Alcohol consumption and inflammatory markers in older adults: the Cardiovascular Health Study


      Objective: We sought to determine the relation of alcohol intake and systemic inflammation in a population-based sample of older adults. Methods and results: As part of the Cardiovascular Health Study (CHS), 5865 adults aged 65 years and older reported their intake of beer, wine, and liquor. We determined white blood cell count (WBC), factor VIII coagulant activity (factor VIIIc), and levels of C-reactive protein (CRP), fibrinogen, and albumin as markers of systemic inflammation. Among participants without confirmed cardiovascular disease, alcohol consumption was inversely associated with WBC, factor VIIIc, and fibrinogen level, and positively associated with albumin concentration in multivariate analyses. We found no consistent modification of these results by sex, obesity, or beverage type. The relation of alcohol use and CRP levels was significantly modified by apoE genotype (P interaction 0.03), with a positive association among participants with an apoE4 allele (P=0.05), but a trend toward an inverse association among those without an apoE4 allele (P=0.15). Conclusions: Alcohol intake is associated with lower levels of inflammatory markers in older adults free of cardiovascular disease.


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        • Ross R
        Atherosclerosis—an inflammatory disease.
        N. Engl. J. Med. 1999; 340: 115-126
        • Stary H.C
        • Chandler A.B
        • Glagov S
        • Guyton J.R
        • Insull Jr., W
        • Rosenfeld M.E
        • et al.
        A definition of initial, fatty streak, and intermediate lesions of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association.
        Circulation. 1994; 89: 2462-2478
        • Ridker P.M
        • Hennekens C.H
        • Buring J.E
        • Rifai N
        C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women.
        N. Engl. J. Med. 2000; 342: 836-843
      1. Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997;336:973–9 [Erratum in: N Engl J Med 1997;337:356].

        • Danesh J
        • Collins R
        • Appleby P
        • Peto R
        Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies.
        JAMA. 1998; 279: 1477-1482
        • Sakkinen P.A
        • Wahl P
        • Cushman M
        • Lewis M.R
        • Tracy R.P
        Clustering of procoagulation, inflammation, and fibrinolysis variables with metabolic factors in insulin resistance syndrome.
        Am. J. Epidemiol. 2000; 152: 897-907
        • Tracy R.P
        • Arnold A.M
        • Ettinger W
        • Fried L
        • Meilahn E
        • Savage P
        The relationship of fibrinogen and factors VII and VIII to incident cardiovascular disease and death in the elderly: results from the Cardiovascular Health Study.
        Arterioscler. Thromb. Vasc. Biol. 1999; 19: 1776-1783
        • Imhof A
        • Froehlich M
        • Brenner H
        • Boeing H
        • Pepys M.B
        • Koenig W
        Effect of alcohol consumption on systemic markers of inflammation.
        Lancet. 2001; 357: 763-767
        • Albert M.A
        • Glynn R.J
        • Ridker P.M
        Alcohol consumption and plasma concentration of C-reactive protein.
        Circulation. 2003; 107: 443-447
        • Stewart S.H
        • Mainous III, A.G
        • Gilbert G
        Relation between alcohol consumption and C-reactive protein levels in the adult US population.
        J. Am. Board Fam. Pract. 2002; 15: 437-442
        • Mennen L.I
        • Balkau B
        • Vol S
        • Caces E
        • Eschwege E
        Fibrinogen: a possible link between alcohol consumption and cardiovascular disease? DESIR Study Group.
        Arterioscler. Thromb. Vasc. Biol. 1999; 19: 887-892
        • Mukamal K.J
        • Jadhav P.P
        • D’Agostino R.B
        • Massaro J.M
        • Mittleman M.A
        • Lipinska I
        • et al.
        Alcohol consumption and hemostatic factors: analysis of the framingham offspring cohort.
        Circulation. 2001; 104: 1367-1373
        • Rimm E.B
        • Williams P
        • Fosher K
        • Criqui M
        • Stampfer M.J
        Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors.
        BMJ. 1999; 319: 1523-1528
        • Sierksma A
        • Van Der Gaag M.S
        • Kluft C
        • Hendriks H.F
        Moderate alcohol consumption reduces plasma C-reactive protein and fibrinogen levels: a randomized, diet-controlled intervention study.
        Eur. J. Clin. Nutr. 2002; 56: 1130-1136
        • Cushman M
        • Yanez D
        • Psaty B.M
        • Fried L.P
        • Heiss G
        • Lee M
        • et al.
