The J-shape effect of alcohol intake on the risk of developing acute coronary syndromes in diabetic subjects: the CARDIO2000 II Study

Aim To identify the threshold of alcohol consumption above which the balance of risk and benefit becomes adverse in diabetic subjects. Methods We studied demographic, lifestyle, dietary and clinical information in 216 hospitalized diabetic patients (171 men, 63 +/- 9 years old, 45 women, 67 +/- 5 years old) with a first event of an acute coronary syndrome (ACS) and 196 frequency matched (age-sex) diabetic controls, without any clinical evidence of coronary heart disease. Alcohol consumption was quantified and a measure for the comparisons was predetermined to be a wine glass (100 ml of wine, 12 g of ethanol) and its alcohol equivalents. Results Alcohol consumption was associated with an age-adjusted J-shape relationship with total cholesterol, blood pressure and smoking (all P < 0.001). A J-shape association was also found between alcohol intake and the risk of ACS (OR = 2.54-2.43 x (alcohol intake) + 0.80 x (alcohol intake)(2), R-2 = 0.96, P < 0.001), adjusted for several risk factors and interactions between alcohol intake and smoking status, job and familial stress, and low income. In particular, low alcohol consumption (< 12 g/day) was associated with a 47% (OR = 0.53, 95% CI 0.28-0.97) reduction of the prevalence of ACS, while a higher intake (12-24 and > 24 g/day) increased the prevalence by 2.7-fold (OR = 2.72, 95% CI 1.39-5.38) and 5.4-fold (OR = 5.44, 95% CI 1.21-24.55), respectively. Conclusions Alcohol intake is a significant predictor of coronary events. Low-to-moderate intake seems to be associated with a reduction in the prevalence of ACS in diabetes, whereas higher consumption is associated with an increase in lipids and blood pressure levels, and also the risk of developing ACS.