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(Circulation. 2005;112:3839-3845.)
© 2005 American Heart Association, Inc.

Coronary Heart Disease

Binge Drinking and Mortality After Acute Myocardial Infarction

Kenneth J. Mukamal, MD; Malcolm Maclure, ScD; James E. Muller, MD; Murray A. Mittleman, MD, DrPH

From the Department of Medicine (K.J.M., M.A.M.), Beth Israel Deaconess Medical Center, and the Department of Epidemiology (M.M., M.A.M.), Harvard School of Public Heath, Boston, Mass; the School of Health Information Science (M.M.), University of Victoria, Victoria, British Columbia, Canada; and the Division of Cardiology (J.E.M.), Massachusetts General Hospital, Boston, Mass.

Correspondence to Kenneth J. Mukamal, MD, MPH, MA, Beth Israel Deaconess Medical Center, 330 Brookline Ave, RO-114, Boston, MA 02215. E-mail kmukamal{at}bidmc.harvard.edu

Received July 8, 2005; revision received August 26, 2005; accepted September 12, 2005.

Background— Moderate drinkers have a lower risk of mortality after myocardial infarction (MI). Although binge drinking has been associated with a higher risk of MI in some studies, its relation to prognosis after MI is uncertain.

Methods and Results— In a prospective, inception cohort study conducted at 45 US hospitals, 1935 patients hospitalized with a confirmed MI between 1989 and 1994 underwent detailed personal interviews. Patients reported their usual frequency of binge drinking of beer, wine, and liquor, defined as intake of 3 or more drinks within 1 to 2 hours, and were followed up for mortality for a median of 3.8 years. Of 1919 eligible patients, 250 (94% men) reported binge drinking during the prior year, and a total of 318 patients died during follow-up. Binge drinkers had a 2-fold higher risk of mortality than drinkers who did not binge (hazard ratio, 2.0; 95% confidence interval, 1.3 to 3.0). A comparison of 192 binge drinkers and 192 other patients matched on propensity scores yielded a similar result. The association between binge drinking and total mortality tended to be similar among patients whose usual alcohol intake was light or heavier and for binge drinkers who consumed beer, wine, or liquor. Usual alcohol intake was inversely associated with mortality, but binge drinking completely attenuated this relation.

Conclusions— Our results suggest that alcohol consumption may be linked to potential hazards among patients who survive acute MI. Although moderate intake has been associated with lower mortality, binge drinking, even among light drinkers, appears to be associated with 2-fold higher mortality.

Key Words: alcohol • epidemiology • myocardial infarction • prognosis

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