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CORK Bibliography: Alcohol's Effects on Cardiovascular System

49 citations. January 2010 to present

Prepared: March 2012

Awtry EH; Philippides GJ. Alcoholic and cocaine-associated cardiomyopathies. (review). Progress In Cardiovascular Diseases 52(4): 289-299, 2010. (71 refs.)

Alcohol and cocaine use are associated with significant cardiovascular complications, including cardiomyopathy. The pathophysiologic mechanisms underlying the development of these toxic cardiomyopathies vary depending on the inciting agent but include direct toxic effects, neurohormonal activation, altered calcium homeostasis, and oxidative stress. The typical patient with alcoholic cardiomyopathy is a long-term excessive alcohol consumer who is otherwise indistinguishable from other patients with nonischemic cardiomyopathy. The typical patient with cocaine cardiomyopathy is a young male smoker who presents with signs of adrenergic excess. Management of these patients is similar to that of patients with other forms of dilated cardiomyopathy, although beta-blockers should be avoided in patients with cocaine-associated heart failure and benzodiazepines should be given in this setting to blunt adrenergic excess. Left ventricular function may improve dramatically with abstinence from alcohol or cocaine. Unfortunately, the rate of recidivism is high and left ventricular dysfunction and symptomatic heart failure often recurs.

Bilello J; McCray V; Davis J; Jackson L; Danos LA. Acute ethanol intoxication and the trauma patient: Hemodynamic pitfalls. World Journal of Surgery 35(9): 2149-2153, 2011. (24 refs.)

Many trauma patients are acutely intoxicated with alcohol. Animal studies have demonstrated that acute alcohol intoxication inhibits the normal release of epinephrine, norepinephrine, and vasopressin in response to acute hemorrhage. Ethanol also increases nitric oxide release and inhibits antidiuretic hormone secretion. This article studies the effects of alcohol intoxication (measured by blood alcohol level, BAL) on the presentation and resuscitation of trauma patients with blunt hepatic injuries. A retrospective registry and chart review was conducted of all patients who presented with blunt liver injuries at an ACS-verified, level I trauma center. Data collected included admission BAL, systolic blood pressure, hematocrit, International Normalized Ratio (INR), liver injury grade, Injury Severity Score (ISS), intravenous fluid and blood product requirements, base deficit, and mortality. From September 2002 to May 2008, 723 patients were admitted with blunt hepatic injuries. Admission BAL was obtained in 569 patients, with 149 having levels > 0.08%. Intoxicated patients were more likely to be hypotensive on admission (p = 0.01) despite a lower liver injury grade and no significant difference in ISS. There was no significant difference in the percent of intoxicated patients requiring blood transfusion. However, when blood was given, intoxicated patients required significantly more units of packed red blood cells (PRBC) than their nonintoxicated counterparts (p = 0.01). Intoxicated patients also required more intravenous fluid during their resuscitation (p = 0.002). Alcohol intoxication may impair the ability of blunt trauma patients to compensate for acute blood loss, making them more likely to be hypotensive on admission and increasing their PRBC and intravenous fluid requirements. All trauma patients should have BAL drawn upon admission and their resuscitation should be performed with an understanding of the physiologic alterations associated with acute alcohol intoxication.

Boschloo L; Vogelzangs N; Licht CMM; Vreeburg SA; Smit JH; van den Brink W et al. Heavy alcohol use, rather than alcohol dependence, is associated with dysregulation of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. Drug and Alcohol Dependence 116(1-3): 170-176, 2011. (43 refs.)

Background: Heavy alcohol use as well as alcohol dependence (AD) have been associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA)-axis and the autonomic nervous system (ANS). However, the relative contribution of alcohol use and AD is unclear. Methods: Baseline data were derived from 2947 persons of the Netherlands Study of Depression and Anxiety (NESDA), including non-drinkers (n = 498), moderate drinkers (n = 2112) and heavy drinkers (n = 337). We also distinguished between persons with no lifetime DSM-IV AD (n = 2496), remitted AD (>1 year; n = 243), and current AD (<= 1 year; n=208). ANS measures included ECG-based heart rate (HR), respiratory sinus arrhythmia (RSA, high RSA reflecting high cardiac parasympathetic control) and pre-ejection period (PEP, high PEP reflecting low cardiac sympathetic control). HPA-axis measures included the cortisol awakening response (area under the curve with respect to the ground [AUCg] and increase [AUCip, evening cortisol and a 0.5 mg dexamethasone suppression test, all measured in saliva. Results: Heavy drinkers showed higher basal cortisol levels (AUCg: p=.02; evening cortisol: p=.006) and increased cardiac sympathetic control (higher HR: p=.04; lower PEP: p=.04) compared to moderate drinkers. Persons with current or remitted AD did not differ from persons without lifetime AD on any of the HPA-axis or ANS indicators (all p>.33). Similar patterns of HPA-axis and ANS activity across alcohol use groups were found in persons with and without lifetime AD. Conclusions: Our findings suggest that current heavy alcohol use, rather than current or remitted AD, is associated with hyperactivity of the HPA-axis and increased cardiac sympathetic control.

