greatest in quantity information about the consequences of excessive alcohol intake is derived from studies of alcoholic males.

greatest in quantity information about the consequences of excessive alcohol intake is derived from studies of alcoholic males. on a level studie using animal models have largely exclud female research animals. Nevertheless, women account for approximately one-third of the alcohol abusers and alcoholics in the United States, and there is growing evidence that the health risk factors assocaited with alcohol use are different for women than for men (Lex 1985) This article describes epidemiologic studies that have attempted to evaluate the part of gender in the progressive growth of alcohol-induced heart disease.

CORONARY ARTERY DISEASE

Coronary artery disease (CAD) is recognized as a leading cause of death in men Although women are generally considered to be saveed from the disease, nearly 250000 women in the United States die each year of incidents related to CAD. This accounts for one-third of all female deaths (Leaf 1988)

In principally studies of men, moderate alcohol consumption has been associated with a decreased risk fo CAD compared to either abstention or heavy drinking. Discovery of this U-shaped or J-shaped association has l to the suggestion that moderate amounts of alcohol may actually put in action a protective effect on the heart (Camacho et al. 1987) (The disputation surrounding this concept is beyond the opportunity of this article; for details diocese the articles in this issue through Klatsky, pp. 289-300, and by the agency of Lands and Zakhari, pp. 304-312)

Data upon alcohol intake and the risk of coronary disease in women are sparse and inconclusive. common of the first major prospective studies upon heart disease to include women in the Framingham inquiry in which 5,209 men and women aged 30 to 62 were followed biennially since 1949 subdues were randomly selected from among 10000 men and women living in Framingham, Massachusetts (Castelli 1984)

undivided analysis of Framingham data (Gordon and Kannel 1983) showed a slight on the contrary statistically significant inverse association for the two sexes between alcohol intake and all forms of CAD when other variables were taken into account. For men relative risk (actual/expected) was lowest at the moderate consumption horizontal of 30 ounces to 59 ounce of alcohol by month. For women, risk was higher for nondrinkers and occasional drinkers (les than 9 ounce by month) than for those drinking larger quantities; the relation was inverse, if it be not that not U-shaped, because there was no indication of exces risk at high consumption flushs However, fewer women than men drank 60 or more ounce by means of month. Moreover, the arises for women, but not for men varied considerably according to the particular manifestation of CAD. The inverse relationship to alcohol consumption was strongest for angina; it was negligible for CAD-relted death, either unexpected or non-sudden (Gordon and Kannel 1983)

A different pair of authors, using basically the same dta, establish a strong U-shaped relationship with CAD mortality for male nonsmokers and heavy smoker nevertheless no relationship at all between alcohol and CAD for female nonsmokers (Friedman and Kimball 1986)

Other studies based upon the Framingham data are inconclusive with look up to to women. In a review of several of these studies, Shaper (1990) conclud that the Framingham data are inadequate for drawing any conclusions about the forces of alcohol on cardiovascular disease.

A not many studies have been conducted using alone women. Smith and colleagues (1983) deportment ed an 11-year followup of 103 women who had been admitted consecutively to sum of two units psychiatric hospitals in the St Louis, Missouri, area during 1967-1968 for alcohol-related point to be solved [i]or[/i] settleds During this period, 31 percent died, for the greatest part from alcohol-related causes. In alcoholic women the percentage of deaths caused at circulatory disease was markedly lower than in the general population.

It should be noted that the sample size in this studious mood was quite small. Moreover, 85 percent of deaths caused on circulatory disease in the general female population occurr in women 55 years and older In the alcoholic sample, 60 percent of the deaths occurr before age 55 in such a manner that there were few alcoholic women at risk for this particular disease (Smith et al. 1983)

The Nurses' Health consideration employed a much larger sample size. In 1980 87526 female nurtures aged 34 to 59, complet a dietary questionnaire, that assessed their consumption of beer, wine, and liquor. on 1984, 200 cases of rigid coronary heart disease had discloseed among these nurses, including 164 nonfatal heart attacks and 36 deaths becoming to CAD. Compared with nondrinkers, women who consum 5 grams (g) to 14 g of alcohol by day (three to nine drinks for week) had a relative risk of coronary disease of 06; women who consum 15 g to 24 g by means of day had a relative risk of 06; and women who consum 25 g or more by day had a relative risk of 04 after adjustment for risk factors for coronary disease. The authors conclud that, although the data are sparse, moderate alcohol consumption may decrease the risks of CAD (Stampfer et al. 1988)