Heavy Drinking & Coronary Disease: Acute/Chronic Effects

描述(申请人提供)：大量饮酒与几种不良健康后果有关，但其与心肌梗死(MI)的相关性仍不确定，尚未探讨大量饮酒对引发MI的急性风险，以及大量饮酒对MI早期幸存者预后的影响尚不清楚。鉴于酒精使用与冠心病(CHD)的复杂关系，这些问题具有直接的公共卫生重要性，并可能影响CHD患者的临床护理。 这项建议旨在从三个方面评估间歇性大量饮酒对冠心病持续状态的影响： 1.大量饮酒与心肌梗死事件16年风险的关联--这一目标将在30,000多名健康专业人员后续研究的参与者中得到解决，这是一项前瞻性队列研究，包括酒精摄入量的有效测量和关于潜在混杂因素的反复更新的信息。 2.与大量饮酒有关的急性心肌梗死风险--这一目标将在心肌梗死发病决定因素研究中得到解决，该研究招募了3800多名确诊为急性心肌梗死的住院患者。 使用创新的病例交叉设计，这项研究可以将患者报告在心肌梗死当天大量饮酒的频率与他们通常的饮酒频率和前一天的频率进行比较。通过将患者与他们自己进行比较，病例交叉设计消除了个体之间但不同个体内部不同因素的混淆，并准确地量化了大量饮酒的急性心脏风险。 3.在存活的急性心肌梗塞患者中，大量饮酒与4年死亡风险之间的关系--这一目标将在发病随访研究中进行，这是一项对心肌梗塞发病决定因素研究中的前1,935名患者进行的初始队列研究。这项研究对冠心病患者的临床、人口学和生活方式的预后决定因素有丰富的细节。综上所述，这三个部分将探索大量间歇性饮酒在急性心肌梗死发展中的作用--无论是慢性还是急性--以及在急性心肌梗死患者预后中的作用。这些结果可能被证明对冠心病的治疗具有重要的生物学、临床和公共卫生意义。

DESCRIPTION (provided by applicant): Heavy episodic drinking has been associated with several adverse health outcomes, but its association with myocardial infarction (MI) remains uncertain, the acute risks of heavy drinking episodes on triggering of MI have not been explored, and the effects of heavy episodic drinking on prognosis of early survivors of MI is unknown. Given the complex relation of alcohol use to coronary heart disease (CHD), these issues are of immediate public health importance and may impact the clinical care of patients with CHD. This proposal aims to assess the effects of heavy episodic drinking at three points on the continuum of CHD: 1. The association of heavy episodic drinking with 16-year risk of incident MI - This aim will be addressed in over 30,000 participants of the Health Professionals Follow-up Study, a prospective cohort study that includes validated measures of alcohol intake and repeatedly updated information on potential confounders. 2. The acute risk of precipitating MI associated with episodes of heavy drinking - This aim will be addressed in the Determinants of MI Onset Study, which enrolled over 3,800 patients hospitalized with confirmed Ml. Using an innovative case-crossover design, this study can compare the frequency with which patients report heavy drinking on the day of MI with their usual frequency of such intake and the frequency on the preceding day. By comparing patients to themselves, the case-crossover design eliminates confounding by factors that differ between, but not within, individuals and accurately quantifies the acute cardiac risk of heavy drinking. 3. The association of heavy episodic drinking with 4-year risk of mortality among patients who survive acute MI - This aim will be conducted in the Onset Follow-up Study, an inception cohort study of the first 1,935 patients in the Determinants of MI Onset Study. This study has rich detail on clinical, demographic, and lifestyle determinants of prognosis among patients with CHD. Taken together, these three components will explore the role of heavy episodic drinking in the development of acute MI - both chronically and acutely - and in the prognosis of patients who survive acute MI. These results may prove to have important biological, clinical, and public health implications for the care of CHD.