        Association of fibrinogen and coagulation factors VII and VIII with cardiovascular risk factors in the elderly: the Cardiovascular Health Study.
        Am. J. Epidemiol. 1996; 143: 665-676
        • Corella D
        • Tucker K
        • Lahoz C
        • Coltell O
        • Cupples L.A
        • Wilson P.W
        • et al.
        Alcohol drinking determines the effect of the APOE locus on LDL-cholesterol concentrations in men: the Framingham Offspring Study.
        Am. J. Clin. Nutr. 2001; 73: 736-745
        • Kauma H
        • Savolainen M.J
        • Rantala A.O
        • Lilja M
        • Kervinen K
        • Reunanen A
        • et al.
        Apolipoprotein E phenotype determines the effect of alcohol on blood pressure in middle-aged men.
        Am. J. Hypertens. 1998; 11: 1334-1343
        • Lussier-Cacan S
        • Bolduc A
        • Xhignesse M
        • Niyonsenga T
        • Sing C.F
        Impact of alcohol intake on measures of lipid metabolism depends on context defined by gender, body mass index, cigarette smoking, and apolipoprotein E genotype.
        Arterioscler. Thromb. Vasc. Biol. 2002; 22: 824-831
        • Mukamal K.J
        • Kuller L.H
        • Fitzpatrick A.L
        • Longstreth Jr., W.T
        • Mittleman M.A
        • Siscovick D.S
        Prospective study of alcohol consumption and risk of dementia in older adults.
        JAMA. 2003; 289: 1405-1413
        • Fried L.P
        • Borhani N.O
        • Enright P
        • Furberg C.D
        • Gardin J.M
        • Kronmal R.A
        • et al.
        The Cardiovascular Health Study: design and rationale.
        Ann. Epidemiol. 1991; 1: 263-276
      2. Cardiovascular Health Study Public Use Data. Record 25: Nutrition History. Accessed at:

        • Cushman M
        • Cornell E.S
        • Howard P.R
        • Bovill E.G
        • Tracy R.P
        Laboratory methods and quality assurance in the Cardiovascular Health Study.
        Clin. Chem. 1995; 41: 264-270
        • Macy E.M
        • Hayes T.E
        • Tracy R.P
        Variability in the measurement of C-reactive protein in healthy subjects: implications for reference intervals and epidemiological applications.
        Clin. Chem. 1997; 43: 52-58
        • Kuller L.H
        • Shemanski L
        • Psaty B.M
        • Borhani N.O
        • Gardin J
        • Haan M.N
        • et al.
        Subclinical disease as an independent risk factor for cardiovascular disease.
        Circulation. 1995; 92: 720-726
        • Taylor H.L
        • Jacobs Jr., D.R
        • Schucker B
        • Knudsen J
        • Leon A.S
        • Debacker G
        A questionnaire for the assessment of leisure time physical activities.
        J. Chronic. Dis. 1978; 31: 741-755
        • Kronmal R.A
        • Hart R.G
        • Manolio T.A
        • Talbert R.L
        • Beauchamp N.J
        • Newman A
        Aspirin use and incident stroke in the Cardiovascular Health Study.
        Stroke. 1998; 29: 887-894
        • Kuller L.H
        • Shemanski L
        • Manolio T
        • Haan M
        • Fried L
        • Bryan N
        • et al.
        Relationship between ApoE, MRI findings, and cognitive function in the Cardiovascular Health Study.
        Stroke. 1998; 29: 388-398
        • Van Lenten B.J
        • Navab M
        • Shih D
        • Fogelman A.M
        • Lusis A.J
        The role of high-density lipoproteins in oxidation and inflammation.
        Trends Cardiovasc. Med. 2001; 11: 155-161
        • Rimm E.B
        • Stampfer M.J
        Wine, beer, and spirits: are they really horses of a different color?.
        Circulation. 2002; 105: 2806-2807
        • Mukamal K.J
        • Longstreth Jr., W.T
        • Mittleman M.A
        • Crum R.M
        • Siscovick D.S
        Alcohol consumption and subclinical findings on magnetic resonance imaging of the brain in older adults: the Cardiovascular Health Study.
        Stroke. 2001; 32: 1939-1946
        • Balleisen L
        • Bailey J
        • Epping P.H
        • Schulte H
        • van de Loo J
        Epidemiological study on factor VII, factor VIII and fibrinogen in an industrial population. I. Baseline data on the relation to age, gender, body-weight, smoking, alcohol, pill-using, and menopause.
