Alcohol,smoking, coffee and risk of non-fatal acute myocardial infarction in Italy

Objectives: To assess the relation between cigarette smoking, alcohol, coffee, decaffeinated coffee and tea consumption, and the risk of non-fatal acute myocardial infarction (AMI). Design and setting: Hospital-based case–control study conducted in 1995–1999 in Milan, Italy. Patients: 507 cases with a first episode of non-fatal AMI, and 478 controls admitted to hospital for acute diseases. Methods: Information was collected by interviewer-administered questionnaires. Odds ratios (OR) and 95% confidence intervals (CI) were calculated by multiple logistic regression. Results: Compared to alcohol non-drinkers the OR was 0.6 (95% CI: 0.4–0.9) in drinkers, and 0.5 in drinkers of >3 drinks/day. The OR for >1 drink/day of wine was 0.5, and those for beer, amari, grappa and spirits ranged between 0.4 and 0.6. Compared to never smokers, the OR was 2.2 (95% CI: 1.5–3.1) among current smokers, and 4.6 among current smokers of 25 cigarettes/day. The risk was similar to that of never smokers 5 years after cessation (OR: 1.1 after 5–9 years, 0.7 after 10 years). The OR was 2.3 for low tar cigarettes and 2.0 for high tar ones. The OR for coffee intake (expresso and mocha) was around unity up to 3 cups/day, but rose to 1.9 (95% CI: 1.1–3.3) for 6 cups/day. Moderate decaffeinated coffee and tea intake was not associated with AMI risk. Compared to non-smokers drinking 3 cups of coffee/day, the OR was 1.6 among non-smokers drinking >3 cups of coffee/day and 3.3 (95% CI: 2.1–5.0) among current smokers drinking >3 cups of coffee/day. Compared to alcohol drinkers with a coffee intake of 3 cups/day, alcohol non-drinkers with higher coffee intake had an OR of 2.2, and compared to non-smokers alcohol drinkers, the OR was 3.3 in current smokers alcohol non-drinkers. Conclusions: In this Italian population alcohol intake was inversely associated to AMI risk, while smoking and heavy (but not moderate) coffee drinking increased the risk.