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CORK Bibliography: Alcohol's Effects on Cardiovascular System

122 citations. January 2004 to present

Prepared: March 2008

Badia E; Sacanella E; Fernandez-Sola J; Nicolas JM; Antunez E; Rotilio D et al. Decreased tumor necrosis factor-induced adhesion of human monocytes to endothelial cells after moderate alcohol consumption. American Journal of Clinical Nutrition 80(1): 225-230, 2004. (31 refs.)

Background: Moderate alcohol consumption protects against ischemic heart disease, possibly through an antiinflammatory effect. However, little is known about the mechanisms by which alcohol may interfere in the development of atherosclerosis. Objective: We analyzed the effects of 2 alcoholic beverages with high (red wine) or low (gin) polyphenolic content on human monocyte adhesion to an endothelial cell line (Ea.hy926). Design: This was a randomized, crossover trial with 8 healthy men. After a washout period, the subjects received 30 g ethanol/d as red wine or gin for 28 d. Before and after each intervention, a dietary survey and laboratory analysis were performed. Adhesion of human monocytes to endothelial cells was measured in basal and stimulated [by tumor necrosis factor alpha (TNF-alpha)] conditions. Adhesion molecules involved in monocyte-endothelium interactions were determined on the cell surface. Results: The mean expression of very late activation antigen 4 on monocytes significantly decreased after red wine intake [by 18% (95% Cl: 33%, 3%); P = 0.022]. Monocyte adhesion significantly increased after TNF-alpha stimulation of endothelial cells. This increase, however, was 39% less (95% CI: 48%,35%; P = 0.049) after gin intake than after the respective washout period and was nearly abolished by red wine intake [96% less than after the respective washout period (95% Cl: 142%, 76%); P < 0.001]. The reduction after red wine intake was significantly different from that after gin intake (P = 0.014). Conclusions: TNF-alpha-induced adhesion of monocytes to endothelial cells was virtually abolished after red wine consumption but was only partially reduced after gin consumption. This effect may be due to the down-regulation of adhesion molecules on the monocyte surface.

Bartley M; Martikainen P; Shipley M; Marmot M. Gender differences in the relationship of partner's social class to behavioural risk factors and social support in the Whitehall II study. Social Science & Medicine 59(9): 1925-1936, 2004. (47 refs.)

In most countries health inequality in women appears to be greater when their socio-economic position is measured according to the occupation of male partners or spouses than the women's own occupations. Very few studies show social gradients in men's health according to the occupation of their female partners. This paper aims to explore the reasons for the differences in social inequality in cardiovascular disease between men and women by analysing the associations between own or spouses (or partners) socio-economic position and a set of risk factors for prevalent chronic diseases. Study participants were married or cohabiting London based civil servants included in the Whitehall II study. Socio-economic position of study participants was measured according to civil service grade; socio-economic position of the spouses and partners according to the Registrar General's social class schema. Risk factors were smoking, diet, exercise, alcohol consumption, and measures of social support. In no case was risk factor exposure more affected by the socio-economic position of a female partner than that of a male study participant. Wives' social class membership made no difference at all to the likelihood that male Whitehall participants were smokers, or took little exercise. Female participants' exercise and particularly smoking habit was, in contrast, related to their spouse's social class independently of their own grade of employment. Diet quality was affected equally by the socio-economic position of both male and female partners. Unlike the behavioural risk factors, the degree of social support reported by women participants was in general not strongly negatively affected by their husband or partner being in a less advantaged social class. However, non-employment in the husband or partner was associated with relatively lower levels of positive, and higher negative social support, while men with non-working wives or partners were unaffected. Studying gender differences in health inequality highlights some of the problems in health inequality research more broadly. We are brought face to face with the fact that the development of conceptual models that can be applied consistently to aetiology in both men and women are still at an early stage of development. Closer attention is needed to the different processes behind material power and 'emotional power' within the household when investigating gender differences in health and risk factors.

Bassus S; Mahnel R; Scholz T; Wegert W; Westrup D; Kirchmaier CM. Effect of dealcoholized beer (Bitburger Drive (R)) consumption on hemostasis in humans. Alcoholism: Clinical and Experimental Research 28(5): 786-791, 2004. (33 refs.)

Background: The beneficial effect of moderate alcohol consumption in lowering the risk of cardiovascular disease has been shown in several epidemiologic studies. Such studies have also shown, however, that the protective effect of alcoholic beverages like wine and beer is not only due to the ethanol content but also to the presence of nonalcoholic constituents. The positive effect of alcoholic beverages has been attributed to changes in lipoprotein metabolism, but there is substantial evidence that effects on hemostasis play an important role. Whether the effects of alcoholic beverages on hemostasis are due exclusively to ethanol or are due, in part, to nonalcoholic components, is still under debate.Methods: We have examined the hemostatic effects of 3 liters of beer, dealcoholized beer, and ethanol/water (v/v 4%), consumed over a period of 3 hr, in 12 young healthy volunteers. Platelet parameters CD62, PAC-1, and monocyte platelet aggregates were analyzed using flow cytometric measurements. The activity of factor VII was determined with a prothrombin time (PT) assay and plasminogen activator inhibitor activity using a chromogenic substrate. Thrombin generation was determined according to the method of Hemker. Results: All three fluids administered, dealcoholized beer, beer, and ethanol, reduced the expression of activated fibrinogen receptor, the platelet activation marker CD62, and the formation of monocyte-platelet-aggregate. In addition, dealcoholized beer also showed significant inhibitory effects on thrombin generation, whereas beer and ethanol showed procoagulatory effects.Conclusions: This study has shown that the acute consumption of dealcoholized beer inhibits thrombogenic activity in young adults. This action could have a beneficial effect on the development of coronary artery disease. Thus, the consumption of dealcoholized beer could provide cardiovascular benefit without the negative effects of alcohol.

Bau PFD; Bau CHD; Naujorks AA; Rosito GA. Early and late effects of alcohol ingestion on blood pressure and endothelial function. Alcohol 36(1): 53-58, 2006. (29 refs.)

Previous investigations have shown a biphasic effect of alcohol on blood pressure (BP). However, there are no studies on possible simultaneous influences in endothelial function. This study aims to evaluate the early and late effects of alcohol ingestion on vascular and endothelial function parameters in healthy young men. The diameter of brachial artery (DBA), endothelium-dependent flow-mediated dilatation, endothelium-independent nitroglycerin-mediated dilatation, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate were measured 30 min before intake, 4 h after intervention (when there is a reported hypotensive effect of alcohol), and after 13 h (subsequent increase in BP). The study group consisted of 100 males aged 18-25 years who were evaluated by brachial artery ultrasound. Subjects were randomized to drink either an alcoholic (60 g of ethanol) or a similar nonalcoholic beverage. Alcohol induced a biphasic effect on SBP and DBP, with a 4-h decrease followed by an increase after 13 h. After 4 h, the alcohol-drinking group presented a DBA increase that was significant at baseline and after hyperemia but not after nitroglycerin administration. There were no DBA differences between the intervention and control groups 13 h after drinking. This study replicates the initial reports of alcohol-induced biphasic alteration in BP. Our results showed that despite the late increase in BP, there were no accompanying changes in endothelial function.

Bednarska-Makaruk M; Rodo M; Markuszewski C; Rozenfeld A; Swiderska M; Habrat B et al. Polymorphisms of apolipoprotein E and angiotensin-converting enzyme genes and carotid atherosclerosis in heavy drinkers. Alcohol and Alcoholism 40(4): 274-282, 2005. (59 refs.)

Aims: To investigate the influence of apolipoprotein E (APOE) and angiotensin-converting enzyme (ACE) gene polymorphisms on carotid artery atherosclerosis in alcoholism. Methods: Polymorphism of both genes was identified by DNA analysis in 130 male alcohol-dependent patients. Intima-media thickness (IMT) was measured ultrasonographically. Results: Multivariate regression analysis showed that of all the known risk factors the greatest impact on carotid atherosclerosis in alcoholics was exerted by age, hypertension, LDL cholesterol and fasting plasma glucose levels. Subjects carrying the APO E epsilon 4 allele were more liable to develop atherosclerotic changes in carotid arteries compared with subjects with the epsilon 3/3 genotype, which showed statistical significance in patients under 50 years of age. No association was shown between ACE I/D polymorphism and carotid atherosclerosis. Conclusions: APO E polymorphism can increase the risk of carotid atherosclerosis development in an alcoholic subject. The association of the APO E epsilon 4 allele with carotid atherosclerosis was significant in younger patients. Since the elevated carotid IMT is considered to be a good marker of increased risk of generalized atherosclerosis the consequences could involve both cardiac and cerebrovascular events.

Bleich S; Carl M; Bayerlein K; Reulbach U; Biermann T; Hillemacher T. Evidence of increased homocysteine levels in alcoholism: The Franconian Alcoholism Research Studies (FARS). Alcoholism: Clinical and Experimental Research 29(3): 334-336, 2005. (14 refs.)

Background: A limited number of investigations have studied clearly defined patients with alcoholism and blood alcohol concentrations with their correlation to plasma homocysteine values and differentiated actively drinking patients from those with early abstinence. Therefore, this power analysis-based study was undertaken to determine whether plasma homocysteine levels are evidently altered in actively drinking alcoholic patients and patients with early abstinence. Methods: Two groups of patients with an established diagnosis of alcohol dependence. For both groups, a power of 90% (alpha = 0.05) was applied. Group A comprised 144 consecutively admitted actively drinking patients with alcoholism. Group B consisted of 56 patients with alcoholism who had abstained from alcohol for 24 to 72 hr before admission to the hospital. Results: Plasma homocysteine levels were significantly (t test: df = 198, t = -8.6,p < 0.0001) higher at admission when comparing group A with group B. The highly increased homocysteine levels in actively drinking patients with alcoholism were based on a strong significant positive correlation with the blood alcohol concentration (multiple regression analysis, p < 0.0001). Conclusions: Plasma homocysteine levels are evidently altered in actively drinking patients with alcoholism. Even though it has been described, the authors found no evidence for an increase of homocysteine levels in alcoholic patients with early abstinence. The current results emphasize the proposed pathogenetic role of increased plasma homocysteine levels in alcohol-related disorders (i.e., brain atrophy, alcohol withdrawal seizures).

Bohm M; Rosenkranz S; Laufs U. Alcohol and red wine: Impact on cardiovascular risk. (editorial). Nephrology, Dialysis, Transplantation 19(1): 11-16, 2004. (45 refs.)

Booth BM; Weber JE; Walton MA; Cunningham RM; Massey L; Thrush CR et al. Characteristics of cocaine users presenting to an emergency department chest pain observation unit. Academic Emergency Medicine 12(4): 329-337, 2005. (49 refs.)

Objectives: This report examines the sociodemographic and substance use characteristics, co-occurring psychological status, substance abuse consequences, and prior experiences with substance abuse treatment among patients with cocaine-associated chest pain presenting to an emergency department chest pain observation unit. Methods: This was a consecutive cohort of patients in the emergency department chest pain observation unit aged 18-60 years with low to moderate risk for acute coronary syndrome and recent cocaine use. Responses on standardized and validated instruments were used to examine demographic and clinical characteristics of the sample and to compare patients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for past three-month substance abuse or substance dependence with patients who did not. Results: Of 145 eligible patients identified between June 1, 2002, and February 29, 2004, 86% met criteria for a lifetime DSM-IV substance use disorder and 50% met past three-month criteria. Approximately one half of the total sample reported substantial symptoms of depression. Substance use frequency and consequences, depression, and psychological distress were significantly more severe among those with past three-month substance use diagnoses; however, most sociodemographic characteristics were not associated with substance. use diagnoses. Interest in treatment services and treatment history was also significantly associated with the presence of a substance use disorder diagnosis. Conclusions: Findings regarding diversity in alcohol and drug involvement, current level of psychological functioning, depressive symptomatology, and interest in treatment services provide useful information for designing emergency department-based interventions for this population.

Britton A; Marmot M. Different measures of alcohol consumption and risk of coronary heart disease and all-cause mortality: 11-year follow-up of the Whitehall II Cohort. Addiction 99(1): 109-116, 2004. (29 refs.)

Aims: To investigate the relationship between three measures of alcohol consumption obtained simultaneously in a large cohort and the validated risk of coronary heart disease and all-cause mortality during follow-up. Design: Prospective cohort study with median follow-up of 11 years. Setting: The Whitehall II Cohort Study: London-based civil service. Participants: A total of 10 308 (33% female) civil servants aged 35-55 years at baseline (1985-88). Measurements: Self-reported volume of alcohol consumed during past week, frequency of drinking over past year, usual amount consumed per drinking session. Main outcome measures: Coronary heart disease and all-cause mortality until 1999. Findings: A U-shaped relationship was found between volume of alcohol consumed per week and outcome. Compared to those who drank moderately (10-80 g alcohol per week), non-drinkers and those drinking more than 248 g per week had approximately a twofold increased risk of mortality. The optimal frequency of drinking was between once or twice a week and daily, after adjustment for average volume consumed per week. Those drinking twice a day or more had an increased risk of mortality (male hazard ratio 2.44 95% CI 1.31-4.52) compared to those drinking once or twice a week. Drinking only once a month or only on special occasions had a 50% increased risk of mortality. The usual amount consumed per drinking session was not indicative of increased health risk in this cohort. Conclusions: Epidemiological studies should collect information on frequency of drinking in addition to average volume consumed in order to inform sensible drinking advice.