Britton A; Marmot MG; Shipley MJ. How does variability in alcohol consumption over time affect the relationship with mortality and coronary heart disease? Addiction 105(4): 639-645, 2010. (26 refs.)

Objective: To examine the relationship between alcohol consumption and risk of mortality and incident coronary heart disease (CHD), taking account of variation in intake during follow-up. Method: Prospective cohort study of 5411 male civil servants aged 35-55 years at entry to the Whitehall II study in 1985-88. Alcohol consumption was reported five times over a 15-year period. Mortality, fatal CHD, clinically verified incident non-fatal myocardial infarction and definite angina were ascertained during follow-up. Results: We found evidence that drinkers who vary their intake during follow-up, regardless of average level, have increased risk of total mortality (hazard ratio of high versus low variability 1.52: 95% CI: 1.07-2.17), but not of incident CHD. Using average consumption level, as opposed to only a baseline measure, gave slightly higher risk estimates for CHD compared to moderate drinkers at the extremes of the drinking range. Conclusions: Multiple repeated measures are required to explore the effects of variation in exposure over time. Caution is needed when interpreting risks of exposures measured only once at baseline, without consideration of changes over time.

Butman S. In-stent restenosis: While not exactly about smoking, it so often is about smoking. (editorial). Catheterization and Cardiovascular Interventions 78(4): 609-610, 2011. (7 refs.)

Cameli M; Ballo P; Garzia A; Lisi M; Bocelli A; Mondillo S. Acute effects of low doses of ethanol on left and right ventricular function in young healthy subjects. Alcoholism: Clinical and Experimental Research 35(10): 1860-1865, 2011. (43 refs.)

Background: Moderate-to-high blood concentrations of ethanol acutely impair conventional echocardiographic measures of left ventricular (LV) performance, but the effects of low concentrations are unclear. This study explored the acute effects of low blood concentrations of ethanol on sensitive and load-independent indices of LV and right ventricular (RV) function. Methods: This is a crossover experimental study conducted in 64 young healthy volunteers. Participants were asked to drink a light dose of Italian red wine equivalent to 0.5 mg/kg of ethanol, and an equal volume of fruit juice in separate experiments. The following measurements were taken at baseline and 60 minutes after the challenges: tissue Doppler mitral annulus systolic velocity (S') and excursion (MAPSE), early diastolic velocity (E'), its ratio to late diastolic velocity (E'/A'), and the ratio of mitral-to-myocardial early diastolic velocities (E/E'); and tricuspid annulus systolic velocity (tricuspid S') and amplitude (TAPSE), early diastolic velocity (tricuspid E'), and its ratio to late diastolic velocity (tricuspid E'/A'). Results: Blood ethanol concentration after wine intake was 0.48 +/- 0.06 g/l. Compared with the control challenge, ethanol yielded a decrease in all measures of LV function (S', -9.7%; E', -11.2%; E'/A', -13.4%; MAPSE, -8.8%; p < 0.05 for all). Among indices of RV function, increases in tricuspid E'/A' ratio and TAPSE were observed (+24.5% and +9.0%, respectively; p < 0.05 for both). Conclusions: Low blood concentrations of ethanol acutely impair LV function and increase some indices of RV function in young healthy individuals.

Carter MD; Lee JH; Buchanan DM; Peterson ED; Tang FM; Reid KJ et al. Comparison of outcomes among moderate alcohol drinkers before acute myocardial infarction to effect of continued versus discontinuing alcohol intake after the infarct. American Journal of Cardiology 105(12): 1651-1654, 2010. (18 refs.)

