Heavy episodic drinking has been associated with several adverse health outcomes, but its association with myocardial infarction (MI) remains uncertain, the acute risks of heavy drinking episodes on triggering of MI have not been explored, and the effects of heavy episodic drinking on prognosis of early survivors of MI is unknown. Given the complex relation of alcohol use to coronary heart disease (CHD), these issues are of immediate public health importance and may impact the clinical care of patients with CHD. This proposal aims to assess the effects of heavy episodic drinking at three points on the continuum of CHD: 1. The association of heavy episodic drinking with 16-year risk of incident MI - This aim will be addressed in over 30,000 participants of the Health Professionals Follow-up Study, a prospective cohort study that includes validated measures of alcohol intake and repeatedly updated information on potential confounders. 2. The acute risk of precipitating MI associated with episodes of heavy drinking - This aim will be addressed in the Determinants of MI Onset Study, which enrolled over 3,800 patients hospitalized with confirmed Ml. Using an innovative case-crossover design, this study can compare the frequency with which patients report heavy drinking on the day of MI with their usual frequency of such intake and the frequency on the preceding day. By comparing patients to themselves, the case-crossover design eliminates confounding by factors that differ between, but not within, individuals and accurately quantifies the acute cardiac risk of heavy drinking. 3. The association of heavy episodic drinking with 4-year risk of mortality among patients who survive acute MI - This aim will be conducted in the Onset Follow-up Study, an inception cohort study of the first 1,935 patients in the Determinants of MI Onset Study. This study has rich detail on clinical, demographic, and lifestyle determinants of prognosis among patients with CHD. Taken together, these three components will explore the role of heavy episodic drinking in the development of acute MI - both chronically and acutely - and in the prognosis of patients who survive acute MI. These results may prove to have important biological, clinical, and public health implications for the care of CHD.
