Alcohol consumption, serum low density lipoprotein cholesterol concentration, and risk of ischaemic heart disease: six year follow up in the Copenhagen male study

Abstract Objectives : To investigate the interplay between use of alcohol, concentration of low density lipoprotein cholesterol, and risk of ischaemic heart disease. Design : Prospective study with controlling for several relevant confounders, including concentrations of other lipid fractions. Setting : Copenhagen male study, Denmark. Subjects : 2826 men aged 53-74 years without overt ischaemic heart disease. Main outcome measure : Incidence of ischaemic heart disease during a six year follow up period. Results : 172 men (6.1%) had a first ischaemic heart disease event. There was an overall inverse association between alcohol intake and risk of ischaemic heart disease. The association was highly dependent on concentration of low density lipoprotein cholesterol. In men with a high concentration (>/=5.25 mmol/l) cumulative incidence rates of ischaemic heart disease were 16.4% for abstainers, 8.7% for those who drank 1-21 beverages a week, and 4.4% for those who drank 22 or more beverages a week. With abstainers as reference and after adjustment for confounders, corresponding relative risks (95% confidence interval) were 0.4 (0.2 to 1.0; P/=3.63 mmol/l who abstained from drinking alcohol was 43% (10% to 64%). Conclusions : In middle aged and elderly men the inverse association between alcohol consumption and risk of ischaemic heart disease is highly dependent on the concentration of low density lipoprotein cholesterol. These results support the suggestion that use of alcohol may in part explain the French paradox. Key messages Key messages The low risk of ischaemic heart disease in men with a low concentration of serum low density lipoprotein cholesterol was not modified by use of alcohol The risk of ischaemic heart disease in men with a high concentration of serum low density lipoprotein cholesterol was strongly modified by use of alcohol: those who did not drink alcohol had five times the risk of ischaemic heart disease compared with those who consumed three alcoholic beverages or more a day The results support the hypothesis that the apparent discrepancy between a low risk of ischaemic heart disease and a high intake of fat, a phenomenon known as the French paradox, may partly be explained by consumption of alcohol In studies of the use of alcohol and risk of ischaemic heart disease, serum low density lipoprotein cholesterol should be regarded as a potentially strong effect modifier not as a potential confounder