Burger M; Bronstrup A; Pietrzik K. Derivation of tolerable upper alcohol intake levels in Germany: A systematic review of risks and benefits of moderate alcohol consumption. Preventive Medicine 39(1): 111-127, 2004. (292 refs.)

Background. The objective of this study is to weigh the risks of moderate alcohol consumption against its benefits and, as a result, to derive tolerable upper alcohol intake levels (TUALs) for the German adult population. Methods. Human studies assessing the effects of moderate alcohol consumption (less than or equal to40 g/day) on coronary heart disease, stroke, blood pressure, diseases of the liver, gallbladder, bile duct, and pancreas, cancer of the mouth/pharynx/larynx/oesophagus, stomach, colon/rectum, and breast, foetal alcohol syndrome/foetal alcohol effects, as well as all-cause mortality, published in the 10-15 years before 1999, have been systematically reviewed. The quality of studies has been evaluated using a self-constructed evaluation scheme. As a result of comparing the critical endpoints of alcohol intake related to morbidity and mortality, the TUALs have been derived. Results. The TUALs have been set at 10-12 g/day for healthy women and 20-24 g/day for healthy men of the adult population (18 years and older). Additional guidelines on alcohol use have been defined, taking into account further important aspects like alcohol consumption patterns and high-risk groups. Conclusions. The TUALs are not intended to be recommended intake levels. However, if the TUALs and the additional guidelines are followed, a relation of alcohol consumption to an increased risk of alcohol-associated diseases is unlikely for the majority of the population.

Burger M; Mensink G; Bronstrup A; Thierfelder W; Pietrzik K. Alcohol consumption and its relation to cardiovascular risk factors in Germany. European Journal of Clinical Nutrition 58(4): 605-614, 2004. (62 refs.)

Objective: To analyse the association of alcohol consumption and blood lipids, haemostatic factors, and homocysteine in German adults by gender and age groups. Design: Cross-sectional population-based survey.Setting: Data from the German National Health Interview and Examination Survey 1998, representative for age, gender, community size, and federal state Subjects: From a sample of 7124 Germans between 18 and 79 y old, 2420 women and 2365 men were selected. Only individuals who were not currently receiving medical treatment or did not have disorders related to cardiovascular disease were selected for this study.Results: Using analyses of variance, mean blood levels of total cholesterol, HDL cholesterol, HDL/total cholesterol ratio, total glycerides, fibrinogen, antithrombin III, and homocysteine adjusted for age, socioeconomic status, East/West Germany residence, body mass index, tobacco use, sports activity, and coffee consumption, if appropriate are presented by alcohol consumption groups (0, >0-10, >10-20, >20-30 and >30 g/day). The HDL/total cholesterol ratio increased with higher alcohol groups up to 10-20 g/day (+15%) for women and 430 g/day (+18%) for men, showing the strongest rise among men aged 55-79 y. Fibrinogen decreased with higher alcohol groups up to 10-20 g/day for women and 20-30 g/day for men. Among women, homocysteine levels showed a U-shaped curve with a minimum of 8.49 mmol/l at 10-20 g alcohol/day (8%, reference: nondrinking), whereas an inverse association was observed for men. Conclusions: Moderate alcohol consumption is associated with favourable levels of several cardiovascular risk factors. The most favourable cardiovascular risk factor profile among women was observed among those drinking 10-20 g alcohol/day. Beneficial effects seem to be more pronounced among older men.

Cooper KA; Chopra M; Thurnham DI. Wine polyphenols and promotion of cardiac health. (review). Nutrition Research Reviews 17(1): 111-129, 2004. (139 refs.)

Wine polyphenols are considered to have beneficial effects on CHD and atherosclerosis. The consumption of red wine is high in Italy and France, approximately four times greater than that in the UK. This disparity in red wine consumption is thought to be the reason for the 'French paradox', where France was shown to have a coronary mortality rate close to that of China or Japan despite saturated fat intakes and cholesterol levels similar to the UK and USA. In the present review, we discuss the effects of wine and some of its polyphenol constituents on early pathological indicators of CHD such as plasma lipids, the endothelium and vasculature, platelets and serum antioxidant activity. The review also examines whether the polyphenols or the alcohol in wine is responsible for the effects on markers of heart disease. The present review concludes that red wine polyphenols have little effect on plasma lipid concentrations but wine consumption appears to reduce the susceptibility of LDL to oxidation and increase serum antioxidant capacity. However, these effects do depend on the amount of wine and period of supplementation. Authors who have examined specific polyphenols suggest that some phenolics appear to have endothelium-dependent vaso-relaxing abilities and some a positive effect on NO concentrations. Red wine phenolics also have an inhibitory effect on platelet aggregation, and individual phenolics also have a similar effect in vitro, although it should be noted that there are often discrepancies as large as ten-fold between the concentrations of polyphenolics tested in vitro and their measured levels in vivo. Evidence suggests that alcohol has a positive synergistic effect with wine polyphenols on some atherosclerotic risk factors. Thus evidence that wine drinking is beneficial for cardiac health continues to accumulate but more research is required to understand fully and exactly the functions of red wine polyphenols.

Crabb DW; Matsumoto M; Chang D; You M. Overview of the role of alcohol dehydrogenase and aldehyde dehydrogenase and their variants in the genesis of alcohol-related pathology. Proceedings of the Nutrition Society 63(1): 49-63, 2004. (175 refs.)

Alcohol dehydrogenase (ADH) and mitochondrial aldehyde dehydrogenase (ALDH2) are responsible for metabolizing the bulk of ethanol consumed as part of the diet and their activities contribute to the rate of ethanol elimination from the blood. They are expressed at highest levels in liver, but at lower levels in many tissues. This pathway probably evolved as a detoxification mechanism for environmental alcohols. However, with the consumption of large amounts of ethanol, the oxidation of ethanol can become a major energy source and, particularly in the liver, interferes with the metabolism of other nutrients. Polymorphic variants of the genes for these enzymes encode enzymes with altered kinetic properties. The pathophysiological effects of these variants may be mediated by accumulation of acetaldehyde; high-activity ADH variants are predicted to increase the rate of acetaldehyde generation, while the low-activity ALDH2 variant is associated with an inability to metabolize this compound. The effects of acetaldehyde may be expressed either in the cells generating it, or by delivery of acetaldehyde to various tissues by the bloodstream or even saliva. Inheritance of the high-activity ADH beta2, encoded by the ADH2*2 gene, and the inactive ALDH2*2 gene product have been conclusively associated with reduced risk of alcoholism. This association is influenced by gene-environment interactions, such as religion and national origin. The variants have also been studied for association with alcoholic liver disease, cancer, fetal alcohol syndrome, CVD, gout, asthma and clearance of xenobiotics. The strongest correlations found to date have been those between the ALDH2*2 allele and cancers of the oro-pharynx and oesophagus. It will be important to replicate other interesting associations between these variants and other cancers and heart disease, and to determine the biochemical mechanisms underlying the associations.

de Lorgeril M; Salen P. Is alcohol anti-inflammatory in the context of coronary heart disease? (editorial). Heart 90(4): 355-357, 2004. (24 refs.)

Although the cardioprotective effect of alcohol has been primarily explained by its effect on blood lipids and platelets, could an anti-inflammatory mechanism be involved?

Ding JZ; Eigenbrodt ML; Mosley TH; Hutchinson RG; Folsom AR; Harris TB et al. Alcohol intake and cerebral abnormalities on magnetic resonance imaging in a community-based population of middle-aged adults: The Atherosclerosis Risk in Communities (ARIC) Study. Stroke 35(1): 16-21, 2004. (23 refs.)

Background and Purpose - Although the risks associated with heavy drinking for increased stroke and neurodegenerative changes are well established, the effects on the brain of low to moderate alcohol intake are unclear. Subclinical cerebral abnormalities identified on MRI have been associated with neurocognitive decline and incident stroke. We examined the associations of alcohol intake with MRI-defined cerebral abnormalities in a middle-aged, population-based cohort. Methods - During 1993 - 1994, a total of 1909 middle-aged adults (40% men and 49% blacks) from 2 communities in the Atherosclerosis Risk in Communities (ARIC) Study (Forsyth County, North Carolina, and Jackson, Miss) underwent a cerebral MRI examination. Trained neuroradiologists coded the images for the presence of infarction and the extent (10-point scale) of white matter lesions, ventricular size, and sulcal size. Results - In logistic regression analyses, there was no association between alcohol intake and the presence of MRI infarction. In linear regression analyses, alcohol intake was not associated with white matter grade. However, intake of each additional alcoholic drink per week was associated with a 0.01 grade greater ventricular size (P = 0.03) and a 0.009 grade greater sulcal size (P = 0.02) after adjustment for age, sex, race, body mass index, smoking, income, sports index, and diabetes. The positive associations of alcohol intake with ventricular and sulcal size were consistent across sex and race subgroups. Conclusions - A protective effect of low to moderate alcohol intake on cerebral infarction was not found; moreover, increased alcohol intake was associated with brain atrophy.

Djousse L; Levy D; Benjamin EJ; Blease SJ; Russ A; Larson MG et al. Long-term alcohol consumption and the risk of atrial fibrillation in the Framingham Study. American Journal of Cardiology 93(6): 710-713, 2004. (18 refs.)

Atrial fibrillation (AF) is a major risk factor for stroke. Although acute alcohol intake has been associated with AF, it is not known whether long-term alcohol consumption in moderation is associated with an increased risk of AF. We used a risk set method to assess the relation of long-term alcohol consumption to the risk of AF among participants in the Framingham Study. For each case, up to 5 controls were selected and matched for age, age at baseline examination, sex, cohort, baseline history of hypertension, congestive heart failure, and myocardial infarction. Within each risk set, alcohol consumption was averaged from baseline until the examination preceding the index case of AF. Of the 1,055 cases of AF occurring during. a follow-up of >50 years, 544 were men and 511 were women. in a conditional logistic regression with additional adjustment for systolic blood pressure, age at baseline examination, education, and cumulative history of myocardial, infarction, congestive heart failure, diabetes mellitus, left ventricular hypertrophy, and valvular heart disease, the relative risks were 1.0 (reference), 0.97 (95% confidence interval [CI] 0.78 to 1.22), 1.06 (95% CI 0.80 to 1.38), 1.12 (95% CI 0.80 to 1.55), and 1.34 (95% CI 1.01 to 1.78) for alcohol categories of 0, 0.1 to 12, 12.1 to 24, 24.1 to 36, and >36 g/day, respectively. In conclusion, our data indicate little association between long-term moderate alcohol consumption and the risk of AF, but a significantly increased risk of AF among subjects consuming >36 g/day (approximately >3 drinks/day).

Egred M; Viswanathan G; Davis GK. Myocardial infarction in young adults. (review). Postgraduate Medical Journal 81(962): 741-745, 2005. (67 refs.)

Although myocardial infarction (MI) mainly occurs in patients older than 45, young men or women can suffer MI. Fortunately, its incidence is not common in patients younger than 45 years. However, the disease carries a significant morbidity, psychological effects, and financial constraints for the person and the family when it occurs at a young age. The causes of MI among patients aged less than 45 can be divided into four groups: (1) atheromatous coronary artery disease; (2) non-atheromatous coronary artery disease; (2) hyper-coagulable states; (4) MI related to substance misuse. There is a considerable overlap between all the groups. This article reviews the literature and highlights the practical issues involved in the management of young adults with MI.

Fatjo F; Fernandez-Sola J; Lluis M; Elena M; Badia E; Sacanella E et al. Myocardial antioxidant status in chronic alcoholism. Alcoholism: Clinical and Experimental Research 29(5): 864-870, 2005. (46 refs.)

Background: Excessive ethanol intake is one of the most frequent causes of acquired dilated cardiomyopathy in developed countries. The pathogenesis is multifactorial, with the antioxidant imbalance of cardiac muscle being a potential factor. The current study evaluates myocardial antioxidant status in ethanol consumers and its relation to cardiac damage. Methods: The authors assessed superoxide dismutase, glutathione peroxidase, and glutathione reductase enzyme activities as well as the total antioxidant status capacity in myocardial samples obtained from organ donors with sudden death of traumatic or neurological origin. They studied 23 high-dose chronic alcohol consumers, 27 individuals with long-standing hypertension, and 11 healthy controls. Cardiomyopathy was defined according to standard functional and histological criteria. Results: Patients with dilated cardiomyopathy, either of alcoholic or hypertensive origin, showed increased myocardial superoxide dismutase activities compared with patients without cardiomyopathy (p < 0.001, both) and controls (p < 0.05, both). Total antioxidant status capacity and the activity of glutathione peroxidase and glutathione reductase enzymes were similar in all groups. Superoxide dismutase activity was related to the presence of cardiac enlargement and the degree of cardiac histological damage. The amount and type of alcoholic beverages as well as the nutritional status of the patients were not related to myocardial antioxidant activity. Conclusions: The presence of dilated cardiomyopathy, of either alcoholic or hypertensive origin, is related to an increase in myocardial superoxide dismutase activity.