Light-to-moderate alcohol consumption has been previously associated with a lower risk of acute myocardial infarction (AMI) and mortality. The association of changes in drinking behavior after an AMI with health status and long-term outcomes is unknown. Using a prospective cohort of patients with AMI evaluated with the World Health Organization's Alcohol Use Disorders Identification Test, we investigated changes in drinking patterns in 325 patients who reported moderate drinking at the time of their AMI. One-year alcohol consumption, disease-specific (angina pectoris and quality of life) and general (mental and physical) health status and rehospitalization outcomes, and 3-year mortality were assessed. Seattle Angina Questionnaire Angina Frequency and Quality of Life, Short Form-12 Mental and Physical Component Summary Scales were modeled using multivariable hierarchical linear models within site. Of the initial 325 moderate drinkers at baseline, 273 (84%) remained drinking and 52 (16%) quit. In fully adjusted models, Physical Component Scale scores (beta 6.47, 95% confidence interval 3.73 to 9.21, p<0.01) were significantly higher during follow-up in those who remained drinking. Persistent moderate drinkers had a trend toward less angina (relative risk 0.65, 95% confidence interval 0.39 to 1.10, p = 0.11), fewer rehospitalizations (hazard ratio 0.79, 95% confidence interval 0.44 to 1.41, p = 0.42), lower 3-year mortality (relative risk 0.75, 95% confidence interval 0.23 to 2.51, p = 0.64), and better disease-specific quality of life (Seattle Angina Questionnaire Quality of Life, beta 3.88, 95% confidence interval -0.79 to 8.55, p = 0.10) and mental health (Mental Component Scale, beta 0.83, 95% confidence interval -1.62 to 3.27, p = 0.51) than quitters. In conclusion, these data suggest that there are no adverse effects for moderate drinkers to continue consuming alcohol and that they may have better physical functioning compared to those who quit drinking after an AMI.

Chiuve SE; Rimm EB; Mukamal KJ; Rexrode KM; Stampfer MJ; Manson JE et al. Light-to-moderate alcohol consumption and risk of sudden cardiac death in women. Heart Rhythm 7(10): 1374-1380, 2010. (36 refs.)

BACKGROUND Moderate alcohol intake is associated with lower risk of coronary heart disease (CHD), but the association with sudden cardiac death (SCD) is less clear. In men, heavy alcohol consumption may increase risk of SCD, whereas light-to-moderate alcohol intake may lower risk. There are no parallel data among women. OBJECTIVE The purpose of this study was to assess the association between alcohol intake and risk of SCD among women and to investigate how this risk compared to other forms of CHD. METHODS We conducted a prospective cohort study among 85,067 women from the Nurses' Health Study who were free of chronic disease at baseline. Alcohol intake was assessed every 4 years through questionnaires. Primary endpoints included SCD, fatal CHD, and nonfatal myocardial infarction. RESULTS We found a U-shaped association between alcohol intake and risk of SCD, with the lowest risk among women who drank 5.0-14.9 g/day of alcohol (P for quadratic trend = 0.02). Compared to abstainers, the multivariate relative risk (95% confidence interval) for SCD was 0.79 (0.55-1.14) for former drinkers, 0.77 (0.57-1.06) for 0.1-4.9 g/day, 0.64 (0.43-0.95) for 5.0-14.9 g/day, 0.68 (0.38-1.23) for 15.0-29.9 g/day, and 1.15 (0.70-1.87) for >= 30.0 g/day. In contrast, the relationship of alcohol intake and nonfatal and fatal CHD was more linear (P for linear trend <.001). CONCLUSION: In this cohort of women, the relationship between light-to-moderate alcohol intake and SCD is U-shaped, with a nadir at 5.0-14.9 g/day. Low levels of alcohol intake do not raise the risk of SCD and may lower risk in women.

Costanzo S; Di Castelnuovo A; Donati MB; Iacoviello L; de Gaetano G. Wine, beer or spirit drinking in relation to fatal and non-fatal cardiovascular events: A meta-analysis. (review). European Journal of Epidemiology 26(11): 833-850, 2011. (52 refs.)

In previous studies evaluating whether different alcoholic beverages would protect against cardiovascular disease, a J-shaped relationship for increasing wine consumption and vascular risk was found; however a similar association for beer or spirits could not be established. An updated meta-analysis on the relationship between wine, beer or spirit consumption and vascular events was performed. Articles were retrieved through March 2011 by PubMed and EMBASE search and a weighed least-squares regression analysis pooled data derived from studies that gave quantitative estimation of the vascular risk associated with the alcoholic beverages. From 16 studies, evidence confirms a J-shaped relationship between wine intake and vascular risk. A significant maximal protection-average 31% (95% confidence interval (CI): 19-42%) was observed at 21 g/day of alcohol. Similarly, from 13 studies a J-shaped relationship was apparent for beer (maximal protection: 42% (95% CI: 19-58%) at 43 g/day of alcohol). From 12 studies reporting separate data on wine or beer consumption, two closely overlapping dose-response curves were obtained (maximal protection of 33% at 25 g/day of alcohol). This meta-analysis confirms the J-shaped association between wine consumption and vascular risk and provides, for the first time, evidence for a similar relationship between beer and vascular risk. In the meta-analysis of 10 studies on spirit consumption and vascular risk, no J-shaped relationship could be found.

