Lifelong teetotallers, ex-drinkers and drinkers: mortality and the incidence of major coronary heart disease events in middle-aged British men

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Abstract
BACKGROUND: To determine the risk of all cause mortality and the incidence of major coronary heart disease (CHD) events in lifelong teetotallers and in ex-drinkers compared with occasional and regular drinkers. METHODS: A prospective study of middle-aged men drawn at random from one general practice in each of 24 British towns. Five years after the screening of 7735 men aged 40-59 years, 7167 provided further information on postal questionnaire enabling separation of non-drinkers into lifelong teetotallers and ex-drinkers. RESULTS: During the follow-up period of 9.8 years after the postal questionnaire there were 929 deaths from all causes and 490 major CHD events. Ex-drinkers exhibited increased cardiovascular and non-cardiovascular mortality; lifelong teetotallers showed the lowest cardiovascular mortality but a significantly increased non-cardiovascular mortality. After adjustment for confounding factors and pre-existing disease, the two non-drinking groups did not differ significantly in all cause mortality from occasional and regular drinkers (light, moderate or heavy) but lifelong teetotallers still showed a significant increase in non-cardiovascular mortality. Adjustment considerably attenuated the risk of both cardiovascular and non-cardiovascular mortality in the ex-drinkers. In men without a diagnosis of CHD, lifelong teetotallers and ex-drinkers showed similar increased relative risk (RR) of heart attacks, with regular drinkers (combined) having a significantly decreased risk compared to occasional drinkers (RR = 0.78, 95% confidence interval [CI] : 0.64-0.96) and non-drinkers (RR = 0.69, 95% CI : 0.52-0.91). This decreased risk was small in absolute terms at around 2-3 major CHD events/1000 person-years. CONCLUSIONS: Lifelong teetotallers and ex-drinkers showed a significantly increased RR of major CHD events compared with regular drinkers, although this risk is small in absolute terms. Lifelong teetotallers have a low risk of overall cardiovascular mortality and an increased risk of non-cardiovascular mortality. Non-drinkers constitute an unsuitable reference group in alcohol-related studies; occasional or even light drinkers may be more appropriate. Overall, there is no convincing evidence that light or moderate drinking has a protective effect on total or cardiovascular mortality in these middle-aged British men.

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