Fazio M; Bardelli M; Fabris B; Macaluso L; Fiammengo F; Vran F et al. Large-artery hemodynamics after acute alcohol administration in young, healthy volunteers. Angiology 55(2): 139-145, 2004. (21 refs.)

The objective of the present study was to investigate the acute effects of alcohol on blood flow volume and velocity, on wall motion of superficial large arteries, and on systemic hemodynamics in humans. In 10 healthy volunteers small doses of alcohol were administered either orally (0.3 g/kg in 250 mL water) or intravenously (7.5 mg/kg/minute in 250 mL saline in 40 minutes). The effects of alcohol were compared with those of saline 250 mL infused for 40 minutes (6.25 mL/min). Blood velocity and systodiastolic changes of wall diameter were measured in the common carotid, femoral, and brachial arteries simultaneously with cardiac output and finger blood pressure. Skin temperature was measured at the cheek, hand, and toe. Ethanol administration caused a transitory blood pressure increase accompanied by a rise in peripheral resistances at 20 minutes. Arterial blood flow was not changed by either mode of alcohol administration at any of the measurement sites. However, this result was achieved through different compensatory mechanisms in each artery. In fact, mean carotid diameter increased after both oral and intravenous ethanol administration but remained unchanged at the brachial and femoral level. Mean blood velocity was reduced after alcohol administration at the carotid but was unchanged at the brachial and femoral level after oral or intravenous alcohol administration. Skin temperature increased 20 minutes after alcohol administration at all sites. This study shows that although acute alcohol administration does not change blood flow in superficial large arteries, it causes different autoregulatory local responses of vessel walls.

Fiellin DA; O'Connor PG; Wang YF; Radford MJ; Krumholz HM. Quality of care for acute myocardial infarction in elderly patients with alcohol-related diagnoses. Alcoholism: Clinical and Experimental Research 30(1): 70-75, 2006. (29 refs.)

Background: Elderly adults with alcohol-related diagnoses represent a vulnerable population that may receive lower quality of treatment during hospitalization for acute myocardial infarction. We sought to determine whether elderly patients with alcohol-related diagnoses are less likely to receive standard indicators of quality care for acute myocardial infarction. Methods: We conducted a retrospective cohort analysis using administrative and medical record data from the Cooperative Cardiovascular Project. Subjects were Medicare beneficiaries with a confirmed principal discharge diagnosis of acute myocardial infarction from all acute care hospitals in the United States over an 8-month period. Our primary outcome was the receipt of 7 guideline-recommended care measures among all eligible patients and patients who were ideal candidates for a given measure. Results: In all, 1,284 (1%) of the 155,026 eligible patients met criteria for an alcohol-related diagnosis. Among the alcohol-related diagnoses, 1,077/1,284 (84%) were for the diagnoses of alcohol dependence or alcohol abuse. Patients with alcohol-related diagnoses were less likely than those without alcohol-related diagnoses to receive beta-blockers at the time of discharge (55% vs. 60%, p = 0.02). We found no other significant differences in performance of the quality indicators after stratifying by indication and adjustment for baseline characteristics. Conclusions: Alcohol-related diagnoses are not a barrier to receiving most quality of care measures in elderly patients hospitalized for acute myocardial infarction.

Fuchs FD. Vascular effects of alcoholic beverages: Is it only alcohol that matters? (editorial). Hypertension 45(5): 851-852, 2005. (15 refs.)

Fuchs FD; Chambless LE; Folsom AR; Eigenbrodt ML; Duncan BB; Gilbert A et al. Association between alcoholic beverage consumption and incidence of coronary heart disease in whites and blacks: The Atherosclerosis Risk in Communities Study. American Journal of Epidemiology 160(5): 466-474, 2004. (57 refs.)

The authors evaluated the relation between consumption of alcoholic beverages and incidence of coronary heart disease in White and African-American participants in the Atherosclerosis Risk in Communities Study. The average duration of follow-up was 9.8 years between 1987 and 1998. The association was analyzed by means of Cox proportional hazards regression models. The authors found a positive association between ethanol consumption and incident coronary heart disease for Black men (for a 13-g/day increment in ethanol consumption, adjusted hazard ratio (HR) = 1.13, 95% confidence interval (CI): 1.01, 1.28) and an inverse association for White men (HR = 0.88, 95% CI: 0.79, 0.99). There was an inverse association of coronary heart disease with rare drinking (HR = 0.47, 95% CI: 0.28, 0.80) and with consumption of greater than or equal to70 g of ethanol per week (HR = 0.49, 95% CI: 0.24, 0.98) in White women and with consumption of greater than or equal to210 g/week (HR = 0.56, 95% CI: 0.33, 0.95) in White men. In Black men, the association was positive for consumption of 140-<210 g/week (HR = 2.61, 95% CI: 1.11, 6.17). The contrasting findings in Whites and Black men in this cohort raise the question of whether the cardioprotective effect of alcohol is real or may be confounded by lifestyle characteristics of drinkers.

Happonen P; Voutilainen S; Salonen JT. Coffee drinking is dose-dependently related to the risk of acute coronary events in middle-aged men. Journal of Nutrition 134(9): 2381-2386, 2004. (36 refs.)

Heavy coffee consumption has been associated with increased coronary heart disease (CHD) risk although many studies have not observed any relation. We studied the effect of coffee consumption, assessed with a 4-d food record, on the incidence of nonfatal acute myocardial infarction or coronary death in a cohort of 1971 men who were 42 to 60 y old and free of symptomatic CHD at baseline in 1984-1989. During a mean follow-up of 14 y, 269 participants experienced an acute coronary event. After adjustment for age, smoking, exercise ischemia, diabetes, income, and serum insulin concentration, the rate ratios (95% CIs) in daily nondrinkers and light (375 mL or less), moderate (reference level), and heavy (814 mL or more) drinkers were 0.84 (0.41-1.72), 1.22 (0.90-1.64), 1.00, and 1.43 (1.06-1.94). To address time dependence of the effect, the analysis was repeated for 75 CHD events that occurred during the first 5 y; the respective rate ratios were 0.42 (0.06-3.10), 2.00 (1.16-3.44), 1.00, and 2.07 (1.17-3.65). Further adjustment for serum HDL and LDL cholesterol concentration, diastolic blood pressure, maximal oxygen uptake, and waist-hip ratio slightly increased the rate ratio for heavy coffee intake. Neither the brewing method (boiling vs. filtering) nor the serum LDL cholesterol concentration had any impact on the risk estimates for coffee intake. In conclusion, heavy coffee consumption increases the short-term risk of acute myocardial infarction or coronary death, independent of the brewing method or currently recognized risk factors for CHD.

Hines LM. Genetic modification of the effect of alcohol consumption on CHD. Proceedings of the Nutrition Society 63(1): 73-79, 2004. (61 refs.)

The deleterious health effects of high alcohol consumption are numerous and well recognized; however, the effect of moderate alcohol consumption on overall health continues to be a debated issue. Among the more prevalent diseases in Westernized countries, epidemiological research suggests that alcohol in moderation substantially reduces the risk of CHD, while it modestly increases the risk for certain cancers, such as breast and colon cancer. Despite the overwhelming data supporting the beneficial effect of moderate alcohol consumption on the cardiovascular system, some researchers are not convinced. Sceptics argue that the reduction in risk is attributed to a favourable lifestyle factor associated with moderate alcohol consumption, or that it may be attributed to constituents of alcoholic beverages other than ethanol, such as the antioxidants in the grapes. In order to promote overall health for the general public, it is necessary to elucidate these issues. One approach is to study population differences in alcohol metabolic efficiency, which is likely to contribute to an individual's susceptibility to alcohol-associated diseases. Among the population there is substantial variability in the efficiency to metabolize alcohol. Genetic variation among the alcohol-metabolizing genes is known to produce isoenzymes with distinct kinetic properties. Studying genetic differences that potentially influence disease susceptibility among populations may provide insight into the mechanism(s) for the relationship between risk factor and disease, such as alcohol and CHD.

Howard AA; Arnsten JH; Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: A systematic review. (review). Annals of Internal Medicine 140(3): 211-219, 2004. (53 refs.)

Background: Both diabetes mellitus and alcohol consumption are prevalent in the United States, yet physicians are poorly informed about how alcohol use affects risk for or management of diabetes. Purpose: To conduct a systematic review assessing the effect of alcohol use on the incidence, management, and complications of diabetes mellitus in adults. Data Sources: English-language studies in persons 19 years of age or older that were identified by searching the MEDLINE database from 1966 to the third week of August 2003 and the reference lists of key articles. Study Selection: Two independent assessors reviewed 974 retrieved citations to identify all experimental, cohort, or case-control studies that assessed the effect of alcohol use on diabetes risk, control, self-management, adverse drug events, or complications. Data Extraction: Two independent reviewers extracted data and evaluated study quality on the basis of established criteria. Data Synthesis: Thirty-two studies that met inclusion criteria were reviewed. Compared with no alcohol use, moderate consumption (one to 3 drinks/d) is associated with a 33% to 56% lower incidence of diabetes and a 34% to 55% lower incidence of diabetes-related coronary heart disease. Compared with moderate consumption, heavy consumption (>3 drinks/d) may be associated with up to a 43% increased incidence of diabetes. Moderate alcohol consumption does not acutely impair glycemic control in persons with diabetes. Conclusions: Moderate alcohol consumption is associated with a decreased incidence of diabetes mellitus and a decreased incidence of heart disease in persons with diabetes. Further studies are needed to assess the long-term effects of alcohol consumption on glycemic control and noncardiac complications in persons with diabetes.

Huntgeburth M; ten Freyhaus H; Rosenkranz S. Alcohol consumption and hypertension. Current Hypertension Reports 7(3): 180-185, 2005. (58 refs.)

Hypertension is a major independent risk factor for cardiovascular disease. In alcohol-consuming populations, the amount of alcohol consumption has significant impact on blood pressure values, the prevalence of hypertension, and cardiovascular as well as all-cause mortality. In this review, we focus on the connection between alcohol consumption and hypertension, and discuss the consequences on cardiovascular risk.

Irwin MR; Ziegler M. Sleep deprivation potentiates activation of cardiovascular and catecholamine responses in abstinent alcoholics. Hypertension 45(2): 252-257, 2005. (44 refs.)

Alcohol dependence is associated with an increased incidence of hypertension and cardiac arrhythmias, but the triggering mechanisms are not known. Sleep loss, common in alcohol-dependent patients, causes an activation of the sympathetic nervous system. To determine whether sleep deprivation induces differential cardiovascular and sympathetic responses in alcohol dependence, we measured heart rate, blood pressure, and circulating sympathetic catecholamines in 36 abstinent alcohol-dependent men and 36 age-, gender-, and ethnicity-matched controls after a baseline night of sleep, in the morning after early night partial sleep deprivation, and again after a full night of recovery sleep. Subjects were on average normotensive and none was being treated for hypertension. Baseline heart rate, blood pressure, and sympathetic catecholamines were similar in the 2 groups. Administration of partial night sleep deprivation induced greater increases of heart rate (P < 0.01) and circulating levels of norepinephrine (P < 0.05) and epinephrine (P < 0.05) in the alcohol-dependent men as compared with responses in controls. Even after a full night of recovery sleep, elevations in heart rate (P < 0.05) and circulating catecholamines (P < 0.05) persisted in the alcoholic subjects. Partial night sleep deprivation induces elevated heart rate and sympathetic catecholamine responses in alcoholic subjects as compared with controls, and this sympathetic activation is sustained after nights of partial and recovery sleep. It is possible that modest habitual sleep loss could contribute to triggering cardiac arrhythmias or other cardiovascular events in alcohol dependence.

Jackson R; Broad J; Connor J; Wells S. Alcohol and ischaemic heart disease: Probably no free lunch. (editorial). Lancet 366(9501): 1911-1912, 2005. (14 refs.)

Janszky I; Ericson M; Blom M; Georgiades A; Magnusson JO; Alinagizadeh H. Wine drinking is associated with increased heart rate variability in women with coronary heart disease. Heart 91(3): 314-318, 2005. (49 refs.)

Objective: To test the hypothesis that alcohol consumption is positively related to heart rate variability (HRV) in women with coronary heart disease (CHD) and therefore that cardiac autonomic activity is potentially implicated in the mediation of the favourable effects of moderate drinking. Design, settings, and patients: Cross sectional study of female patients who survived hospitalisation for acute myocardial infarction or underwent a revascularisation procedure, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting. Main outcome measures: Ambulatory 24 hour ECG was recorded during normal activities. The mean of the standard deviations of all normal to normal intervals for all five minute segments of the entire recording (SDNNI) and the following frequency domain parameters were assessed: total power, high frequency power, low frequency power, and very low frequency power. A standardised questionnaire evaluated self reported consumption of individual alcoholic beverage types: beer, wine, and spirits. Other clinical characteristics, such as age, body mass index, smoking habits, history of diabetes mellitus, menopausal status, educational status, and treatment, were also assessed. Results: Wine intake was associated with increased HRV in both time and frequency domains independently of other clinical covariates (for example, ln SDNNI was 3.89 among wine drinkers v 3.59 among wine non- drinkers in the multivariate model; p = 0.014). In contrast, consumption of beer and spirits and the total amount of alcohol consumed did not relate significantly to any of the HRV parameters. Conclusion: Intake of wine, but not of spirits or beer, is positively and independently associated with HRV in women with CHD. These results may contribute to the understanding of the complex relation between alcohol consumption and CHD.

