Alcohol intake and cardiovascular disease and mortality: the role of pre-existing disease.

OBJECTIVES: Pre-existing conditions have been postulated as possible causes of the J-shaped relationship between alcohol intake and cardiovascular disease. Two research questions have been addressed in this paper. First, whether never drinkers and former drinkers differ from moderate drinkers in terms of health, and if so, which health problems contribute to this difference. Second, whether the U-shaped relationship between current alcohol intake and cardiovascular disease or all-cause mortality could in part be explained by difference in pre-existing disease burden. DESIGN, SETTING AND PARTICIPANTS: A prospective case-cohort, the Lifestyle and Health Study, consisting of 16,210 men and women aged between 45 and 70 years. Alcohol intake and risk factors were assessed at baseline with a self-administered questionnaire. Medical information was obtained from general practitioners. Cardiovascular events and mortality were followed for a period of 5 years (1996-2001). MAIN RESULTS: Never drinkers and former drinkers were less healthy than moderate drinkers. They rated their health more often as poor, and often had more diseases, such as cardiovascular disease, diabetes, and also alcohol-related diseases. The difference in disease burden did not change the observed relationship between alcohol intake and cardiovascular events, and only partially changed the U-shaped relationship between alcohol intake and all-cause mortality. CONCLUSIONS: The found difference in health between never drinkers and former drinkers compared with moderate drinkers appeared to be only a partial explanation of the observed relationships between alcohol intake and cardiovascular disease, and between alcohol intake and all-cause mortality.

Lower prevalence of heart disease but higher mortality risk during follow-up was found among nonrespondents to a cohort study.

OBJECTIVE: The primary aim was to assess the association between response behavior and health status at baseline, and survival in a 5-year follow-up period. A secondary aim was to assess whether reasons for nonresponse were associated with health status at baseline. STUDY DESIGN AND SETTING: Data came from a prospective study cohort consisting of 31,349 men and women aged 45-70 years. Objective retrospective and prospective health information derived from general practitioner registries was available for both respondents and nonrespondents. RESULTS: Results show that among respondents coronary heart disease was more prevalent. Compared with respondents, noncontacts had a higher mortality risk during follow-up. Refusals had hypercholesterolemia more often than did noncontacts, and coronary heart disease or diabetes mellitus less often. CONCLUSION: The paradoxical results that respondents are less healthy at baseline but prospectively have a lower mortality risk may point to a selection effect indicating that the 'worried ill' are more inclined to participate. This effect could imply that observed relationships between risk factors or behaviors and outcomes in cohort studies may be attenuated.

Measurement of lifetime alcohol intake: utility of a self-administered questionnaire.

Prior epidemiologic research revealing cardioprotective effects of alcohol intake has systematically neglected lifetime exposure to alcohol, which may cause serious bias in conclusions regarding drinking and heart disease risk. Departing from use of an earlier interview schedule, the authors of the present 1996-2001 cohort study developed a self-administered Lifetime Drinking History questionnaire (LDH-q). A total of 16,211 Dutch men and women older than age 45 years participated by completing the baseline questionnaire. A random sample of 3,255 men and women was used to determine the reliability and validity of the LDH-q. Test-retest reliability was assessed by means of the intraclass correlation coefficient and kappa scores. Correlations between lifetime and current intake scores were used to assess discriminant and convergent validity. Both reliability and validity appeared to be reasonably high compared with results obtained by using interview formats to measure lifetime alcohol intake. Reliability of the LDH-q was higher for men than for women, probably because of the more frequent and regular drinking of men. Indices of validity were similar for men (0.75) and women (0.70). Results show that the LDH-q can be a useful instrument in large-scale cohort studies.