东亚男性饮酒与冠心病的关系

Alcohol consumption and coronary heart disease in Eastern Asian men： a meta-analysis of prospective cohort studies

目的 探讨东亚男性饮酒对冠心病发病率、病死率和全因死亡率的影响.方法 检索Pubmed等数据库,纳入中国、日本、韩国符合入选条件的前瞻性队列研究.记录研究来源国家,例数,性别,年龄,随访期限,饮酒量,与饮酒相关的冠心病发病率、病死率及全因死亡率的相对风险等资料.应用荟萃分析,系统评价饮酒量与冠心病发病率、病死率及全国死亡率的风险效应.结果 纳入前瞻性队列研究15项;共计汇总冠心病研究对象177 723例,含冠心病患者2406例;全因死亡研究对象216 233例,含各种原因死亡15 462例.与不饮酒者比较,每日饮酒量≤20、21～40、41～60、＞60g/d者冠心病发病风险分别为0.65（95%CI：0.34～1.23,P=0.18）、0.48（95%CI：0.26～0.87,P=0.02）、0.46（95%CI：0.32～0.67,P＜0.01）和0.48（95%CI：0.29～0.78,P＜0.01）,冠心病死亡风险分别为0.98（95%CI：0.73～1.31,P=0.87）、0.68（95%CI：0.58～0.79,P＜0.01）、0.64（95%CI：0.43～0.96,P=0.03）和0.75（95%CI：0.54～1.03,P=0.08）,全因死亡风险分别为0.83（95%CI：0.79～0.91,P＜0.01）、0.93（95%CI：0.87～0.99,P=0.03）、1.01（95%CI：0.95～1.07,P=0.86）和1.32（95%CI：1.29～1.36,P＜0.01）.结论 东亚男性适量饮酒可降低冠心病发病率及病死率.随着饮酒量增加,全因死亡的风险明显增加.每日饮用酒精量不应超过40g.

Objective To assess the dose-response relationship between alcohol consumption and relative risk of coronary heart disease （CHD） morbidity, mortality and all-cause mortality among Eastern Asian men. Methods Potential prospective cohort studies were retrieved by searching Pubmed （1966-2000）, Biosis Previews （1980-2009）, Embase （1980-2009） and ISI Web of Knowledge （1986-2009）using Medical Subject Headings alcohol drinking, ethanol, coronary heart （or artery） disease, myocardial infarction, mortality, etc; and Koreans,or Japanese or Chinese.From the 28 relevant retrieved reports,15 prospective cohort studies met the criteria were included.Information on study design,participant characteristics, level of alcohol consumption, CHD outcome, control for potential confounding factors, and risk estimates were abstracted using a standardized protocol.For each study, relative risks （RR） and 95% confidence intervals （CI） were extracted and pooled with either a fixed effect model or random effect model according to the result of the test of heterogeneity. Results Due to the limited available data for women,this study only comprised of 2406 cases of CHD among 177 723 male subjects.Findings were also pooled from 216 233 male subjects and 15 462 deaths from any cause. Compared with nondrinkers, the RRs on CHD morbidity for those who drank alcohol≤20, 21-40, 41-60,〉60g/d were 0.65 （0.34-1.23,P=0.18）, 0.48 （0.26-0.87,P=0.02）, 0.46 （0.32-0.67,P〈0.01）,and 0.48（0.29-0.78,P〈0.01 ） respectively; the RRs on CHD mortality were 0. 98 （0.73-1.31 ,P=0.87）, 0.68 （0.58-0.79,P〈0.01）, 0.64 （0.43-0.96,P=0.03）, 0.75 （0.54-1.03,P=0.08）; and on all-cause mortality were 0.83 （0.79-0.91, P〈0.01）, 0.93 （0.87-0.99, P=0.03）, 1.01 （0.95-1.07, P=0.86）,1.32 （1.29-1.36, P〈 0.01 ）. Conclusion Light-to-moderate alcohol intake was associated with decreased risk of CHD morbidity and mortality, while heavy alcohol intake was associated with increased allcause mortality among Eastern Asian men.