Janszky I; Mukamal KJ; Orth-Gomer K; Romelsjo A; Schenck-Gustafsson K; Svane B. Alcohol consumption and coronary atherosclerosis progression: The Stockholm Female Coronary Risk Angiographic Study. Atherosclerosis 176(2): 311 -319, 2004. (44 refs.)

Objective: To assess the association of alcohol intake with progression of coronary atherosclerosis. Although moderate drinkers have a lower risk of coronary heart disease than abstainers, the relation of alcohol use and coronary atherosclerosis has not been well studied. Methods and results: In the Stockholm Female Coronary Risk Angiographic Study, we evaluated 103 women, aged 65 years or younger, hospitalized with acute myocardial infarction or unstable angina pectoris who underwent serial quantitative coronary angiography 3-6 months following their index event and repeated an average of 3 years and 3 months (range 2-5 years) later. Individual alcoholic beverage consumption was assessed by a standardized questionnaire. We used mixed model analysis to estimate the effect of alcohol consumption on progression of coronary atherosclerosis, as measured by mean luminal diameter change, controlling for age, smoking, body-mass index, education, physical activity, index cardiac event, menopausal status, diabetes, and history of dyslipidemia. Of the 93 women with complete information on alcohol intake, 14 consumed no alcohol (abstainers), 55 consumed up to 5 g of alcohol per day (light drinkers), and 24 consumed more than 5 g of alcohol per day (moderate drinkers). Coronary atherosclerosis progressed by a multivariate-adjusted average of 0.138 mm (95% confidence interval (CI): 0.027-0.249) among abstainers, 0.137 mm (95% CI: 0.057-0.217) among light drinkers, and -0.054 mm (95% CI: -0.154 to 0.047) among moderate drinkers (P < 0.001). The inverse association persisted in analyses stratified by index event. No beverage type appeared to confer particular benefit. Conclusions: Among middle-aged women with coronary heart disease, moderate alcohol consumption (over 5 g/day) was protective of coronary atherosclerosis progression.

Kahkonen S. Responses to cardiovascular drugs during alcohol withdrawal. Alcohol and Alcoholism 41(1): 11-13, 2006. (36 refs.)

Aim: To present findings on the kinetics and dynamics of cardiovascular drugs during alcohol withdrawal (AW), compared with that observed in remission. Method: Studies were reviewed and summarized. Results: A single-dose study in alcoholic patients with propranolol, a beta-adrenergic antagonist, showed that the negative inotropic effect was decreased and the bradycardiac effect increased during AW as compared with during early remission. The hypotensive effect of isosorbid dinitrate, commonly used as a vasodilatator, was weaker at the onset of AW, being associated with the decreased bioavailability of the drug. Verapamil, which is a L-type Ca2+ channel antagonist, produced a bradycardiac effect at the onset of AW, but no effect was observed in early remission. The effect was probably due to changes in L-type Ca2+ channels because no differences in verapamil concentrations between AW and early remission were observed. Conclusion: Taken together, AW modifies the dynamics and kinetics of cardiac drugs, which may have an impact on the treatment of alcoholic patients with cardiac diseases.

Karatzi K; Papamichael C; Aznaouridis K; Karatzis E; Lekakis J; Matsouka C et al. Constituents of red wine other than alcohol improve endothelial function in patients with coronary artery disease. Coronary Artery Disease 15(8): 485-490, 2004. (35 refs.)

Background: Several studies suggest that red wine is beneficial in coronary artery disease (CAD). Although the long-term effect of moderate red wine consumption on endothelial function is currently under investigation, there is little knowledge about its effect on postprandial endothelial function and haemostatic factors. The aim of the present study was to investigate the postprandial effects of alcohol content and the antioxidants of red wine on endothelial function and fibrinogen levels in CAD patients. Methods Fifteen males with angiographically documented CAD were recruited for the study. All volunteers ingested 250 ml of either red wine or de-alcoholized red wine on two different days. Blood samples (for analysis of fibrinogen and blood lipids) were collected and flow-mediated dilatation (FMD) was determined before and 30, 60 and 90 min following consumption of each beverage Results: FMD was higher following the consumption of de-alcoholized red wine [type of wine effect, P = 0.05 repeated measures analysis of variance (ANOVA)]. Furthermore, the pattern of the response was different between the two beverages, as FMD increased following the ingestion of de-alcoholized red wine, but it decreased after consumption of regular red wine (type of wine by time interaction effect, P = 0.006 repeated measures ANOVA Fibrinogen concentrations were unaltered Conclusions: Acute ingestion of red wine without alcohol led to higher FMD than ingestion of regular red wine in CAD patients. The acute effect of red wine on endothelial function may be different than its long-term effect and it could be attributed to its constituents other than alcohol.

Klatsky AL. Alcohol and cardiovascular health. Integrative and Comparative Biology 44(4): 324-328, 2004. (56 refs.)

The substantial medical risks of heavy alcohol drinking as well as the existence of a safe drinking limit have been evident for centuries. Modern epidemiologic studies also show lower risk of both morbidity and mortality among lighter drinkers. Defining "heavy" as greater than or equal to3 standard drinks per day, the alcohol-mortality relationship is a J-curve with risk highest for heavy drinkers, lowest for light drinkers and intermediate for abstainers. A number of non-cardiovascular and cardiovascular problems contribute to the increased mortality risk of heavier drinkers. The lower risk of light drinkers is due mostly to lower risk of the most common cardiovascular condition, coronary heart disease (CHD). Thus, disparate relationships of alcoholic drinking to various cardiovascular and non-cardiovascular conditions constitute a modern concept of alcohol and health. Increased cardiovascular risks of heavy drinking include: 1) alcoholic cardiomyopathy, 2) systemic hypertension (high blood pressure), 3) heart rhythm disturbances in binge drinkers, and 4) hemorrhagic stroke. Lighter drinking is unrelated to increased risk of any cardiovascular condition and, in observational studies, is consistently related to lower risk of CHD and ischemic stroke. A protective hypothesis for CHD is robustly supported by evidence for plausible biological mechanisms attributable to ethyl alcohol. International comparisons and some prospective study data suggest that wine is more protective against CHD than liquor or beer. Possible non-alcohol beneficial components in wine (especially red) support possible extra protection by wine, but a healthier pattern of drinking or more favorable risk traits in wine drinkers may also be involved.

Lucas DL; Brown RA; Wassef M; Giles TD. Alcohol and the cardiovascular system: Research challenges and opportunities. Journal of the American College of Cardiology 45(12): 1916-1924, 2005. (51 refs.)

Excessive alcohol consumption has long been associated with cardiovascular disorders, including cardiomyopathy, hypertension, coronary artery disease, and stroke. However, recent evidence suggests that moderate alcohol intake can actually provide a measure of cardioprotection, particularly against coronary heart disease and ischemia-reperfusion injury. To explore the various dimensions of these opposing actions of alcohol, the National Institute on Alcohol Abuse and Alcoholism and the National Heart, Lung, and Blood Institute sponsored a state-of-the-art workshop on "Alcohol and the Cardiovascular System: Research Challenges and Opportunities" in Bethesda, Maryland, in May 2003. Speakers discussed the following topics: the epidemiology of alcohol and cardiovascular disease, clinical manifestations of alcohol, genetics of alcohol and cardiovascular disease, mechanisms underlying the molecular and cellular effects of alcohol, the application of new and emerging technology, and translation from discovery to therapeutic modalities of treatment. The panel concluded that future studies are needed to: 1) determine the role of genes and the environment in assessing mechanisms underlying the benefits of alcohol use and cardiovascular disease risk; 2) define the biological mechanisms underlying alcohol-induced peripheral vascular damage; 3) clarify the role of genetic variation in alcohol-metabolizing enzymes, genetic susceptibility, and pharmacogenomics in determining cardiovascular disease risk and effective treatment; 4) determine common mechanisms underlying alcohol-induced cardiovascular disease, such as oxidative stress and inflammation; 5) assess the role of insulin resistance, blood clotting, protein kinase C isoforms, and signal transduction mechanisms mediating alcohol's beneficial effects; and 6) explore the potential of stem cells in myocardial regeneration and repair in hearts damaged by alcohol.

Li JM; Mukamal KJ. An update on alcohol and atherosclerosis. (review). Current Opinion in Lipidology 15(6): 673-680, 2004. (84 refs.)

Purpose of review: Epidemiological studies consistently link moderate alcohol use with a lower risk of cardiovascular disease, but a number of important issues remain controversial. These include the putative impact of non-alcoholic constituents of some alcoholic beverages, the role of genetic factors, potential mechanisms for this association, and confirmation of the relationship in experimental models. Recent findings Although high-density lipoprotein cholesterol (HDL-C) is considered the primary mediator of the cardiovascular effects of moderate drinking, recent evidence has shown the alcohol-HDL-C relation is not linear beyond the range of moderate drinking. Moderate alcohol use also has important inverse relations with inflammatory factors. Some, but not all, animal models confirm the anti-atherogenic effects of ethanol and highlight inflammatory factors as one possible mechanism. The non-alcoholic constituents of red wine also have anti-atherogenic and perhaps even life-extending properties in vitro, but their relevance to humans remains uncertain. Genetic variants of the apolipoprotein E and interleukin 6 genes in humans may modify how alcohol influences atherosclerosis, further emphasizing the importance of HDL-C and inflammatory factors as mediators. Summary The robust relationship between moderate drinking and lower risk of cardiovascular disease remains an intriguing area of investigation. Clarifying potential gene-environment interactions and translational research into uses for non-alcoholic components will be important areas for future investigation.

Makela P; Paljarvi T; Poikolainen K. Heavy and nonheavy drinking occasions, all-cause and cardiovascular mortality and hospitalizations: A follow-up study in a population with a low consumption level. Journal of Studies on Alcohol 66(6): 722-728, 2005. (20 refs.)

Objective: The purpose of this study was to separate the effects of heavy and nonheavy episodic drinking on mortality and hospitalizations from ischemic heart disease (IHD) and other cardiovascular disease (OCVD) and on all-cause mortality. Method: The respondents in Finnish drinking habit surveys in 1969, 1976 and 1984 (N = 6,394) were followed up for mortality and hospitalizations. There were 1,144 total deaths from all causes, 854 hospitalizations or deaths from IHD and 1,270 from OCVD. The main variables included total volume of consumption and total volume divided into volume consumed on heavy drinking occasions and nonheavy drinking occasions. Four alternative measures of heavy episodic drinking (HED) were also used. Results: Among males, the total volume of consumption showed a protective effect against IHD. A high volume consumed on light drinking occasions was associated with a decreased risk of lHD (hazard ratio [HR] = 0.56, confidence interval [CI]: 0.34-0.92) and an increased risk of OCVD (HR = 1.48, CI: 1.00-2.18). A high volume consumed on heavy drinking occasions was associated with an increased risk of all-cause mortality (HR = 1.34, CI: 1.04-1.73). Among females, a protective effect of total and non-HED volume against all-cause mortality and non-HED volume against IHD was observed. Conclusions: The findings contribute to the cumulating evidence that drinking pattern matters. Moderate drinking is associated with a lower risk of IHD, whereas drinking in a heavy episodic manner (often referred to as "binge drinking") is not. The results underline the importance of considering, in addition to the volume of consumption, the pattern of drinking in epidemiological studies.

Marques-Vidal P; Montaye M; Arveiler D; Evans A; Bingham A; Ruidavets JB et al. Alcohol consumption and cardiovascular disease: Differential effects in France and Northern Ireland. The PRIME study. European Journal of Cardiovascular Prevention & Rehabilitation 11(4): 336-343, 2004. (37 refs.)

Background The effects of wine and other alcoholic beverages on coronary heart disease (CHD) have seldom been studied in several countries using a common methodology. Design Five-year prospective study conducted among 9750 men (7352 in France and 2398 in Northern Ireland) free of CHD at entry. Outcomes were angina pectoris, myocardial infarction or CHD death. Results In all, 90% of subjects in France reported drinking at least once per week, versus 61% in Northern Ireland. In France, after adjusting for other CHD risk factors, subjects in the highest quartile of alcohol consumption had a significantly lower risk of developing angina pectoris relative to non-drinkers. For myocardial infarction and all CHD events, the risk also decreased from the first to the fourth quartile (P for trend=0.02). Conversely, in Northern Ireland, no significant relationship was found between alcohol consumption and the incidence of angina pectoris or all CHD events, although alcohol consumption appeared to decrease the risk for myocardial infarction. Similar findings were obtained when the 5% higher alcohol consumers were excluded from the analysis. Finally, splitting the alcohol consumption into wine, beer and spirits did not improve the relationships, the three types of beverage exerting comparable effects on CHD events. Conclusions Alcohol consumption patterns exert differential effects on CHD risk in middle-aged men from France and Northern Ireland. Further, the amount of alcohol consumption, rather than the type of alcoholic beverage, is related to both angina pectoris and myocardial infarction in France, whereas no relationship was found in Northern Ireland.

