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Original Article • Arq. Bras. Cardiol. 122 (10) • Oct 2025 • https://doi.org/10.36660/abc.20240744i linkcopy

Harmful Alcohol Consumption in Patients with Heart Disease: A Risk Analysis by Lifestyle Behavior – The Brazilian PROSA Project (Projeto Saúde e Álcool)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background Moderate alcohol intake appears to have a protective cardiovascular effect, whereas harmful alcohol consumption (HAC) is associated with a high rate of chronic diseases and mortality. The amount of alcohol intake has been associated with lifestyle behaviors; however, this relationship has not been assessed in patients with heart disease (HD).

Objective To evaluate the association between lifestyle behavior and HAC in HD patients.

Methods This is an observational study that included one group of patients with HD and one group of volunteers designed to assess the association of HAC with lifestyle behavior using a score of lifestyle behavior (the LBS score). We assessed alcohol consumption using the AUDIT-C test. LBS was developed by assigning 1 point to each variable – smoking; overweight or obese (body mass index ≥24.9); anxiety; depression and lack of physical activity, and classified into healthy (0/1 point), regular (2/3 points), or unhealthy (4/5 points). Statistical analysis adopted as a significance level p-value <0.05.

Results The study included 1,999 patients with HD and 2,081 volunteers. Regression analysis controlled for age and sex, revealed that regular and unhealthy LBS are independent predictors of HAC (OR= 1.35, p=0.04 and OR= 1.76, p=0.001, respectively) in HD patients, similar as volunteers. Good discrimination capability of the regression model was reported in the temporal validation (ROC 0.80). Furthermore, LBS improvements were associated with HAC reductions (p=0.02).

Conclusions This study showed that risk assessment for HAC using a new lifestyle score is a reliable predictor in HD patients. Also, it was observed that improving lifestyle behavior may help to reduce HAC.

Keywords:
Alcohol Consumption; Life Style; Heart Diseases

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Central Illustration:
Harmful Alcohol Consumption in Patients with Heart Disease: A Risk Analysis by Lifestyle Behavior – The Brazilian PROSA Project (Projeto Saúde e Álcool)

Variable	Population N = 4080	Heart Disease n = 1999	Volunteers n = 2081
Age – years±SD	57.9±16.0	63.5±14.4	45.6±14.0
Male Sex – n (%)	2116 (51.9)	1283 (64.3)	818 (40.0)
Schooling – n (%)
Elementary	1411 (34.6)	1018 (50.9)	393 (18.9)
High School	1446 (35.4)	529 (26.5)	917 (44.1)
University education	968 (23.7)	340 (17.0)	628 (30.2)
Postgraduate	164 (3.9)	37 (1.9)	127 (6.1)
*Monthly Household Income – n (%)**
Less than $523	377 (9.2)	165 (8.3)	212 (10.2)
$523-1,568	2529 (62.0)	1344 (67.2)	1185 (56.9)
$1,568-$2,613	683 (16.7)	335 (16.8)	348 (16.7)
More than $2,613	434 (10.6)	140 (7.0)	294 (14.1)
Hypertension – n (%)	1612 (39.5)	1275 (63.8)	337 (16.2)
Dyslipidemia (n, %)	941 (23.0)	823 (41.2)	118 (5.7)
Diabetes – n (%)	666 (16.3)	563 (28.2)	103 (4.9)
CKD – n (%)	91 (2.2)	91 (4.6)	-
COPD – n (%)	27 (0.7)	27 (1.4)	-
Smoking – n (%)	455 (11.1)	200 (10.0)	255 (12.3)
Obesity – n (%)	1106 (27.1)	472 (23.6)	634 (30.5)
Anxiety – n (%)	321 (7.9)	158 (7.9)	163 (7.8)
Depression – n (%)	132 (3.2)	69 (3.5)	63 (3.0)
Sedentary – n (%)	1572 (38.5)	854 (42.7)	578 (27.8)
Lifestyle Score – n (%)
Healthy	1572 (38.6)	720 (36.0)	852 (40.9)
Regular	1629 (40.0)	821 (41.1)	808 (38.8)
Unhealthy	803 (19.7)	415 (20.8)	388 (18.6)

	Heart Disease Patients			Volunteers
	Non-HAC	HAC	p	Non-HAC	HAC	p
	n = 1598	n = 341		n = 1370	n = 771
Type of beverage	n (%)	n (%)		n (%)	n (%)
Beer	383 (24.0)	144 (42.2)	<0.001	352 (25.7)	278 (36.1)	0.148
Wine	220 (13.8)	11 (3.2)	<0.001	249 (18.2)	31 (4.0)	<0.001
Spirit	50 (3.1)	9 (2.6)	0.273	47 (3.4)	18 (2.3)	0.019
Variado	628 (39.3)	175 (51.3)	0.409	422 (30.8)	441 (57.2)	<0.001

