Alcohol consumption and risk for coronary heart disease in men with healthy lifestyles

Background: Although moderate alcohol intake is associated with lower risk for myocardial infarction (MI), guidelines generally suggest that adults seek other lifestyle measures to reduce cardiovascular risk. We studied whether alcohol consumption is inversely associated with risk for coronary heart disease in men who report consistently favorable lifestyle behaviors. Methods: From 51 529 male participants of the Health Professionals Follow-up Study who have reported diet and other lifestyle factors in biennial questionnaires since 1986, we defined a cohort of 8867 men free of major illness to participate in a prospective study. All participants reported 4 healthy lifestyle behaviors, including a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 25, moderate to vigorous activity for 30 minutes or more per day, abstention from smoking, and a summary diet score in the top 50% for men. High dietary scores reflected a high intake of vegetables, fruits, cereal fiber, fish, chicken, nuts, soy, and polyunsaturated fat; low consumption of transfat, and red and processed meats; and multivitamin use. Weascertained the incidence of nonfatal MI and fatal coronary heart disease according to reported intake of beer, wine, and liquor every 4 years. Results: During 16 years of follow-up, we documented 106 incident cases of MI. Compared with abstention, the hazard ratios for MI were 0.98 (95% confidence interval, 0.55-1.74) for alcohol intake of 0.1 to 4.9 g/d, 0.59 (95% confidence interval, 0.33-1.07) for alcohol intake of 5.0 to 14.9 g/d, 0.38 (95% confidence interval, 0.16-0.89) for alcohol intake of 15.0 to 29.9 g/d, and 0.86 (95% confidence interval, 0.36-2.05) for alcohol intake of 30.0 g/d or more. In men who met 3 criteria, the lower risk associated with alcohol intake of 5.0 to 29.9 g/d tended to be similar to the lower risk associated with the remaining healthy lifestyle behavior. Conclusion: Even in men already at low risk on the basis of body mass index, physical activity, smoking, and diet, moderate alcohol intake is associated with lower risk for MI.