Masters JA. Moderate drinking and cardiovascular disease. Annual Review of Nursing Research 23: 65-97, 2005

The adverse consequences of heavy alcohol use are well known. However, recent media reports of a possible cardiovascular benefit associated with moderate drinking have revived public interest in the use of alcohol for "medicinal purposes." Knowledge development regarding guidelines for moderate alcohol use has lagged behind public interest in the possible health benefits of moderate alcohol use. At this time, evidence-based primary health promotion interventions related to the risks and benefits of moderate alcohol use are lacking in the health care literature. This chapter reviews 22 reports describing the relationship between moderate drinking and cardiovascular disease. The reports are classified by the level of evidence and critiqued on seven aspects of method. Conclusions: related to the strength of the evidence that moderate drinking is a useful primary health promotion intervention are presented.

Mattace-Raso F; vander Cammen TJM; vanden Elzen APM; Schalekamp MADH; Asmar R; Reneman RS et al. Moderate alcohol consumption is associated with reduced arterial stiffness in older adults: the Rotterdam study. Journal of Gerontology Series A. Biological Sciences and Medical Sciences 60(11): 1479-1483, 2005. (35 refs.)

BACKGROUND: Light-to-moderate alcohol consumption has been associated with a lower risk of cardiovascular disease. The protective effect of alcohol could involve arterial properties as arterial stiffness and distensibility. METHODS: The relationship between alcohol and arterial stiffness was studied within the framework of the Rotterdam Study, a population-based study in individuals aged 55 and older. The present study included 3178 participants in the third examination phase. Arterial stiffness was measured by two different methods, i.e., the carotid-femoral pulse wave velocity and the DC of the common carotid artery. Categories of alcohol consumption were defined as follows: < or =3 glasses of alcohol per week, 4-10 glasses per week, 11-20 glasses per week, and > or =21 glasses per week. Linear regression analysis was used to investigate the association between alcohol consumption and measures of arterial stiffness. RESULTS: In multivariate-adjusted models, women drinking 4-10, 11-20, and > or =21 glasses of alcoholic beverage per week had a -0.07 (0.22 to -0.38), -0.18 (0.12 to -0.49), and 0.12 (0.19 to -0.43) m/s difference in mean pulse wave velocity compared to those drinking 0-3 glasses per week (reference group). Corresponding differences in the carotid DC were 0.68 (1.21 to 0.15), 0.28 (0.82 to -0.25), and 0.36 (0.91 to -0.18) 10(-3)/kPa. In men, the estimates were not statistically significant, although a similar trend was observed. CONCLUSIONS: Moderate alcohol consumption is associated with lower arterial stiffness in women independently of cardiovascular risk factors and atherosclerosis.

McPherson S; Rees CJ. Interactive case report: An alcoholic patient who continues to drink: Case progression. British Medical Journal 332(7533): 98-98, 2006. (0 refs.)

This is the second of a three part case report where we invite readers to take part in considering the diagnosis and ethical issues surrounding the management of a real patient using the rapid response feature on bmj.com. In three weeks' time we will report the outcome and summarise the responses. This involves the case of a man who presented with alcoholic liver disease and presented with haematemesis. Initial management was resuscitation. He was tachycardic, which may partly have been due to alcohol withdrawal and agitation but probably suggested a haemodynamic response to a clinically important bleed. After resuscitation gastroscopy established the cause of bleeding -- a single oesophageal varix was visible that was was bleeding. Treatment approaches are discussed. On day 4 the patient discharged himself from hospital despite strong counselling against this move. The medical team decided he had the mental capacity to make an informed decision, and he was aware that he was at high risk of further bleeding and death.

Mukamal KJ; Chung HJ; Jenny NS; Kuller LH; Longstreth WT; Mittleman MA et al. Alcohol consumption and risk of coronary heart disease in older adults: The Cardiovascular Health Study. Journal of the American Geriatrics Society 54(1): 30-37, 2006. (50 refs.)

OBJECTIVES: To evaluate several aspects of the relationship between alcohol use and coronary heart disease in older adults, including beverage type, mediating factors, and type of outcome. DESIGN: Prospective cohort study. SETTING: Four U.S. communities. PARTICIPANTS: Four thousand four hundred ten adults aged 65 and older free of cardiovascular disease at baseline. MEASUREMENTS: Risk of incident myocardial infarction or coronary death according to self-reported consumption of beer, wine, and spirits ascertained yearly. RESULTS: During an average follow-up period of 9.2 years, 675 cases of incident myocardial infarction or coronary death occurred. Compared with long-term abstainers, multivariate relative risks of 0.90 (95% confidence interval (CI)=0.71-1.14), 0.93 (95% CI=0.73-1.20), 0.76 (95% CI=0.53-1.10), and 0.58 (95% CI=0.39-0.86) were found in consumers of less than one, one to six, seven to 13, and 14 or more drinks per week, respectively (P for trend=.007). Associations were similar for secondary coronary outcomes, including nonfatal and fatal events. No strong mediators of the association were identified, although fibrinogen appeared to account for 9% to 10% of the relationship. The associations were statistically similar for intake of wine, beer, and liquor and generally similar in subgroups, including those with and without an apolipoprotein E4 allele. CONCLUSION: In this population, consumption of 14 or more drinks per week was associated with the lowest risk of coronary heart disease, although clinicians should not recommend moderate drinking to prevent coronary heart disease based on this evidence alone, because current National Institute on Alcohol Abuse and Alcoholism guidelines suggest that older adults limit alcohol intake to one drink per day.

Mukamal KJ; Cushman M; Mittleman MA; Tracy RP; Siscovick DS. Alcohol consumption and inflammatory markers in older adults: The Cardiovascular Health Study. Atherosclerosis 173(1): 79-87, 2004. (44 refs.)

Objective: We sought to determine the relation of alcohol intake and systemic inflammation in a population-based sample of older adults. Methods and results: As part of the Cardiovascular Health Study (CHS), 5865 adults aged 65 years and older reported their intake of beer, wine, and liquor. We determined white blood cell count (WBC), factor VIII coagulant activity (factor VIIIc), and levels of C-reactive protein (CRP), fibrinogen, and albumin as markers of systemic inflammation. Among participants without confirmed cardiovascular disease, alcohol consumption was inversely associated with WBC, factor VIIIc, and fibrinogen level, and positively associated with albumin concentration in multivariate analyses. We found no consistent modification of these results by sex, obesity, or beverage type. The relation of alcohol use and CRP levels was significantly modified by apoE genotype (P interaction 0.03), with a positive association among participants with an apoE4 allele (P = 0.05), but a trend toward an inverse association among those without an apoE4 allele (P = 0.15). Conclusions: Alcohol intake is associated with lower levels of inflammatory markers in older adults free of cardiovascular disease.

Mukamal KJ; Jensen MK; Gronbaek M; Stampfer MJ; Manson JAE; Pischon T et al. Drinking frequency, mediating biomarkers, and risk of myocardial infarction in women and men. Circulation 112(10): 1406-1413, 2005. (51 refs.)

Background - The associations of drinking frequency and quantity with risk of myocardial infarction have not been studied among women, and the degree to which specific risk factors mediate the inverse association of drinking frequency with risk of myocardial infarction is uncertain. Methods and Results - We conducted nested case-control studies of 32 826 women enrolled in the Nurses Health Study followed up from 1990 to 1998 and 18 225 men enrolled in the Health Professionals Follow-Up Study followed up from 1994 to 2000. A total of 249 women and 266 men with incident myocardial infarction were matched on age, smoking, and date of entry to 498 female and 532 male control participants. We determined the risk of myocardial infarction related to frequency and quantity of alcohol intake and the change in risk before and after adjustment for putative cardiovascular risk factors. Among both women and men, drinking frequency tended to be associated with lower risk of myocardial infarction, with the lowest risks among those who drank 3 to 7 days per week. Further adjustment for levels of high-density lipoprotein cholesterol, hemoglobin A(1c), and fibrinogen attenuated 75% of the association of frequent drinking with risk among women and fully attenuated the association among men. Conclusions - Alcohol intake at least 3 to 4 days per week is associated with a lower risk of myocardial infarction among women and men, an association apparently attributable to the relationship of alcohol with HDL cholesterol, fibrinogen, and hemoglobin A1c. Because the effects of alcohol on HDL cholesterol, fibrinogen, and insulin sensitivity have been confirmed in randomized trials, our findings support the hypothesis that the inverse relation of alcohol use and myocardial infarction is causal.

Mukamal KJ; Maclure M; Muller JE; Mittleman MA. Binge drinking and mortality after acute myocardial infarction. Circulation 112(25): 3839-3845, 2005. (49 refs.)

Background - Moderate drinkers have a lower risk of mortality after myocardial infarction (MI). Although binge drinking has been associated with a higher risk of MI in some studies, its relation to prognosis after MI is uncertain. Methods and Results - In a prospective, inception cohort study conducted at 45 US hospitals, 1935 patients hospitalized with a confirmed MI between 1989 and 1994 underwent detailed personal interviews. Patients reported their usual frequency of binge drinking of beer, wine, and liquor, defined as intake of 3 or more drinks within 1 to 2 hours, and were followed up for mortality for a median of 3.8 years. Of 1919 eligible patients, 250 (94% men) reported binge drinking during the prior year, and a total of 318 patients died during follow-up. Binge drinkers had a 2-fold higher risk of mortality than drinkers who did not binge (hazard ratio, 2.0; 95% confidence interval, 1.3 to 3.0). A comparison of 192 binge drinkers and 192 other patients matched on propensity scores yielded a similar result. The association between binge drinking and total mortality tended to be similar among patients whose usual alcohol intake was light or heavier and for binge drinkers who consumed beer, wine, or liquor. Usual alcohol intake was inversely associated with mortality, but binge drinking completely attenuated this relation. Conclusions - Our results suggest that alcohol consumption may be linked to potential hazards among patients who survive acute MI. Although moderate intake has been associated with lower mortality, binge drinking, even among light drinkers, appears to be associated with 2-fold higher mortality.

Murray RP; Barnes GE; Ekuma O. Does personality mediate the relation between alcohol consumption and cardiovascular disease morbidity and mortality? Addictive Behaviors 30(3): 475-488, 2005. (32 refs.)

Alcohol volume and pattern have been previously demonstrated to predict cardiovascular disease (CVD) in these data. The objective of this study is to assess whether personality is a mediator in this relationship. Interview data from 1154 men and women aged 18-64 in Winnipeg, Canada were linked to health care utilization and mortality records, with 8 years of follow-up. Cox regressions were performed for men and women on time to first event for physician visits, hospitalizations, and deaths due to coronary heart disease (CHD), hypertension, or other CVD. Models linking drinking to CHD outcomes were unaffected by personality covariates. Models of hypertension and other CVD outcomes were significantly affected by inclusion of personality covariates, but the only significant individual personality covariate was in the effect on other CVD in men: Ego strength had a protective effect [hazard ratio (HR)=0.95]. Personality covariates as measured by the Eysenck Personality Questionnaire (EPQ) and Barron's Ego Strength Scale make only a modest contribution to statistical models of the relation between drinking and cardiovascular health.

Murray RP; Connett JE; Makela P; Rehm J. Difficulty in demonstrating a risk from drinking pattern in fourteen years of coronary heart disease morbidity and mortality: The Lung Health Study. Addictive Behaviors 30(5): 875-887, 2005. (27 refs.)

The health effects of a binge pattern of alcohol consumption have not been widely investigated. The objective of this study is to evaluate cardiovascular consequences of drinking eight or more drinks at a sitting and of usual drinking of alcohol among 3702 men in the Lung Health Study (LHS), a clinical trial where heavy drinkers were excluded from enrolment. Using a 14-year follow-up period, survival graphs were examined. Cox proportional hazards regressions were performed on time to first event for documented hospitalizations and deaths due to coronary heart disease (CHD). The upper two quartiles of usual drinking were protective against CHD in men [hazard ratios (HRs) 0.76 and 0.69] in adjusted models. When eight or more drinks per occasion was combined with models of usual drinking quartiles, its effect was not significant. The measure of eight or more drinks in these data appears to act as a surrogate for heavy drinking, and does not provide a suitable test of the effect of drinking pattern in men, due primarily to the exclusion of heavier drinkers at baseline. The alcohol effects in women in this study were not significant.

Napoli R; Cozzolino D; Guardasole V; Angelini V; Zarra E; Matarazzo M. Red wine consumption improves insulin resistance but not endothelial function in type 2 diabetic patients. Metabolism: Clinical and Experimental 54(3): 306-313, 2005. (50 refs.)

