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ESC Congress 2003: Relation of daily alcohol consumption with the prevalence of metabolic syndrome; the ATTICA study

August 31, 2003

IMPORTANT: This press release accompanies a poster or oral session given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology

Although alcohol consumption may be considered as a component of diet, it is addressed separately owing to special interest in the association of some levels of intake, in comparison with other food items, with lower risks of coronary heart disease and stroke. The association between alcohol consumption and the development of coronary heart disease is complex and not fully understood. Observational studies support that light to moderate alcohol consumption is associated with lower risk of myocardial infarction and cardiovascular death. In contrast, heavier alcohol consumption is associated with no change or even an increase in coronary risk. The metabolic syndrome is a condition that promotes atherosclerosis and increases the risk of cardiovascular events. Also it has been reported that its prevalence is influenced by several dietary habits. The aim of this study was to examine the association between the clinical and biochemical features of the metabolic syndrome and quantity of alcohol intake in cardiovascular disease free people.

During 2001 - 2002, 1128 men (18-87 years old) and 1154 women (18-89 years old) from the greater Athens area and without any clinical evidence of cardiovascular disease in their history were randomly selected, according to the age-gender distribution provided by the National Statistical Services. Among others, we studied data regarding waist circumference, as well as high lipoprotein cholesterol, triglycerides, fasting glucose, and blood pressure levels. The metabolic syndrome was defined according to the NCEP ATP III criteria. Data on alcohol consumption was collected by serial clinical interviews and a questionnaire.

The overall prevalence of the metabolic syndrome was 453 out of 2282 participants (or 20 / 100). Therefore the odd of having the metabolic syndrome was, roughly, 1:4 or 24.6%. Of the 453 participants who met the ATP III criteria for the metabolic syndrome, 284 were males (25.2% of males) and 169 were females (14.6% of females). The majority of the participants (78% of males and 74% of females) were unaware of their condition!

570 (25%) of the participants reported that they consume at least one wineglass (100 mL, 12% ethanol) per day. Data analysis, after taking into account the effect of several potential confounders revealed that alcohol consumption was associated with higher prevalence of the metabolic syndrome. Also, alcohol consumers showed a marked increase in the adjusted odds ratio of type-2 diabetes compared with rare or no consumers. However, when quantities of alcohol were taken into account there was a U-shaped relationship between the amount and frequency of alcohol consumption and the prevalence of the metabolic syndrome. For example, compared to no alcohol consumption 1-2 wineglasses per day (100 - 200 mL of 12% ethanol concentration per 100 mL) was associated with 16% lower relative risk for having the metabolic syndrome, while alcohol consumption of 3 - 4 wineglasses / day was associated with 81% higher risk, and consumption of more than 5 wineglasses per day 2-fold the previous relative risk. The effect was attenuated when diabetics were excluded from the analysis. Timing of alcohol consumption did not influence outcome measures.

In conclusion a key message from the present study is that light alcohol consumption was associated with a lower prevalence of metabolic syndrome. On the contrary, larger quantities of alcohol consumed were associated with higher likelihood of having the metabolic syndrome.

Dr. Demosthenes Panagiotakos
Dr. Christina Chrysohoou
Assoc. Prof. Christos Pitsavos
Cardiology Clinic,
School of Medicine
University of Athens, Greece

European Society of Cardiology (ESC)