IJCS | Volume 31, Nº3, May/ June 2018

240 Table 4 - Multivariate logistic regression with clinical parameters associated with the presence of myocardial ischemia on exercise stress echocardiography Variables Odds Ratio 95% CI p Alcohol consumption 0.94 0.81-1.01 0.463 Male sex 1.83 1.62-2.09 < 0.001 Age 1.02 1.02-1.03 < 0.001 Diabetes mellitus 1.52 1.28-1.80 < 0.001 Systemic arterial hypertension 1.55 1.34-1.79 < 0.001 Dyslipidemia 1.84 1.61-2.1 < 0.001 Smoking habit 2.03 1.55-2.64 < 0.001 Family history 1.69 1.47-1.93 < 0.001 CI: confidence interval. Table 5 - Multivariate logistic regression with clinical parameters associated with low to moderate alcohol consumption Variables Odds Ratio 95% CI p Myocardial ischemia à ESE 0.96 0.83-1.11 0.603 Male sex 5.88 5.21-6.63 < 0.001 Age 0.97 0.96-0.97 < 0.001 Smoking habit 2.73 2.11-3.54 < 0.001 Dyslipidemia 1.51 1.02-1.29 0.017 ESE: exercise stress echocardiography; CI: confidence interval. ischemia and alcohol intake evidenced in certain studies can be explained by individual differences inherent in genetic characteristics. 11 Roerecke and Rehm6 in a systematic review, have assessed 44 observational studies relating ischemic heart diseases to low to moderate alcohol consumption, between 1980 and 2010, in a total of 957,684 participants. Those authors have shown that, although there is some confirmed cardioprotective association, substantial heterogeneities remain unexplained and the confidence intervals were relatively wide, particularly between one and two drinks of alcoholic beverage daily. Therefore, the cardioprotection related to alcohol intake has been described as an association that cannot be assumed, even when assessing the level of alcohol consumption. The variables male sex, dyslipidemia and smoking habit - independent predictors of low to moderate alcohol consumption in the present study - also showed a close relationship with myocardial ischemia. In accordance with the literature, greater frequency of alcohol intake is observed among men 7,13 and together with the smoking habit, 13,14 widely identified as risk factors for myocardial ischemia. 17 Perissinotto et al. 24 have evidenced higher serum levels of LDL cholesterol and total cholesterol among the elderly whose alcohol intake was moderate, as in the present study, although that consumption has been reported as inversely associated with dyslipidemia. 11,14 The literature lacks ET and echocardiography data related to low to moderate alcohol consumption, and significant differences were evidenced in the present study. Statistical significance was observed in the relationship between alcohol consumption and larger size of the aorta and left atrium, as well as with the higher frequency of ST-segment depression and lower frequency of diastolic dysfunction and chronotropic insufficiency. Regarding the limitations of this study, those inherent in any observation study stand out, inwhich the variables not measured can contribute to the statistical differences between the groups. In addition, distinct intervals of alcohol intake could not be accurately quantified, and neither could the duration of alcohol consumption, the type of alcoholic beverage used and the previous history of that habit. Conclusion Low to moderate alcohol consumption showed not to be an independent predictor of the presence of myocardial ischemia on ESE. In the group of alcohol consumers, there were more individuals of the male sex, dyslipidemic and smokers, which are important predictors of myocardial ischemia. Author contributions Conception and design of the research: Fontes VJB, Oliveira JLM. Acquisition of data: Fontes VJB, Souto MJS, Conceição FMS, Telino CJCL, Silveira MS, Fontes et al. Alcohol consumption and myocardial ischemia on ESE International Journal of Cardiovascular Sciences. 2018;31(3)235-243 Original Article