Epidemiological studies have shown that red wine consumption is associated with less cardiovascular mortality in the general population and in the diabetic patients. To determine whether red wine improves insulin resistance in diabetic patients and to explore the relation between insulin sensitivity and endothelial function, we studied vascular reactivity and insulin-mediated glucose uptake in 9 type 2 diabetic patients before and after 2 weeks of red wine consumption (360 mL/d, wine-treated diabetics) and 8 type 2 diabetic patients who did not consume wine (control diabetics). Vascular reactivity was evaluated by plethysmography during intraarterial infusion of acetylcholine (Ach), sodium nitroprusside, and L-N-monomethylarginine. Forearm nitrite balance was measured during Ach infusion. Insulin sensitivity was measured by euglycemic hyperinsulinemic clamp at 1 mU/kg per minute. The basal forearm blood flow and the response to Ach, to sodium nitroprusside, and to L-N-monomethylarginine were unchanged both in the wine-treated and in the control diabetics. In contrast, insulin-mediated whole body glucose disposal improved by 43% after red wine consumption (from 2.79 +/- 0.4 to 4.02 +/- 0.5 mg/kg of lean body mass per minute, P = .02), but did not change in the control group. In conclusion, red wine consumption for 2 weeks markedly attenuates insulin-resistance in type 2 diabetic patients, without affecting vascular reactivity and nitric oxide production.

O'Connor AD; Rusyniak DE; Bruno A. Cerebrovascular and cardiovascular complications of alcohol and sympathomimetic drug abuse. Medical Clinics of North America 89(6): 1343-+, 2005. (93 refs.)

Alcohol abuse has been linked to intracranial hemorrhage, cardiomyopathy, and hypertension. Some studies have shown a dose-response relationship, with increasing levels of abuse associated with greater risk for disease. Mild-to-moderate drinking, however, is associated with a decreased risk for cerebral infarction and cardiovascular disease. Abuse of sympathomimetic drugs may lead to acute hypertension, focal arterial vasoconstriction, and thrombosis, resulting in ischemic or hemorrhagic stroke, cardiovascular complications, and death. In this article the authors discuss the associated risks for cerebrovascular and cardiovascular disease in users of alcohol and sympathomimetic drugs.

Peasey A; Bobak M; Malyutina S; Pajak A; Kubinova R; Pikhart H et al. Do lipids contribute to the lack of cardio-protective effect of binge drinking: Alcohol consumption and lipids in three eastern European countries. Alcohol and Alcoholism 40(5): 431-435, 2005. (28 refs.)

Aims: The cardio-protective effect of moderate alcohol consumption is partly mediated by HDL cholesterol. However, epidemiological studies suggest that binge drinking may not be associated with reduced risk of heart disease; a possible explanation is that the relationship of blood lipids with binge drinking is different from that with moderate intake. We investigated this hypothesis in a population study in three eastern European countries. Methods: We conducted a cross-sectional study in random population samples in Novosibirsk (Russia), Krakow (Poland) and Karvina (Czech Republic). A sub-sample of 282 men aged 45-64 years who provided a fasting blood sample were analysed. Annual alcohol intake and the frequency of heavy binge drinking (>= 140 g of ethanol per session) were estimated from a graduated frequency questionnaire. Results: Annual intake of alcohol was positively associated with total and HDL cholesterol. After controlling for annual intake, the frequency of heavy binge drinking was associated with increased concentrations of total and HDL cholesterol. By combining annual intake and drinking pattern, we found that men consuming > 8 l of alcohol per year who had a heavy binge at least once a month had the mean total, HDL and LDL cholesterol 1.69 (SE 0.35), 0.61 (0.11) and 0.97 (0.34) mmol/l, respectively, higher than non-drinkers; this resulted in more favourable ratios of total and LDL cholesterol relative to HDL cholesterol in frequent heavy bingers. Triglycerides were not related to alcohol intake or binge drinking. Conclusions: Blood lipids do not seem to explain the apparent lack of the cardio-protective effect of binge drinking reported in epidemiological studies.

Poikolainen K. Best patterns of drinking for the heart. (editorial). Addiction 99(3): 276, 2004. (7 refs.)

This commentary addresses the issues raised by M Trevisan M et al, "Drinking pattern and risk of non-fatal myocardial infarction: A population-based case-control study" in the same issue, pages 313-322

Poikolainen K; Vahtera J; Virtanen M; Linna A; Kivimaki M. Alcohol and coronary heart disease risk: Is there an unknown confounder? Addiction 100(8): 1150-1157, 2005. (23 refs.)

Aims: To evaluate whether confounding by several known or suspected coronary heart disease risk factors are likely to explain the lower coronary heart disease risk among light alcohol drinkers compared with never-drinkers. Designs: A population-based cross-sectional study. Methods: Hypertension, body mass index (BMI), diabetes, depression, sleep disturbances, smoking, physical activity, life satisfaction, psychological distress, trait anxiety, independent and dependent life events, length of working hours, job control, job strain and effort-reward imbalance were compared between never-drinkers and light drinkers (< 70 g of alcohol per week). Data on 41099 participants (6222 men, 34877 women) were derived from two ongoing cohort studies, the '10-Town Study' and 'Finnish Hospital Personnel Study', in Finland in 2000-02. Results: Of the 16 comparisons under study, seven showed significant differences between never-drinkers and light drinkers. Five of the differences favoured never-drinkers and two showed a disadvantage. The latter were low BMI and low leisure-time physical activity, both more common among never-drinkers than among light drinkers. In contrast, smoking, sleep disturbances, trait anxiety, effort-reward imbalance and dependent life events were less common among never-drinkers than among light drinkers. Conclusions: None of the risk factors studied was a likely candidate for an unknown confounder.

Ravaglia S; Marchioni E; Costa A; Maurelli M; Moglia A. Erectile dysfunction as a sentinel symptom of cardiovascular autonomic neuropathy in heavy drinkers. Journal of the Peripheral Nervous System 9(4): 209-214, 2004. (24 refs.)

Because autonomic neuropathy (AN) is not routinely assessed in chronic alcoholism, its features and relationship with other disease parameters remain undefined. The very existence of true alcohol-related autonomic dysfunction, in the absence of alcoholic hepatopathy, is even controversial. We aimed this study at evaluating the frequency and pattern of AN in a population of heavy drinkers without liver dysfunction. We also investigated the putative risk factors for AN as well as its relationship to peripheral neuropathy (PN). Autonomic function was evaluated in 70 detoxified alcoholics and 70 well-matched controls by heart-rate response to deep breathing, heart-rate response to standing from lying position, and blood pressure response to standing up. PN was assessed by electroneurography (ENG). Detailed information about sensorimotor and autonomic symptoms, nutritional status, and parameters reflecting alcohol intake were recorded. No patients showed signs of caloric/protein malnutrition. PN was found in 74% and AN (abnormal test results in two of three tests performed) in 26%; abnormalities in at least one autonomic test were found in 62%. All patients with PN were symptomatic, mainly due to sensory disturbances. In line with this, ENG abnormalities were more evident at sural nerves. AN was symptomatic in 10 of 18 patients, and its sole clinical expression was impotence: indeed, the pattern of autonomic involvement was mainly parasympathetic. AN did not correlate with PN, nor with any parameter reflecting the amount of alcohol intake; only performances on heart-rate response to standing from lying position were related to the duration of abuse. The lack of correlation between PN and AN may suggest a different pathophysiology for these two complications. Unlike PN, AN is often asymptomatic. Among symptomatic patients (55%), erectile dysfunction seems to be the sole symptom, in line with the higher degree of parasympathetic damage.

Rouillier P; Boutron-Ruault MC; Bertrais S; Arnault N; Daudin JJ; Bacro JN et al. Alcohol and atherosclerotic vascular disease risk factors in French men: Relationships are linear, J-shaped, and U-shaped. Alcoholism: Clinical and Experimental Research 29(1): 84-88, 2005. (24 refs.)

Background: Although it is well admitted that alcohol displays a U-shaped relationship with atherosclerotic vascular disease, individual relationships between alcohol and atherosclerosis risk factors may be different and have not been determined precisely for several of them. Methods: A cross-sectional study within the SU.VI.MAX French cohort study was performed to assess the curve of potential relationships between alcohol and atherosclerosis risk factors in 2126 healthy men. Mean daily alcohol intake was derived from 37 alcoholic beverages in twelve 24-hr dietary recalls. Logistic models were adjusted for age. Results: Apolipoprotein B (ApoB), fasting glucose, body mass index, waist-to-hip ratio, and waist circumference displayed a linear relationship with alcohol. The odds ratios and 95% confidence intervals associated with abnormal values of the markers for the highest quintile of alcohol intake were 1.45 (1.06-1.97) for ApoB, 1.98 (1.40-2.80) for fasting glucose, and 1.74 (1.30-2.34) for body mass index. An inverse J-shaped relationship was assumed for ApoA1 and ApoB/ApoA1 ratio, whereas a U-shaped relationship was observed for serum triglycerides and mixed hyperlipidemia. Only the highest quintile of alcohol was associated with hypertension, although the test for linearity was also significant. No association was observed for Lp(a) or homocysteine. Associations were unmodified by further adjustment for carbohydrates, fiber, lipids, tobacco, or exercise. Conclusions: The aggregate of the disparate alcohol risk factor relationships suggests probable net benefit at 15 to 25 g of alcohol/day.

Schroder H; Ferrandez O; Conde JJ; Sanchez-Font A; Marrugat J. Cardiovascular risk profile and type of alcohol beverage consumption: A population-based study. Annals of Nutrition and Metabolism 49(2): 100-106, 2005. (31 refs.)

Aims: To determine the association between several cardiovascular risk factors with total alcohol and types of alcoholic beverage consumption. Methods: The subjects were Spanish men (n = 2,383) and women (n = 2,535) aged 25 - 74 years who were examined in 1994 - 1995 and 1999 - 2000, in two population-based cross-sectional surveys in the north-east of Spain (Gerona). Information of total amount and type of alcohol consumption, educational level, smoking, leisure-time physical, antihypertensive and hyperlipidemic drug treatment was obtained through structured questionnaires. The cardiovascular risk factors total cholesterol, HDL cholesterol, triglycerides, fasting glucose, fibrinogen, lipoprotein (a), heart rate and systolic and diastolic blood pressures were determined. Results: Men consumed significantly more alcohol than women (19.5 vs. 4.5 g/day, respectively) and the prevalence of elevated alcohol consumption (>2 glasses of wine/day) also was higher in men (35.3%) than women (3.5%). Total alcohol intake was significantly related with HDL cholesterol and fibrinogen improvements in both genders. In contrast, total cholesterol, triglycerides, heart rate, and systolic and diastolic blood pressures were directly and significantly (p < 0.05) associated with total alcohol consumption in men but not in women. Wine drinking, particularly in women, was associated with a healthy cardiovascular risk profile. Most of the observed significant associations between type of alcohol beverage and CHD risk factors disappeared after controlling for total alcohol consumption and other confounders. Conclusions: Alcohol consumption was favorably related to the cardiovascular risk profile in women but not in men. The relationship of alcohol beverages seems to be mediated by the total alcohol content rather than by the type of beverage itself.

Seo JS; Yang KM; Kim JM; Min HS; Kim CS; Burri BJ. Effect of chronic alcohol consumption on plasma lipid, vitamins A, and E in Korean alcoholics. Nutrition Research 24(12): 959-968, 2004. (37 refs.)

This human study was conducted to evaluate the effect of chronic alcohol consumption on plasma concentrations of lipid and the antioxidative system in 44 Korean alcoholics and 45 age-, set-, and nationality-matched nonalcoholic subjects. Plasma triacylglycerols and atherogenic index were higher in alcoholics than in control subjects. Plasma total cholesterol was not different among groups, but plasma high-density lipoprotein cholesterol was lower in alcoholics. There were positive correlation between ethanol consumption and plasma lipid peroxide and atherogenic index in all subjects; there were negative correlations between ethanol consumption and plasma high-density lipoprotein cholesterol in all subjects. There were no significant differences between alcoholics and control subjects in plasma concentrations of alpha-tocopherol, although plasma alpha-tocopherol/lipid tended to be lower in alcoholics. Plasma retinol was lower in alcoholics. These results suggest that chronic ethanol consumption can contribute to increased risk for vascular diseases in Korean alcoholics.

Sierksma A; Lebrun CEI; van der Schouw YT; Grobbee DE; Lamberts SWJ; Hendriks HFJ et al. Alcohol consumption in relation to aortic stiffness and aortic wave reflections: A cross-sectional study in healthy postmenopausal women. Arteriosclerosis, Thrombosis, and Vascular Biology 24(2): 342-348, 2004. (34 refs.)

Objective-Moderate alcohol consumption has been postulated to be cardioprotective. Such an effect might be reflected in large-artery properties, such as arterial stiffness and wave reflections. Methods and Results-Three hundred seventy-one healthy postmenopausal women aged 50 to 74 years were sampled from a population-based study. Alcohol intake was calculated from a standardized questionnaire. Applanation tonometry was applied to assess the augmentation index and aortic pulse-wave velocity. Those drinking 1 to 3, 4 to 9, 10 to 14, and 15 to 35 glasses of alcoholic beverages per week had a 0.044 (95% CI -0.47 to 0.56), -0.085 (95% CI -0.59 to 0.43), -0.869 (95% CI -1.44 to -0.29), and -0.225 (95% CI -0.98 to 0.53) m/s difference in mean pulse-wave velocity compared with nondrinkers, respectively, which indicates a J-shaped relationship. Adjustment for potential confounders of pulse-wave velocity or alcohol intake did not materially change the strength of the association. Adjustment for HDL further attenuated the relationship. The augmentation index was not related to alcohol consumption when adjustments were made for physiological determinants such as age, height, and ejection duration. Conclusions-Among postmenopausal women, alcohol consumption is inversely associated with pulse-wave velocity. This supports the presence of a decreased risk of cardiovascular disease with moderate alcohol consumption, which may be mediated in part by HDL cholesterol.