        Thromb. Haemost. 1985; 54: 475-479
        • Iso H
        • Folsom A.R
        • Wu K.K
        • Finch A
        • Munger R.G
        • Sato S
        • et al.
        Hemostatic variables in Japanese and Caucasian men: plasma fibrinogen, factor VIIc, factor VIIIc, and von Willebrand factor and their relations to cardiovascular disease risk factors.
        Am. J. Epidemiol. 1989; 130: 925-934
        • Conlan M.G
        • Folsom A.R
        • Finch A
        • Davis C.E
        • Sorlie P
        • Marcucci G
        • et al.
        Associations of factor VIII and von Willebrand factor with age, race, sex, and risk factors for atherosclerosis: the Atherosclerosis Risk in Communities (ARIC) Study.
        Thromb. Haemost. 1993; 70: 380-385
        • Mili F
        • Flanders W.D
        • Boring J.R
        • Annest J.L
        • DeStefano F
        The associations of alcohol drinking and drinking cessation to measures of the immune system in middle-aged men.
        Alcohol Clin. Exp. Res. 1992; 16: 688-694
        • Yarnell J.W
        • Sweetnam P.M
        • Rumley A
        • Lowe G.D
        Lifestyle and hemostatic risk factors for ischemic heart disease: the Caerphilly Study.
        Arterioscler. Thromb. Vasc. Biol. 2000; 20: 271-279
        • Nakanishi N
        • Yoshida H
        • Okamoto M
        • Matsuo Y
        • Suzuki K
        • Tatara K
        Association of alcohol consumption with white blood cell count: a study of Japanese male office workers.
        J. Int. Med. 2003; 253: 367-374
        • Whitehead T.P
        • Robinson D
        • Allaway S.L
        • Hale A.C
        The effects of cigarette smoking and alcohol consumption on blood haemoglobin, erythrocytes and leucocytes: a dose related study on male subjects.
        Clin. Lab. Haematol. 1995; 17: 131-138
        • Inoue O
        • Seiji K
        • Takahashi M
        • Kudo K
        • Nakatsuka H
        • Watanabe T
        • et al.
        Subtle increase in leukocyte counts in association with drinking and smoking habits.
        Int. Arch. Occup. Environ. Health. 1995; 66: 383-388
        • Parry H
        • Cohen S
        • Schlarb J.E
        • Tyrrell D.A
        • Fisher A
        • Russell M.A
        • et al.
        Smoking, alcohol consumption, and leukocyte counts.
        Am. J. Clin. Pathol. 1997; 107: 64-67
        • Chan-Yeung M
        • Ferreira P
        • Frohlich J
        • Schulzer M
        • Tan F
        The effects of age, smoking, and alcohol on routine laboratory tests.
        Am. J. Clin. Pathol. 1981; 75: 320-326
        • Cockerill G.W
        • Rye K.A
        • Gamble J.R
        • Vadas M.A
        • Barter P.J
        High-density lipoproteins inhibit cytokine-induced expression of endothelial cell adhesion molecules.
        Arterioscler. Thromb. Vasc. Biol. 1995; 15: 1987-1994
        • Dufouil C
        • Tzourio C
        • Brayne C
        • Berr C
        • Amouyel P
        • Alperovitch A
        Influence of apolipoprotein E genotype on the risk of cognitive deterioration in moderate drinkers and smokers.
        Epidemiology. 2000; 11: 280-284
        • Bovill E.G
        • Bild D.E
        • Heiss G
        • Kuller L.H
        • Lee M.H
        • Rock R
        • et al.
        White blood cell counts in persons aged 65 years or more from the Cardiovascular Health Study: correlations with baseline clinical and demographic characteristics.
        Am. J. Epidemiol. 1996; 143: 1107-1115
        • Giovannucci E
        • Colditz G
        • Stampfer M.J
        • Rimm E.B
        • Litin L
        • Sampson L
        • et al.
        The assessment of alcohol consumption by a simple self-administered questionnaire.
        Am. J. Epidemiol. 1991; 133: 810-817
        • Naimi T.S
        • Brewer R.D
        • Mokdad A
        • Denny C
        • Serdula M.K
        • Marks J.S
        Binge drinking among US adults.
        JAMA. 2003; 289: 70-75