Case fatality after an acute cardiac event: the effect of smoking and alcohol consumption

J Clin Epidemiol. 2001 Jan;54(1):58-67. doi: 10.1016/s0895-4356(00)00265-1.


The objective of this study was to use a population-based register of acute cardiac events to investigate the association between survival after an acute event and history of smoking and alcohol consumption. The population was all residents of the Lower Hunter Region of Australia aged 25 to 69 years who suffered myocardial infarction or sudden cardiac death between 1986 and 1994. Among 10,170 events, 2504 resulted in death within 28 days. After adjusting for sex, age and medical history, current smokers had a similar risk of dying after an acute cardiac event to never-smokers [odds ratio (OR)=1.10, 95% confidence interval (CI) 0.94-1.29]. People who consumed more than 8 alcoholic drinks per day on more than 2 days per week (OR=1.93, 95% CI 1.39-2.69) and former moderate to heavy drinkers (OR=4.59, 95% CI 3.65-5.76) were more likely to die than people who were nondrinkers. The results of this large community study, suggesting no effect of smoking on case fatality and an increased risk of death after an acute cardiac event for heavy drinkers and former moderate to heavy drinkers, highlight the importance of a population view of case fatality. These results can also shed some light on reasons for the paradoxical results from clinical trials.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Alcohol Drinking / adverse effects*
  • Analysis of Variance
  • Death, Sudden, Cardiac / epidemiology*
  • Death, Sudden, Cardiac / etiology*
  • Diabetes Complications
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology*
  • Myocardial Infarction / mortality*
  • New South Wales / epidemiology
  • Population Surveillance
  • Registries
  • Risk Factors
  • Sensitivity and Specificity
  • Smoking / adverse effects*
  • Survival Analysis