Association Between Alcohol Use and Cardiovascular Self-Care Behaviors Among Male Hypertensive Veterans Affairs Outpatients: A Cross-Sectional Study

ABSTRACT

Background: Alcohol use is associated with health behaviors that impact cardiovascular outcomes in patients with hypertension, including avoiding salt, exercising, weight management, and not smoking. This study examined associations between varying levels of alcohol use and self-reported cardiovascular health behaviors among hypertensive Veterans Affairs (VA) outpatients. Methods: Male outpatients with self-reported hypertension from 7 VA sites who returned mailed questionnaires (N = 11,927) were divided into 5 levels of alcohol use: nondrinking, low-level use, and mild, moderate, and severe alcohol misuse based on AUDIT-C (Alcohol Use Disorders Identification Test—Consumption) scores (0, 1–3, 4–5, 6–7, and 8–12, respectively). For each category, adjusted logistic regression models estimated the prevalence of patients who self-reported avoiding salt, exercising, controlling weight, or not smoking, and the composite of all four. Results: Increasing level of alcohol use was associated with decreasing prevalence of avoiding salt, controlling weight, not smoking, and the combination of all 4 behaviors (P values all <.001). A linear trend was not observed for exercise (P =.83), which was most common among patients with mild alcohol misuse (P =.01 relative to nondrinking). Conclusions: Alcohol consumption is inversely associated with adherence to cardiovascular self-care behaviors among hypertensive VA outpatients. Clinicians should be especially aware of alcohol use level among hypertensive patients.

Keywords:

• Alcohol
• cardiovascular
• hypertension
• self-care

ACKNOWLEDGMENTS

A portion of this work was presented at the 2007 Association for Medical Education and Research in Substance Abuse Annual Meeting in Washington, DC, as an invited presentation.

FUNDING

This work was funded by VA HSR&D IIR grant IAC 05-206-1 and conducted with support from VA Health Services Research and Development and VA Center of Excellence for Substance Abuse Treatment and Education. The VA Ambulatory Care Quality Improvement Project (ACQUIP) was funded by VA HSR&D grants SDR96-002 and IIR99-376. Dr. Williams is supported by a Career Development Award from VA Health Services Research & Development (CDA 12-276) and is an investigator with the Implementation Research Institute (IRI) at the George Warren Brown School of Social Work at Washington University in St. Louis. IRI is supported through an award from the National Institute of Mental Health (R25 MH080916-01A2) and the Department of Veterans Affairs, Health Services Research & Development Service, Quality Enhancement Research Initiative (QUERI). Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington, or Group Health Research Institute.

AUTHOR CONTRIBUTIONS

K.B., E.W., and C.B. contributed to the study design and execution. H.S. and E.W. conducted data analyses. All authors interpreted the data. S.R. and M.F. co-wrote iterative drafts of the manuscript. All authors read, contributed to, and approved the final manuscript.