Sierksma A; Muller M; van der Schouw YT; Grobbee DE; Hendriks HFJ; Bots ML. Alcohol consumption and arterial stiffness in men. Journal of Hypertension 22(2): 357-362, 2004. (33 refs.)

Objective: Moderate alcohol consumption has been proposed to be anti-atherogenic and protect against coronary heart disease. Arterial stiffness provides a summary measure of atherosclerotic arterial damage and cardiovascular risk. A vascular protective effect of moderate alcohol consumption would be reflected in an inverse association between alcohol intake and aortic stiffness. Design: A cross-sectional study. Setting The male population of Utrecht. Participants Of 370 men, aged 40-80 years, alcohol intake was calculated from a standardized questionnaire and aortic stiffness was non-invasively assessed by pulse-wave velocity (PWV) measurement of the aorta. Results: There were no non-drinkers; therefore the group consuming 0-3 glasses of alcoholic beverage per week was chosen as the reference group in the analyses. Those drinking 4-10, 11-21 and 22-58 glasses of alcoholic beverage per week had a -0.77 m/s (95% confidence interval, -1.26 to -0.28), -0.57 m/s (95% confidence interval, -1.07 to -0.08) and -0.14 m/s (95% confidence interval, -0.65 to 0.36) difference in mean PWV compared with those drinking 0-3 glasses per week. Adjustment for factors that correlated with PWV or alcohol consumption did not change the strength of the association. Conclusion: Among men aged 40-80 years there is a J-shaped association between alcohol consumption and PWV. This further supports a decreased risk of cardiovascular disease with moderate alcohol consumption.

Soardo G; Donnini D; Varutti R; Moretti M; Milocco C; Basan L et al. Alcohol-induced endothelial changes are associated with oxidative stress and are rapidly reversed after withdrawal. Alcoholism: Clinical and Experimental Research 29(10): 1889-1898, 2005. (52 refs.)

Background: Although heavy alcohol drinkers are at an increased risk of developing cardiovascular events, moderate alcohol intake is associated with reduced incidence of cardiovascular death. This paradox might reflect a dose-related effect of different alcohol intakes on endothelial function and this, in turn, might depend on changes in oxidative stress Methods: We tested the effects of alcohol withdrawal in heavy alcohol consumers and compared the plasma levels of endothelin-1, nitric oxide, plasminogen activator inhibitor-1, von Willebrand factor, malondialdehyde, and intracellular glutathione with those of alcoholics that did not modify their alcohol intake and teetotalers. In human endothelial cells that had been cultured for 2 weeks in the presence of different concentrations of ethanol, we assessed the same parameters after withdrawal of ethanol exposure Results: Alcohol increased the levels of endothelin-1, nitric oxide, and plasminogen activator inhibitor-1 and decreased the levels of von Willebrand factor both in vivo and in vitro. These changes were dose dependent, rapidly reversed after withdrawal of exposure, and associated with the presence of increased oxidative stress as indicated by increased levels of both malondialdehyde and intracellular glutathione. Blockade of oxidative stress by incubation of endothelial cells in the presence of oxidants' scavengers prevented the alcohol-induced functional modifications of the endothelium Conclusions: Alcohol affects endothelial function with an effect that is mediated by an activated oxidative stress and is rapidly reversed after withdrawal. Dose-related endothelial responses to different alcohol intakes might translate in either vascular protection or vascular damage.

Standridge JB; Zylstra RG; Adams SM. Alcohol consumption: An overview of benefits and risks. (review). Southern Medical Journal 97(7): 664-672, 2004. (73 refs.)

Published health benefits of regular light-to-moderate alcohol consumption include lower myocardial infarction rates, reduced heart failure rates, reduced risk of ischemic stroke, lower risk for dementia, decreased risk of diabetes and reduced risk of osteoporosis. Numerous complimentary biochemical changes have been identified that explain the beneficial effects of moderate alcohol consumption. Heavy alcohol consumption, however, can negatively affect neurologic, cardiac, gastrointestinal, hematologic, immune, psychiatric and musculoskeletal organ systems. Binge drinking is a significant problem even among moderate drinkers and is associated with particularly high social and economic costs. A cautious approach should be emphasized for those individuals who drink even small amounts of alcohol. Physicians can apply the research evidence describing the known risks and benefits of alcohol consumption when counseling their patients regarding alcohol consumption.

Stockley CS; Hoj PB. Better wine for better health: Fact or fiction? (review). Australian Journal of Grape and Wine Research 11(2): 127-138, 2005. (160 refs.)

In the first decade of the twenty-first century, the potential therapeutic effects of regular moderate wine consumption are being increasingly acknowledged. They include a reduction in the risk of, and death from, cardiovascular disease, which accounted for 40% of all Australian deaths in 2000. The reduction in risk for wine consumers is similar to that of consumers of fruits, grains and vegetables, which, together with wine, are the core components of a 'Mediterranean-style diet. The chemical components of wine considered primarily responsible for this therapeutic effect are ethanol, and the phenolic compounds and their polyphenolic forms. indeed, moderate wine consumption has been observed to Supplement the cardioprotective effects of an already high phenolic diet, and more importantly, to counter the harmful effects of a high fat diet on blood clotting, endothelial function and lipid oxidation, which contribute to the development of cardiovascular disease. This paper explores both the viticultural and vinification factors that influence phenolic concentration in grapes and wine. The synthesis and accumulation of phenolic compounds in grapes is primarily dependent upon varietal factors, the expression of which is influenced by a combination of climatic and viticultural factors Such as sunlight and temperature during ripening, as well as ripeness at harvest. While the maximum possible concentration of phenolic compounds in a wine will be determined by the content in the constituent grapes, factors which influence the extraction of the phenolic compounds from the skins and seeds primarily influence their concentration in the juice, must and wine. Once harvested, the concentration of phenolic compounds in grapes is invariate, but extraction efficiency can vary during vinification. Accordingly, this paper also explores innovative techniques and technologies that can increase the phenolic content of the resultant wine. At best, winemaking can only extract at 50% of the total phenolic compounds accumulated in the grapes. Therefore, the phenolic content of the resultant wine can only be increased by supplementation Of the must during fermentation with additional Sources of phenolic compounds. Alternatively, a grape seed extract could be added to wine post fermentation to supplement its phenolic content, although this same grape seed extract may also be added to other foods such as yoghurt, from which the phenolic compounds are readily absorbed. Regular and moderate consumption of wine by consumers should, however, be placed in context with the other constituents and characteristics of a healthy diet and lifestyle. Indeed, wine consumers generally have fewer risk factors for cardiovascular disease compared with beer and spirits Consumers, which is reflected in an approximately 25% to 35% lower risk of cardiovascular disease for wine consumers compared to consumers of beer and spirits, respectively.

Suzuki K; Osada N; Akasi YJ; Suzuki N; Sakakibara M; Miyake F; Maki F; Takahashi Y. An atypical case of "Takotsubo cardiomyopathy" during alcohol withdrawal: Abnormality in the transient left ventricular wall motion and a remarkable elevation in the ST segment. Internal Medicine 43(4): 300-305, 2004. (16 refs.)

A 64-year-old man was admitted due to hypokalemia-related myopathy. He was heavy drinker. He felt the stress of alcohol withdrawal during his hospitalization. The patient suffered a cardiopulmonary arrest lasting approximately 5 minutes on the fifth hospital day. One day later, ST-segment elevation was observed in leads I, V-a(L), and V2-6. Emergent cardiac catheterization was performed for suspicion of acute myocardial infarction. Normal coronary arteries with anterior akinesis of the left ventricle were revealed during the procedure. The present case may be an atypical form of "Takotsubo cardiomyopathy" in which the left ventricular contraction is due to focal anterior wall motion abnormalities.

Suzuki Y; Fujisawa M; Ando F; Niino N; Ohsawa I; Shimokata H; Ohta S. Alcohol dehydrogenase 2 variant is associated with cerebral infarction and lacunae. Neurology 63(9): 1711-1713, 2004. (7 refs.)

The authors examined the association of the alcohol dehydrogenase 2 (ADH2) genotype with vascular events in community-dwelling Japanese (1,102 men/1,093 women). The allele ADH2*2 encodes an isozyme with a higher level of activity than ADH2*1. Here, the authors show that the ADH2*1 carriage is associated with high prevalence of cerebral infarction and lacunae in men. Multiple regression analyses confirmed that the risk of lacunae and cerebral infarction was increased by the ADH2*1 allele.

Szmitko PE; Verma S. Antiatherogenic potential of red wine: Clinician update. American Journal of Physiology 288(5): H2023-H2030, 2005. (116 refs.)

Complications of atherosclerosis remain the leading cause of morbidity and mortality in industrialized countries. Epidemiology studies have repeatedly demonstrated that moderate alcohol intake has a beneficial effect on cardiovascular disease. The purpose of this review is to examine the epidemiological and biological evidence supporting the intake of red wine as a means of reducing atherosclerosis. On the basis of epidemiological studies, moderate intake of alcoholic beverages, including red wine, reduces the risk of cardiovascular, cerebrovascular, and peripheral vascular disease in populations. In addition to the favorable biological effects of alcohol on the lipid profile, on hemostatic factors, and in reducing insulin resistance, the phenolic compounds in red wine appear to interfere with the molecular processes underlying the initiation, progression, and rupture of atherosclerotic plaques. Whether red wine is more beneficial than other types of alcohol remains unclear. Definitive data from a large-scale, randomized clinical end-point trial of red wine intake would be required before physicians can advise patients to use wine as part of preventative or medical therapies.

Talmud PJ. How to identify gene-environment interactions in a multifactorial disease: CHD as an example. Proceedings of the Nutrition Society 63(1): 5-10, 2004. (23 refs.)

CHD is a multifactorial disease, caused by both genetic and environmental factors. The inherited 'defective' genes will vary from individual to individual, and any single mutation is likely to be making only a small contribution to risk. The context dependency, i.e. the importance of environmental factors in influencing genetic risk, is now becoming evident. Thus, a mutation may have a modest effect on risk in individuals who maintain a low environmental risk, but a major effect in a high-risk environment. Methods of analysing gene-environment interactions on CHD risk will be discussed and illustrated with several examples. APOE has three common alleles, epsilon2, epsilon3 and epsilon4. The epsilon4 allele has consistently been associated with CHD risk, which has been confirmed by meta-analysis. However, when the effect of genotype on risk was considered in smokers and non-smokers separately, risk in non-smokers was similar in all APOE genotypes. By comparison, in the smokers, epsilon3 homozygotes, as expected, had an approximately 2-fold higher risk, while for epsilon4 carriers there was a significantly greater than additive effect of genotype and smoking on risk (P < 0.007). Thus, the impact of the ε 4 allele on CHD risk appears to be confined to current smokers, an effect that has been confirmed in several studies. Another example is the interaction between the alcohol dehydrogenase 3 gene variant and alcohol consumption on CHD risk (P < 0.001), showing the context dependency of the effect. Thus, the importance of considering environmental factors as potential genotype-risk modifiers has major public health implications.

Tavani A; Augustin L; Bosetti C; Giordano L; Gallus S; Jenkins DJA et al. Influence of selected lifestyle factors on risk of acute myocardial infarction in subjects with familial predisposition for the disease. Preventive Medicine 38(4): 468-472, 2004. (31 refs.)

Background. The joint effect of family history of acute myocardial infarction (AMI) and selected adult life risk factors on the risk of the disease is not clear.Methods. We used the combined data set from three Italian case-control studies including 1,737 cases of incident, nonfatal AMI and 2,317 hospital controls, aged less than 75 years. An adult lifestyle risk score (ALRS) was computed, including tobacco, body mass index, physical activity, and consumption of coffee, alcohol, fish, and vegetables. Results. Compared to the reference category (subjects with no family history of AMI and low ALRS), the risk of AMI was 4.97 (95% confidence intervals, CI: 4.00-6.18) in subjects without family history and high ALRS, 2.19 (95% CI: 1.65-2.90) in subjects with family history and low ALRS, and 11.90 (95% CI: 8.94-15.84) in subjects with family history and high ALRS. Conclusions. The risk of AMI in subjects with a familial predisposition to ischaemic heart disease might be substantially reduced by intervention on selected lifestyle risk factors for AMI. In absolute terms, any such intervention would be more effective than a comparable one on subjects without a familial predisposition.

Tofferi JK; Taylor AJ; Feuerstein IM; O'Malley PG. Alcohol intake is not associated with subclinical coronary atherosclerosis. American Health Journal 148(5): 803-809, 2004. (40 refs.)

