Abstract P044: Alcohol Consumption, Statin Use and Risk of All-Cause Mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort
Background: Moderate alcohol consumption is associated with a lower risk of all-cause mortality while heavy alcohol intake increases this risk. Statins also reduce all-cause mortality. In recent years, use of statins has increased, resulting in frequent joint exposure to both alcohol and statins, but whether moderate alcohol consumption confers a mortality benefit beyond that from statin therapy is not known.
Methods: We followed 23,555 black and white men and women in the REGARDS cohort to determine whether statin use modifies effects of alcohol consumption on the risk of all-cause mortality. Alcohol consumption, statin use, and data on potential confounders were assessed at baseline while occurrence of clinical events including death was assessed by telephone every 6 months. Participants were classified as never, past, moderate (≤2 drinks/day for men, ≤ 1 drink/day for women) and heavy drinkers (>2 drinks/day for men, >1 drink/day for women). Statin use was defined as use of any statin regardless of type or dose. Cox-regression analyses were used to test whether alcohol intake was associated with mortality and whether there was an interaction with statin use. Models included baseline age, sex, BMI, race, region, smoking, income, education, marital status, diabetes, stroke, hypertension, coronary artery disease, regular use of anti-inflammatory medications, alcohol use, statin use and alcohol*statin use interaction term.
Results: Over a median follow-up of 6.1 years there were 3,076 deaths. Most participants (65%) consumed alcohol, but even among heavy drinkers (n=1,105), only 341 participants reported consuming >3 drinks/day. Statins were used by 31%, 36%, 32% and 28% of never, past, moderate and heavy drinkers, respectively. We observed a significant interaction between alcohol consumption and statin use with regard to risk of all-cause mortality (P <0.0001 for main effects and the interaction). In fully adjusted models and using never drinkers as the referent group, the hazard ratios and 95% confidence intervals for all-cause mortality for past, moderate and heavy drinkers were 1.12 (0.99-1.25), 0.73 (0.65-0.82) and 0.91 (0.73-1.13), respectively, among non-statin users, while they were 0.88 (0.76-1.03), 0.87 (0.75-1.01) and 0.49 (0.32-0.75) among statin users. In cross-sectional analyses of baseline data, alcohol intake was positively associated with HDL-C and inversely associated with CRP and triglycerides, with significant interactions between alcohol consumption and statin use for all three markers (P for interaction <0.01 for all).
Conclusions: Statin use is common among heavy drinkers. Our data show that alcohol consumption at levels observed in this study is inversely associated with risk of all-cause mortality, and its effects may be synergistic to those of statins. Future studies with adequate sample size of heavy drinkers are needed to confirm these findings.
Author Disclosures: E.K. Kabagambe: None. J.N. Kiage: None. S.E. Judd: None. J.C. Slaughter: None. L. Lipworth: None. U. Sampson: None. L. Djousse: None. E.B. Rimm: None. M. Cushman: None. S. Fazio: B. Research Grant; Modest; Isis Pharmaceuticals, Merck. G. Consultant/Advisory Board; Modest; Merck, Kowa, Sanofi-Aventis, Roche, Amarin, Lupin, BASF. M. Safford: None. V.J. Howard: None. G. Howard: None.
- © 2015 by American Heart Association, Inc.