Moderate Alcohol Intake, Though Not Regular Heavy Drinking, Is Protective for Acute Coronary Syndrome: A Population-Based, Case-Control Study in Southeast Europe

Purpose: We assessed the association of alcohol drinking frequency and quantity with acute coronary syndrome (ACS) in a predominantly Muslim southeast European population, where heavy drinkers drink consistently. Methods: A population-based, case-control study conducted in 2003 through 2006 in Tirana, Albania, included 465 nonfatal sequential ACS patients aged 35 to 74 years (369 men, 96 women; 88% response) and a population-based control group (450 men and 235 women aged 35-74 years; 65.5% response). A structured interview included sociodemographic, psychosocial, and behavioral characteristics. Anthropometric measurements were performed. Statistical analysis employed multivariable-adjusted logistic regression. Results: Women abstained or were light drinkers. Among men, there was a protective association of ACS with both frequency of intake [multivariable-adjusted odds ratio (OR; almost daily versus occasional drinkers), 0.3; 95% confidence interval (CI), 0.2-0.5] and "moderate" drinking quantities [OR (100-299 versus <10 g/wk), 0.4; 95% CI, 0.2-0.6]. Heavy drinking (≥300 g/wk; ≈10% of men) was regular rather than episodic, and was associated with loss of protection. Conclusions: Among the men in this transitional Mediterranean population, we found a strong protective effect associated with both moderate frequency and quantity of intake. The unique context of our study reinforces the case for causality in the relationship between moderate alcohol intake and coronary health.