Background: The inverse relation between alcohol intake and clinical coronary artery disease (CAD) is well established, although the mechanisms remain speculative. We studied the relation between alcohol intake and subclinical CAD to assess the possible role of alcohol in atherogenesis. Methods We conducted a prospective study of 731 consecutive, consenting, active-duty US Army personnel (39 to 45 years of age) without known CAD who were undergoing a routine physical examination. Each participant was surveyed with the validated Block dietary questionnaire, which included detailed information on alcohol intake as wine, beer, or liquor. Subclinical CAD was determined by means of electron beam computed tomography to quantify coronary artery calcification (CAC). Results The mean age was 42 (+/-2); 83% were male, 71% were white, and 82% were college graduates. The prevalence of CAC was 18.6% (mean CAC. score = 12 +/- 69). Twenty-two percent drank alcohol daily, with an average of 2.4 drinks per day. Systolic blood pressure was correlated with number of drinks per day (r = 0.10, P =.025). Among drinkers, HDL was weakly correlated with daily alcohol consumption (r = 0. 10, P =.025). There was no relation between the CAC score and the alcohol intake as measured by drinks per day (OR, 1.02; 95% Cl, 0.64 to 1.63; 1.13, 0.59 to 2.15; 1.26, 0.69 to 2.59, for less than 1, 1 to 2, and more than 2 drinks per day, respectively). Stratified analyses based on type of alcohol and multivariate analyses indicated no independent relation between any type or quantity of alcohol intake and the presence or extent of coronary calcification. Conclusions Alcohol intake does not appear to be inversely related to subclinical CAC, implying that previous observations of a protective effect of alcohol on clinical CAD may involve factors related to plaque stability rather than atherogenesis.

Trevisan M; Dorn J; Falkner K; Russell M; Ram M; Muti P et al. Drinking pattern and risk of non-fatal myocardial infarction: A population-based case-control study. Addiction 99(3): 313-322, 2004. (33 refs.)

Aims: Alcohol consumption has been associated with a reduced risk of heart disease incidence and mortality. However, most studies have focused on an average volume per specific time period and have paid little attention to the pattern of drinking. The aim of this study was to examine the association between various drinking patterns and myocardial infarction (MI). Design: A population-based case-control study. Methods: Participants were 427 white males with incident MI and 905 healthy white male controls (age 35-69 years) selected randomly from two Western New York counties. During computer-assisted interviews detailed information was collected regarding patterns of alcohol consumption during the 12-24 months prior to interview (controls) or MI (cases). Findings: Compared to life-time abstainers, adjusted odds ratios (ORs) and 95% confidence interval (CI) for non-current and current drinkers were 0.66 (0.31-1.39) and 0.50 (0.24-1.02), respectively. Daily drinkers exhibited a significantly lower OR (0.41) compared to life-time abstainers. Participants who drank mainly without food had an OR of 1.49 (0.96-2.31) compared to those who drank mainly with food and 0.62 (0.28-1.37) compared to life-time abstainers. Men who reported drinking only at weekends had a significantly greater MI risk [1.91; (1.21-3.01)] compared to men who drank less than once/week, but not compared to life-time abstainers [0.91 (0.40-2.07)]. Conclusions: Our results indicate that patterns of alcohol use have important cardiovascular health implications.

Umar A; Depont F; Jacquet A; Lignot S; Segur MC; Boisseau M et al. Effects of armagnac or vodka on platelet aggregation in healthy volunteers: A randomized controlled clinical trial. Thrombosis Research 115(1-2): 31-37, 2005. (41 refs.)

Background: Cardiovascular mortality is especially low in southwest France (the French Paradox). In previous experimental studies, we found that alcohol-free extracts of armagnac could inhibit human platelet function in vitro and experimental thrombosis in vivo. To test the possible relevance of these findings, we tested the effects of daily use of small quantities of armagnac against same alcohol strength, potyphenol-free vodka in healthy volunteers. Method: Randomized control. led trial comparing 5-year old armagnac. (30 ml/day for 2 weeks), to same alcoholic strength vodka, in 20 healthy volunteers, on platelet aggregation induced by ADP, collagen, and thrombin, as well as bleeding time, partial thromboplastin time (OTT), and plasma lipids during and after consumption. Platelet testing was done blind. Results: After 14 days, ADP-induced platelet aggregation was inhibited more in armagnac (-31 +/- 3.2% compared to pretreatment values, p<.01) than in vodka (-11.0 +/- 6.8%, NS) users (p<.05, armagnac vs. vodka). A rebound increase of aggregation was found 2 weeks later in vodka but not in armagnac users. The same pattern was found for thrombin-induced aggregation, including post-treatment rebound. No effect was found on. collagen-induced aggregation, bleeding time, pTT, or plasma lipids. Conclusion: The chronic ingestion of moderate quantities of armagnac modified platelet aggregation to ADP in healthy volunteers. The difference with the effects of same alcohol degree vodka is in favour of an effect of the nonalcoholic fraction in the effects of armagnac, rather than just alcohol. All spirits may not be equal for cardioprotection.

Uyarel H; Ozdol C; Gencer AM; Okmen E; Cam N. Acute alcohol intake and QT dispersion in healthy subjects. Journal of Studies on Alcohol 66(4): 555-558, 2005. (24 refs.)

Objective: QT dispersion (QTd) is the maximal interlead difference in the QT interval on the surface 12-lead electrocardiogram (ECG). An increase in QTd is found in patients with various cardiac diseases and reflects cardiac autonomic imbalance. Variability of QT duration among the 12 surface ECG leads expresses electrical instability and greater susceptibility to malignant ventricular arrhythmias. Electrophysiological studies have shown that heavy episodic drinking facilitates the induction of ventricular tachyarrhythmias in some heavy drinkers. However, the association between QTd and acute alcohol intake has not been studied previously in healthy subjects. Method: In a randomized crossover study, 10 healthy mate volunteers (average [SD] age 30 [2.1] years, range: 25-33) received either alcohol (six 12-oz cans of beer) or placebo (juice). The alcohol group consumed 0.97 [0.12] g/kg body weight ethanol, and the placebo group consumed the same amount of juice in a 1-hour period. After a 48-hour washout period, the alcohol group drank juice, and the juice group drank alcohol. QTd and corrected QTd (cQTd) were measured in a baseline ECG after the alcohol period (AP) and after the juice period (JP). Results: In comparison with baseline ECG (31.7 [9.4] ms), QTd values after AP (42.1 [10.8] ms) were significantly prolonged (p =.027), but this was not so after J-P (33.8 [7.1] ms; P = Ns). Also in comparison with baseline ECG (35.7 [11.1] ms), cQTd values after the AP (49.8 [12.7] ms) were significantly prolonged (p =.005), but again, this was not so after the JP (36.8 [7.3] MS; P = NS). Conclusions: Heavy episodic drinking is associated with an increase in QTd and cQTd.

van de Wiel A. Diabetes mellitus and alcohol. (review). Diabetes/Metabolism Research and Reviews 20(4): 263-267, 2004. (50 refs.)

Alcohol influences glucose metabolism in several ways in diabetic patients as well as in non-diabetic patients. Since alcohol inhibits both gluconeogenesis and glycogenolysis, its acute intake without food may provoke hypoglycaemia, especially in cases of depleted glycogen stores and in combination with sulphonylurea. Consumed with a meal including carbohydrates, it is the preferred fuel, which may initially lead to somewhat higher blood glucose levels and hence an insulin response in type 2 diabetic patients. Depending on the nature of the carbohydrates in the meal, this may be followed by reactive hypoglycaemia. Moderate consumption of alcohol is associated with a reduced risk of atherosclerotic disorders. Diabetic patients benefit from this favourable effect as much as non-diabetic patients. Apart from effects on lipid metabolism, haemostatic balance and blood pressure, alcohol improves insulin sensitivity. This improvement of insulin sensitivity may also be responsible for the lower incidence of type 2 diabetes mellitus reported to be associated with light-to-moderate drinking. in case of moderate and sensible use, risks of disturbances in glycaemic control, weight and blood pressure are limited. Excessive intake of alcohol, however, may not only cause loss of metabolic control, but also annihilate the favourable effects on the cardiovascular system.

van den Elzen AP; Sierksma A; Oren A; Vos LE; Witteman JC; Grobbee DE. Alcohol intake and aortic stiffness in young men and women. Journal of Hypertension 23(4): 731-735, 2005. (24 refs.)

Background Moderate alcohol consumption has been shown to protect against cardiovascular disease. Aortic stiffness can be regarded as a marker of cardiovascular disease risk. Previously we have shown an inverse to J-shaped association between alcohol intake and aortic stiffness in middle-aged and elderly men and postmenopausal women. Objective In the present study we examined whether a relation between alcohol intake and aortic stiffness is already present at a younger age. Design: Cross-sectional data of a cohort study in men and women aged 28 years were analysed stratified by gender (240 men and 283 women). Measurements: Alcohol intake was derived from a questionnaire and aortic stiffness was assessed by pulsewave velocity measurement. Results: In women an alcoholic beverage intake of >= 1 glass/day is associated with a 0.36 m/s (95% confidence interval, -0.58 to -0.14) lower pulse-wave velocity compared with non-drinkers. In men alcohol intake is also inversely related to pulse-wave velocity, but this was not significant. These findings were independent of age, blood pressure and heart rate. Conclusions These findings suggest that moderate intake of alcohol may affect vascular stiffness at an early age, notably in women. These findings may be viewed as compatible with a vascular protective effect of alcohol that expresses well before the occurrence of symptomatic cardiovascular disease.

Vliegenthart R; Oei HHS; van den Elzen APM; van Rooij FJA; Hofman A; Oudkerk M et al. Alcohol consumption and coronary calcification in a general population. Archives of Internal Medicine 164(21): 2355-2360, 2004. (37 refs.)

Background: A U- or J-shaped association exists between alcohol consumption and coronary heart disease. One Of the proposed mechanisms for this association involves atherogenesis, but there are no data on the association between alcohol consumption and coronary atherosclerosis in asymptomatic subjects. Coronary calcification, a measure of coronary atherosclerosis, allows for the study of the association. Methods: This cross-sectional study was performed using data from the population-based Rotterdam Coronary Calcification Study. Data on alcohol consumption were available for 1795 individuals without coronary heart disease. Mean +/-SD age of the participants was 71 +/- 5.7 years. Coronary calcification was detected on electron beam computed tomographic scans and quantified as a calcium score by the Agatston method. Extensive coronary calcification was defined as a calcium score above 400. Results: In this population, 15.8% of individuals consumed no alcohol; 46.5% consumed 1 alcoholic drink or less per day; 16.9% consumed 1 to 2 drinks per day; and 20.9% consumed more than 2 drinks per day. A U-shaped association was found between alcohol consumption and coronary calcification. Compared with nondrinkers, the odds ratio of extensive coronary calcification was 0.60 (95% confidence interval [CI], 0.44-0.82) for those who consumed 1 drink or less daily; 0.51 (95% CI, 0.35-0.76) for those who consumed 1 to 2 drinks daily; and 0.90 (95% CI, 0.62-1.29) for those who consumed more than 2 drinks. The association remained after multivariate adjustment.Conclusions: The consumption of 2 alcoholic drinks or fewer per day was inversely associated with extensive coronary calcification. The risk of extensive coronary calcification was 50% lower in individuals who consumed 1 to 2 alcoholic drinks per day than in nondrinkers.

von Mach MA; Brinkmann X; Weilemann LS. Epidemiology of cardiac dysrhythmias in acute intoxication. Zeitschrift fur Kardiologie 93(Supplement 4): 9-15, 2004. (19 refs.)

Cardiac dysrhythmias are common in acute intoxications. However, epidemiological data is rare and restricted to specific substances. From 1995 to 2003 (until September) 91285 inquiries of physicians and paramedics to a poison center regarding acute intoxications were analyzed revealing 9888 patients (10.8%) suffering from disturbances of the cardiac rhythm. In a first step of the explorative data analysis dysrhythmias were graduated into three categories (I: tachycardia/bradycardia; II: arrhythmia/conduction disorder; III: ventricular dysrhythmia/cardiac arrest) and the frequencies of the involved substances were determined. In a second step substances which resulted to be of significant interest were investigated for their specific pattern of dysrhythmias. For category I (n = 8730) predominatly tricyclic antidepressants, neuroleptics, benzodiazepines, betablockers, and nonsteroidal antiinflammatory drugs were registered (II: [n = 949] tricyclic antidepressants, digitalis glycosides, benzodiazepines, neuroleptics, Caantagonists; III: [n = 209] tricyclic antidepressants, neuroleptics, sotalol, ethanol, central nervous system stimulants). Tricyclic antidepressants resulted in 23.4% of the reported cases in symptoms of category I (II: 2.3%, III: 0.6%; n = 8535). The highest rates of dysrhythmias were observed for sotalol (I: 34.7%, II: 21.6%, III: 8.0%; n = 176) as compared to the lowest rates found for paracetamol (I: 5.2%, II: 0.3%, III: 0.1%; n = 6429). The present investigation provided a comprehensive clinical overview about the frequency of dysrhythmias and involved substances during acute poisonings in emergency medicine. Furthermore, the specific effects of selected substances conc