Variable (n, %)	Non-HAC	HAC	Univariate				Multivariate				Bootstrap
	Non-HAC	HAC		95.0% CI				95.0% CI				95.0% CI
	n=1309	n=772	OR	Lower	Upper	p	OR	Lower	Upper	p	OR	Lower	Upper	p
Age	48.5±13.7	40.7±12.9				<.0001	0.96	0.95	0.96	<.0001	0.96	0.95	0.96	<.0001
Male Sex	403 (30.8)	428 (55.4)	2.80	2.32	3.36	<.0001	3.00	2.46	3.68	<.0001	3.00	2.46	3.68	<.0001
Schooling
Elementary	470 (35.9)	285 (36.9)				.02
High School	557 (42.6)	359 (46.5)	1.81	0.50	6.64	.36
University education	269 (20.6)	122 (15.8)	2.58	0.72	9.20	.15
Postgraduate	12 (0.9)	3 (0.3)	2.42	0.88	8.67	.17
Family income
Less than 1 income	117 (8.9)	95 (12.7)				.02
1 to 3 incomes	765 (58.4)	418 (54.1)	0.67	0.50	0.90	.009
3 to 5 incomes	221 (16.9)	126 (16.3)	0.70	0.50	1.00	.05
More than 5 incomes	279 (9.4)	155 (14.2)	0.87	0.61	1.25	.45
Hypertension	226 (17.3)	109 (14.1)	0.78	0.61	1.01	.06
Dyslipidemia	88 (6.7)	27 (3.5)	0.51	0.32	0.78	.002
Diabetes	72 (5.5)	29 (2.8)	0.66	0.42	1.02	.06
Lifestyle
Healthy	176 (13.5)	69 (8.9)				.003
Regular	323 (24.7)	202 (26.1)	1.29	1.05	1.57	0.01	1.32	1.06	1.65	.01	1.32	1.07	1.63	.009
Unhealthy	23 (1.76)	16 (2.1)	1.39	1.09	1.78	0.009	1.47	1.12	1.93	.005	1.48	1.12	1.95	.006

Variable (n, %)	Non-HAC	HAC	Univariate				Multivariate				Bootstrap
	Non-HAC	HAC		95.0% CI				95.0% CI				95.0% CI
	n=1659	n=340	OR	Lower	Upper	p	OR	Lower	Upper	p	OR	Lower	Upper	p
Age	65.3±13.6	54.5±14.8				< 0.0001	0.95	0.94	0.96	<0.0001	0.95	0.94	0.96	<0.0001
Male Sex	1008 (65.6)	277 (81.5)	2.84	2.12	3.80	< 0.0001	2.95	2.17	3.99	<0.0001	2.95	2.16	4.03	<0.0001
Schooling
Elementary	873 (52.6)	187 (55)				< 0.0001
High School	368 (22.2)	162 (47.6)	2.10	1.61	2.62	< 0.0001
University education	254 (15.3)	86 (25.3)	1.18	2.11	9.20	0.002
Postgraduate	27 (1.6)	10 (2.9)	1.72	0.82	3.63	0.15
Family income
Less than 1 income	137 (8.3)	28 (8.2)				0.06
1 to 3 incomes	1133(68.3)	213 (62.6)	0.92	0.60	1.41	0.70
3 to 5 incomes	231 (13.9)	58 (17.0)	1.22	0.74	2.02	0.42
More than 5 incomes	107 (6.5)	33 (9.7)	1.50	0.86	2.65	0.15
Hypertension	1104 (66.5)	173 (51.0)	0.52	0.41	0.66	< 0.0001
Dyslipidemia	706 (42.5)	120 (35.3)	0.73	0.58	0.94	0.01
Diabetes	494 (30.0)	70 (20.6)	0.61	0.47	0.81	0.001
Lifestyle
Healthy	616 (37.1)	105 (31.0)				0.009
Regular	711 (42.9)	144 (42.4)	1.19	0.90	1.56	0.21	1.34	1.01	1.80	0.04	1.35	1.01	1.80	0.040
Unhealthy	325 (19.6)	90 (26.5)	1.63	1.19	2.22	0.002	1.75	1.26	2.44	0.001	1.76	1.25	1.46	0.001

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