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Alcohol and coronary artery calcium prevalence, incidence, and progression: results from the Multi-Ethnic Study of Atherosclerosis (MESA)^1,2,3

¹ From the Department of Biostatistics, University of Washington, Seattle, WA (RLM and RAK); the National Institutes of Health, Bethesda, MD (DEB); the Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC (GLB); the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (KJM); and the Department of Cardiology, Johns Hopkins University, Baltimore, MD (JAL)

² Supported by contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute.

³ Reprints not available. Address correspondence to RL McClelland, Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Building 29, Suite 310, 6200 NE 74th Street, Seattle, WA 98115. E-mail: rmcclell{at}u.washington.edu.

Background: Alcohol use has been consistently found to have a J-shaped association with coronary heart disease, with moderate drinkers exhibiting a decreased risk compared with both heavy drinkers and nondrinkers. However, results of studies of the association between alcohol use and subclinical coronary artery disease are conflicting.

Objective: The objective was to determine whether alcohol is associated with the presence, amount, or progression of coronary calcium over a 2- to 4-y period.

Design: The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective community-based cohort study of subclinical cardiovascular disease in a multi-ethnic cohort. In 2000–2002, 6814 participants free of clinical cardiovascular disease were enrolled at 6 participating centers.

Results: The subjects consisted of 3766 (55.5%) current drinkers, 1635 (24.1%) former drinkers, and 1390 (20.5%) never drinkers. Although light-to-moderate alcohol consumption was associated with lower coronary heart disease risk, we found no evidence of a protective or J-shaped association of alcohol and coronary artery calcium (CAC). In fact, there was evidence that heavy consumption of hard liquor was associated with greater CAC accumulation. Other alcoholic beverages were not associated with CAC prevalence, incidence, or progression.

Conclusions: This was the first large study to evaluate the association of alcohol with CAC in 4 racial-ethnic groups and to evaluate the progression of calcification. These results suggest that the cardiovascular benefits that may be derived from light-to-moderate alcohol consumption are not mediated through reduced CAC accumulation.