stress Echocardiography

Abstract Background: The impact of alcohol consumption on the development of myocardial ischemia remains uncertain. Studies diverge whether low to moderate alcohol consumption provides cardioprotection or whether it is a risk factor for myocardial ischemia. Objective: To study the relationship between low to moderate alcohol consumption and myocardial ischemia on exercise stress echocardiography (ESE). Methods: Cross-sectional study with 6,632 patients with known or suspected coronary artery disease undergoing ESE between January/2000 and December/2015. The patients were divided into two groups: G1, composed of 2,130 (32.1%) patients whose report showed maximal consumption of 1 drink per day on average for women or of 2 drinks per day for men; G2, composed of individuals denying any alcohol consumption. For comparing between the groups, Student t test was used for quantitative variables, and chi-square test or Fisher exact test, for categorical variables. The significance level adopted was p < 0.05. Logistic regression was also used to evaluate independent risk factors for myocardial ischemia. Results: G1 had a higher number of men (77.1%; p < 0.001), lower mean age (54.8 ± 10.3 years old; p < 0.001) and higher frequency of myocardial ischemia on ESE (p = 0.014). Age, male sex, dyslipidemia, systemic arterial hypertension, diabetes mellitus, smoking and family history were independently associated with myocardial ischemia on ESE. Independent association between low to moderate alcohol consumption and myocardial ischemia on ESE (OR 0.96; 95%CI: 0.83 to 1.11) was not observed. However, age, male sex, smoking and dyslipidemia were associated with alcohol consumption. Conclusion: Low to moderate alcohol consumption was not an independent predictor of myocardial ischemia on ESE. Nevertheless, we observed a predominance of the male sex, dyslipidemia and smoking habit, important predictors of myocardial ischemia, in the group of alcohol consumers.

背景：饮酒对心肌缺血发生发展的影响尚未明确。现有研究对少量至中等量饮酒究竟能否发挥心脏保护作用，还是会成为心肌缺血的危险因素，尚未达成共识。
目的：探讨运动负荷超声心动图（exercise stress echocardiography, ESE）下，少量至中等量饮酒与心肌缺血的关联。
方法：本研究为横断面研究，纳入2000年1月至2015年12月期间接受ESE检查的6632名已知或疑似冠状动脉粥样硬化性心脏病患者。将受试者分为两组：G1组共2130例（占比32.1%），其饮酒报告显示女性平均每日最大饮酒量为1份标准饮酒单位，男性为2份标准饮酒单位；G2组为否认任何饮酒行为的受试者。组间比较时，定量资料采用学生t检验，分类资料采用卡方检验或费希尔精确检验，检验水准设定为p<0.05。此外采用logistic回归分析心肌缺血的独立危险因素。
结果：G1组男性占比更高（77.1%；p<0.001），平均年龄更低（54.8±10.3岁；p<0.001），且ESE下心肌缺血检出率更高（p=0.014）。年龄、男性性别、血脂异常、系统性动脉高血压、糖尿病、吸烟及冠心病家族史与ESE下心肌缺血存在独立关联。未观察到少量至中等量饮酒与ESE下心肌缺血存在独立关联（比值比（Odds Ratio, OR）=0.96；95%置信区间（Confidence Interval, CI）：0.83~1.11）。不过，年龄、男性性别、吸烟及血脂异常与饮酒行为存在显著关联。
结论：少量至中等量饮酒并非ESE下心肌缺血的独立预测因素。但在饮酒受试者组中，男性、血脂异常及吸烟习惯等心肌缺血重要预测因素的占比更高。