May 5, 2016
Compared with no or very low alcohol intake, low or moderate alcohol consumption predicted longer cardiovascular disease-free survival in the Swiss HIV Cohort Study (SHCS). But alcohol consumption did not predict cardiovascular events alone in this 9764-person analysis.
In the general population, light to moderate alcohol consumption is linked to lower cardiovascular morbidity and mortality. To see whether the same associations hold true in people with HIV infection, SHCS investigators conducted a prospective analysis of this large HIV cohort.
The study group consisted of antiretroviral-treated adults in follow-up with alcohol consumption data after August 2005. Researchers categorized participants by self-reported alcohol consumption as abstention or very low (<1 g/d), low (1 to 9 g/d), moderate (10 to 29 g/d in women and 10 to 39 g/d in men) and high (>39 g/d). They used Cox proportional hazards models adjusted for relevant baseline variables to describe associations between time-updated alcohol intake and the primary endpoint, a cardiovascular disease event or death and three secondary endpoints: (1) a cardiovascular disease event, (2) cardiovascular death and (3) overall mortality.
During follow-up, 788 people had a new cardiovascular event or died. This combined outcome developed in 8.8% of people with no or very low alcohol use, 6.1% with low alcohol use, 7.1% with moderate alcohol use and 11.4% with high alcohol use. Proportional hazards models determined that, compared with people who drank little or no alcohol, people with low alcohol use had a 21% lower risk of the combined endpoint (adjusted hazard ratio [aHR] 0.79, 95% confidence interval [CI] 0.63 to 0.98) and people with moderate alcohol use had a 22% lower risk (aHR 0.78, 95% CI 0.64 to 0.95). High alcohol use did not affect the combined endpoint compared with no-or-very-low alcohol use.
Other variables associated with the combined endpoint of a cardiovascular event or death were cumulative abacavir use, cumulative protease inhibitor use, lower education, lower CD4+ count, anemia and several classic cardiovascular risk factors: older age, diabetes, smoking, pulmonary hypertension and higher total-to-HDL cholesterol ratio.
Compared with no or very low alcohol use, low alcohol consumption was associated with a 43% lower risk of all-cause mortality (aHR 0.57, 95% CI 0.42 to 0.78), moderate alcohol consumption was associated with a 40% lower risk (aHR 0.60, 95% CI 0.46 to 0.80) and high alcohol use was not associated with all-cause mortality. Low or moderate alcohol use was not associated with a lower risk of cardiovascular events alone or with a lower risk of cardiovascular death.
The SHCS team concludes that "the J-shaped association between alcohol consumption and mortality shown previously in the general population also seems to hold true in HIV-infected individuals" on antiretroviral therapy (ART). The researchers speculate that the make-up of the no-or-very-low alcohol group or statistical overcorrection could explain the failure to show an association between low or moderate drinking and a lower risk of cardiovascular events alone.
The Swiss investigators believe their study "underlines the protective effect of low and moderate alcohol consumption on cardiovascular event-free survival and overall survival." As a result, "there is no signal that low-to-moderate alcohol consumption should be avoided by HIV-infected persons on ART."
Mark Mascolini writes about HIV infection.
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