Alcohol use and cardiovascular risk in a prospective cohort study of Latino Adults: the mediating effect of inflammation
Authors: Arevalo Sandra P , Bazzi Angela Roberston , Falcon Luis M , Tucker Katherine L 
Published: November 2023

Background

Moderate alcohol consumption has been associated with reduced risk of cardiovascular disease (CVD), which may be due to anti‐inflammatory effects of moderate alcohol use. However, most studies examining the alcohol‐CVD association have focused on healthy, non‐Hispanic white populations using cross‐sectional designs.

Methods and Results

To examine alcohol intake and CVD risk (measured by the 10‐year Framingham risk score, FRS‐10y) in an ethnic minority population, we drew from the Boston Puerto Rican Health Study, a prospective, population‐based cohort of 866 older Puerto Ricans (aged 45–75 years) with high prevalence of obesity, type 2 diabetes, and metabolic syndrome. We also evaluated the inflammatory marker C‐reactive protein (CRP) as a mediator. In prospective multivariable models, moderate alcohol use had a significant indirect and protective effect on FRS‐10y through CRP (β=−0.16; bias‐corrected 95% CI: −0.35 to −0.05) after adjusting for age, sex, education, smoking, body mass index, physical activity level, dietary quality, language acculturation, and white blood cell concentration.

Conclusions

Results from this large longitudinal study of Puerto Ricans are in line with findings suggesting that the link between moderate alcohol consumption and cardiovascular health may be primarily through an anti‐inflammatory effect. We add to the alcohol‐CVD literature by longitudinally demonstrating the relationships between alcohol consumption, anti‐inflammatory effects, and reduced CVD risk in Puerto Rican adults, a group at high CVD risk.

Support or Funding Information

Grant Funding Source: This study was funded by the National Heart, Lung, and Blood Institute; National Institutes of Health (Grant 5P50HL105185, Katherine L. Tucker, PhD, Principal Investigator)

Effects of Alcohol Use (baseline), and the Mediating Effect of C‐reactive Protein (CRP), on 10y risk of Coronary Heart Disease (FRS‐10y) at follow‐up

Path αAlcohol→ CRP
Path βCRP→ FRS‐10y
Path tAlcohol→ FRS‐10y
Path t′Alcohol→ FRS‐10y (adj.CRP)
α × β

β
(95% C.I.)
β
(95% C.I.)
β
(95% C.I.)
β
(95% C.I.)
β
(95% C.I.*)

Alcohol use

No use (ref.)

‐

‐

‐

‐

‐

Moderate
−0.21
(−0.35 −0.07)

‐
−0.34
(−1.4 0.68)
−0.18
(−1.2 0.83)
−0.16
(−0.35 −0.05)

Heavy
−0.21
(−0.47 0.04)

‐
0.43
(−1.4 2.3)
0.59
(−1.2 2.3)
−0.16
(−0.46 0.01)

CRP

0.77
(0.31 1.2)

All models adjusted for sex, age, education, language acculturation level, physical activity score, dietary quality, BMI, smoking status, and white blood cell count

Bias‐correct 95% Confidence Interval based on 5000 replications

IV=Alcohol use at baseline; Mediator=CRP (average of baseline and follow‐up); DV=FRS‐10y at follow‐up

Path α quantifies the effect of IV on Mediator; Path β: quantifies the effect of Mediator on DV; Path t: total effect of IV on DV when Mediator is not included; Path t′: direct effect of IV on DV adjusting for Mediator; α × β: quantifies indirect effect of IV on DV through the Mediator