IJCS | Volume 31, Nº3, May/ June 2018

236 than one drink of alcoholic beverage daily for women and more than two drinks for men. In addition, 4,168 individuals did not report the frequency of consumption, resulting in a final sample of 6,632 patients. The isolated or combined indications for ESE were: assessment of chest pain; preoperative assessment for non-cardiac surgery; positive exercise test (ET) for myocardial ischemia in patients at low risk for CAD; negative ET for myocardial ischemia in patients at intermediate risk for CAD; arrhythmia during ET; stratification of previously established CAD; and risk stratification after acute coronary syndrome. The study patients were divided into two groups according to their frequency of alcoholic beverage intake as follows: G1 - 2,130 (32.1%) patients reporting a maximum daily consumption of one drink (women) or two drinks (men); and G2 - 4,502 (67.9%) individuals reporting no alcohol intake. Clinical characteristics The clinical datawere collected and recordedduring an interview conducted before the ESE, by use of a standard questionnaire assessing: weight; height; symptoms, such as dyspnea and chest pain; medications; risk factors for CAD; family or personal history of heart disease; and data regarding previous CAD, such as acute myocardial infarction, and percutaneous and surgical myocardial revascularization. In addition, the results of previous laboratory and cardiovascular tests were recorded. Alcohol consumption was quantified by use of self- report as follows: low to moderate alcohol consumption, consisting of a maximum daily intake of two drinks of alcoholic beverage for men, and of one drink for women. One drink of alcoholic beverage can be defined as approximately 330 mL of common beer, 100 mL of wine, or 30 mL of distilled beverage. 10,16 Based on those parameters and on the reports in the interview, the average daily consumption for each patient was estimated. Obesity was defined as a body mass index greater than 30 kg/m². Hypercholesterolemia was defined as total cholesterol serum levels greater than 200 mg/dL (after 12-hour fasting), while hypertriglyceridemia, as triglyceride serum levels greater than 150 mg/dL (after 12-hour fasting) or use of lipid-lowering agents (statins and/or fibrates). Systemic arterial hypertension was identified in the presence of systolic blood pressure ≥ 140 mm Hg and/ Health System. Therefore, it is mandatory to identify high-risk groups that would benefit from further investigation, and low-risk groups that would not require additional investigative procedures. 4,5 There are numerous effects of alcohol consumption, most of which are harmful to health. 6,7 While its influence on deaths from external causes and on morbidity and mortality due to neoplasms is often reported, 8 the impact of low to moderate alcohol consumption on the prognosis of CAD remains uncertain. 6,8 Recent studies have described moderate alcohol consumption as cardioprotective, 7-11 although that association has been questioned. 12-15 The definition of moderate alcohol consumption varies widely (from 5 to 60 grams of ethanol per day); however no more than one drink daily of alcoholic beverage for women and up to two drinks daily for men are commonly considered moderate alcohol consumption. 10-11 More specifically, one drink of alcoholic beverage can be defined as approximately 330 mL of common beer, 100 mL of wine, or 30 mL of distilled beverage. 16 Stress echocardiography is a well-established non- invasive test to assess myocardial ischemia in patients with suspected or known CAD, to determine its diagnosis and prognosis, and to aid in therapeutic decision- making. 17 Exercise stress echocardiography (ESE) is the first choice for patients with preserved physical capacity, being safer and more versatile than pharmacological stress echocardiography. 18 This study was aimed at assessing the relationship between low to moderate alcohol consumption and the presence of myocardial ischemia on ESE. Methods This analytical and descriptive cross-sectional study was carried out from January 2000 to December 2015. Patients The convenience sample consisted initially of 10827 patients with suspected and/or established CAD, who underwent ESE at the accredited Echocardiography Laboratory (ECOLAB) of the São Lucas Hospital and Foundation ( Instituto Qualisa de Gestão - IQG) , in Aracaju city, Sergipe State. All patients older than 25 years referred to the service were included in this study, except for those who refused to participate. Of those, 27 patients were excluded due to their average intake of more Fontes et al. Alcohol consumption and myocardial ischemia on ESE International Journal of Cardiovascular Sciences. 2018;31(3)235-243 Original Article