酒精悖論：利用世代資料庫數據探討酒精對重大不良心血管事件的影響

The Alcohol Paradox: Investigating the Impact of Alcohol on Major Adverse Cardiovascular Events Using LIONS Data

目的：本研究旨在探討台灣成年人酒精攝取量與重大不良心血管事件(major cardiovascular events, MACE)風險之間的關聯性。

方法：這是一個在台灣北部進行的前瞻性世代研究，共納入5,145名參與者進行分析。透過問卷調查收集參與者的社會經濟狀況、過去病史、藥物使用情形以及生活型態等相關資料。主要終點為重大不良心血管事件，並依據ICD-9及ICD-10診斷編碼進行資料連結。採用Cox 迴歸模型計算各酒精攝取量分類之風險比值(hazard ratio, HR)及95%信賴區間(CI)，並在模型中調整年齡、BMI、吸菸狀態及糖尿病病史等干擾因子。

結果：本次分析中，包含男性2,167人、女性2,978人。於男性組中，隨著每週酒精攝取量臨界值(cut-off level)提高，重度飲酒組的重大不良心血管事件風險比值逐漸上升，並於每週攝取420克時達到統計學顯著差異(HR=1.657，p=0.034)。相對之下，輕度飲酒組的風險比值低於1，暗示可能存在一定保護效應，但未達統計顯著性。於女性組中，儘管重度飲酒組的重大不良心血管事件風險比值亦隨攝取量增加而上升，但尚未達顯著水準；而輕度飲酒組的危險比仍超過1，顯示不同酒精攝取量在女性族群中皆可能增加重大不良心血管事件風險，但尚未達到統計顯著水準。

結論：在調整了年齡、身體質量指數(body mass index)、吸菸狀態及糖尿病病史後，酒精攝取量仍為重大不良心血管事件的重要影響因子，尤以男性為甚。於男性中觀察到J曲線現象，當每週酒精攝取量超過420克時，其重大不良心血管事件風險顯著高於非飲酒者。相較之下，女性組中重大不良心血管事件危險比雖隨酒精攝取量增加而上升，但尚未達到統計顯著性，需要更多研究來確認。

 

Purpose: This study aimed to examine the association between alcohol consumption and the risk of major adverse cardiovascular events (MACE) among Taiwanese adults.

Methods: This prospective cohort study was conducted in northern Taiwan, including 5,145 participants. Data were collected through questionnaires covering socio-economic status, medical history, medication use, and lifestyle factors. MACE, the primary endpoint, was identified using ICD-9 and ICD-10 diagnostic codes. Hazard ratios (HR) and 95% confidence intervals (CI) for each alcohol consumption category were estimated using a Cox proportional hazards model, adjusted for age, body mass index (BMI), smoking status, and diabetes history.

Results: A total of 2,167 males and 2,978 females participated. Among males, the hazard ratio for MACE increased progressively with higher weekly alcohol consumption, reaching statistical significance at a cut-off of 420g (HR=1.657, p=0.034). In light drinkers, the HR was below 1, suggesting a potential protective effect, although not statistically significant. Among females, the HR for MACE also increased with higher alcohol consumption, but it did not reach statistical significance. In light drinkers, the HR remained above 1, indicating an increased risk, though this was not statistically significant.

Conclusion: After adjusting for age, BMI, smoking status, and diabetes history, alcohol consumption was found to be a significant risk factor for MACE, particularly in males. A J-shaped relationship was observed in males, where weekly alcohol consumption exceeding 420g was associated with a significantly higher risk of MACE compared to non-drinkers. In females, while alcohol consumption appeared to increase the risk of MACE, the association did not reach statistical significance. These findings suggest that the relationship between alcohol consumption and cardiovascular risk may differ between genders, warranting further investigation to better understand these differential effects and inform public health strategies aimed at reducing alcohol-related cardiovascular risk.