BMC MED:适度饮酒可能降低心血管患者死亡风险

2021-07-27 K.K MedSci原创

适度饮酒可降低心血管疾病患者的心脏病发作和死亡风险

在健康人中,轻~中度的饮酒对心脏有保护作用,美国心脏协会(AHA)和美国心脏病学院基金会2011年二级预防指南建议 "适度饮酒"--男性最高为196克/周(2杯/天),女性最高为98克/周(1杯/天),且适用于动脉硬化性血管疾病患者。英国国家健康与护理卓越研究所2020年指南建议,男性和女性在发生心肌梗塞后,酒精摄入量应保持在112克/周(14英国单位/周)以内;世界卫生组织2007年关于预防复发性心肌梗塞和心肌梗塞的建议是不超过约166克/周。

发表在7月27日的BMC Medicine上的研究显示,在心血管疾病患者中,降低死亡率和心血管发病率风险的饮酒上限约为105g/周,这低于大多数指南中推荐的上限。

Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women, BMC Medicine (2021). DOI: 10.1186/s12916-021-02040-2

饮酒与死亡率和心血管发病率的关联

研究纳入英格兰健康调查、苏格兰健康调查的2802名参与者(心肌梗死/心绞痛=2341,中风=535)和英国生物银行14386名参与者(心肌梗死=5333,心绞痛=9589,中风=2064)都有完整的数据用于新的队列分析。平均来说,英国生物银行的参与者比英格兰、苏格兰的参与者更年轻,并且报告了更高的饮酒量。

在英格兰健康调查、苏格兰调查的9.5年和英国生物银行的8.7年的中位随访期间,结果发现英格兰、苏格兰健康调查参与者中有1257例死亡,英国生物银行参与者中有1640例死亡,其中492例(39.1%)和631例(38.5%)死亡是由于心血管。英国生物银行共记录了2950例致命和非致命的心血管事件, 随访时间中位数为7.5年。在所有类别的饮酒者中都观察到较低的心血管事件风险。

英国生物银行数据集最大调整模型显示,饮酒类别均与全因死亡率和心血管死亡率呈J型关联,与从未饮酒者相比,低级和中级饮酒者的死亡风险较低,但高级或曾经饮酒者的死亡风险没有差异。

 

饮酒与心血管疾病患者的发病率和死亡率的关系,48,423名男性和女性的原始数据和荟萃分析

心血管患者的饮酒量和全因死亡率

汇总11项研究中,包含41,743名心血管疾病患者。研究人员观察到了一个J型的关联,当心血管患者饮酒7g/天时预防死亡作用达到顶峰,当心血管患者饮酒62g/天时预防作用仍然显着。男性的剂量反应趋势呈J型曲线,但是女性在较高的饮酒水平下没有增加死亡风险。适度饮酒与患者有过心肌梗塞或心绞痛的总死亡率风险较低有关。对于不是经常饮酒者的汇总分析显示,酒精摄入量达到约75g/天时,死亡风险降低。

心血管患者的饮酒量和心血管死亡率

汇总9项研究中,有24,770名患者被纳入心血管死亡率的荟萃分析。研究发现,当心血管患者饮酒8g/天时,心血管死亡率风险的最大降低幅度为27%。与男性的J型曲线不同,女性在较高的饮酒水平下没有超额的死亡风险。在分析以前有过心肌梗死的患者中发现,适度饮酒与较低的心血管死亡风险有关;然而,在有心绞痛或中风的患者中,这种剂量反应趋势几乎没有看到。

心血管疾病患者饮酒与心血管事件

在观察饮酒和心血管事件的四项研究(28621名患者)中,心血管疾病患者饮酒摄入量在15g/天以内,与心血管事件风险的显着降低有关。对女性心血管患者的研究汇总分析显示,女性患者酒精摄入量达到约49g/天时,死亡风险有所下降,而男性在任何饮酒水平下,死亡风险都没有减少。在不同原发事件的患者和多种酒精测量的研究中发现,适度饮酒对心血管事件有预防作用。然而,当曾经饮酒者类目被排除后,整体的饮酒预防作用被削弱。

 

饮酒与死亡和心血管事件风险之间的剂量反应关系

总的来说,对英国三个主要队列的结果以及12个已发表的研究结果进行的分析发现,心血管疾病患者的饮酒量和死亡率之间存在J型曲线关系,对于目前不饮酒的心血管患者来说,饮酒为7g/天的全因死亡率和饮酒为8g/天的心血管死亡风险最低,在其他高危人群,如高血压和糖尿病患者中也有可能存在。

原始出处:

Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women, BMC Medicine (2021). DOI: 10.1186/s12916-021-02040-2

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    2021-07-30 ms3000001741732165

    是不是真的也有人说完全不喝酒

    0

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    2021-07-27 Doctoryangbai

    不一样的进展

    0

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