Darke S; Torok M; Kaye S; Duflou J. Cardiovascular disease risk factors and symptoms among regular psychostimulant users. Drug and Alcohol Review 29(4): 371-377, 2010. (35 refs.)

Introduction and Aims. The aim of this study is to determine the prevalence of risk factors and possible symptoms of cardiovascular disease among regular psychostimulant users. Design and Methods. A total of 239 regular psychostimulant users were administered a structured interview on health and cardiovascular disease symptoms. Results. Thirty per cent had a family history of cardiovascular disease, 37% had sought treatment for possible symptoms of cardiovascular disease and 14% had been prescribed medications for symptoms of possible cardiovascular problems. The most commonly reported severe symptoms were: chronic shortness of breath (17%), chest pains (15%), palpitations (14%), chronic fatigue (13%) and dizziness/loss of consciousness (11%). Chest pains had been experienced on at least a weekly basis in the past 12 months by 13%. All symptoms occurred at significantly higher levels after the initiation of psychostimulant use. Higher levels of psychostimulant dependence were positively correlated with the number of frequently occurring symptoms (r = 0.23). Independent correlates of higher levels of frequently occurring symptoms were higher level of psychostimulant dependence, higher levels of alcohol dependence, a family history of cardiovascular disease and a diagnosis of cardiovascular disease. Discussion and Conclusions. While a great deal of clinical attention has been given to the sequelae of psychostimulant use, such as psychosis, the potential effects upon the cardiovascular systems of users are worthy of specific public health attention.

Di Castelnuovo A; Costanzo S; Donati MB; Iacoviello L; de Gaetano G. Prevention of cardiovascular risk by moderate alcohol consumption: Epidemiologic evidence and plausible mechanisms. (review). Internal and Emergency Medicine 5(4): 291-297, 2010. (65 refs.)

An inverse association between moderate alcohol intake and cardiovascular risk, in particular coronary disease and ischemic stroke, has been shown in many epidemiologic studies. In addition, several other diseases are also known to occur less frequently in moderate drinkers than in non-drinkers, whereas excess of drinking is invariably harmful. However, some concern has been recently raised about the possibility that at all dosages the harm of alcohol could overcome its beneficial effects. We present here the epidemiologic and mechanistic evidence to support the protective effect of moderate alcohol intake against cardiovascular disease and all-cause mortality.

Dichter ME; Cerulli C; Bossarte RM. Intimate partner violence victimization among women veterans and associated heart health risks. Women's Health Issues 21(4, special issue): S190-S194, 2011. (40 refs.)

Purpose: Cardiovascular disease (CVD) is the leading cause of death for women in the United States. CVD risk factors, including depression, smoking, heavy drinking, being overweight, and physical inactivity, are associated with stress and may be linked to women's experiences of intimate partner violence (IPV) victimization. We know little about IPV and CVD risk factors among veteran women. The purpose of this study was to identify the association between lifetime IPV victimization and CVD risk factors among women, accounting for veteran status. Methods: We used data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System for 2006 for the eight states that included the IPV module. We explored the associations between veteran status and lifetime IPV victimization and between IPV exposure and CVD risk factors, for veteran and non-veteran women. Findings: Veteran women were more likely than non-veteran women to report lifetime IPV victimization (33.0% vs. 23.8%). IPV exposure was associated with depression, smoking, and heavy drinking. We did not find evidence for an association between IPV exposure and lack of exercise or being overweight or obese, when controlling for demographic characteristics and veteran status. Conclusion: Women veterans have particularly high rates of lifetime IPV victimization. In addition, IPV victimization is associated with an increased risk of heart health risk factors. The findings suggest that we should attend to IPV exposure among veteran women and further investigate the link between IPV and military service, and the associated health impacts.

Fillmore KM; Chikritzhs T. Commentary on Britton et al. (2010): The dangers of declining drink. (commentary). Addiction 105(4): 646-647, 2010. (17 refs.)

Freiberg MS; Kraemer KL. Focus on the heart: Alcohol consumption, HIV infection, and cardiovascular disease. Alcohol Research & Health 33(3): 237-246, 2010. (68 refs.)

With the advent of effective antiretroviral therapy, people infected with HIV have a longer life expectancy and, consequently, are likely to develop other chronic conditions also found in noninfected people, including cardiovascular disease (CVD). Alcohol consumption, which is common among HIV-infected people, may influence the risk of CVD. In noninfected adults, moderate alcohol consumption can reduce the risk of coronary heart disease (CHD), heart attacks, and the most common type of stroke, whereas heavy drinking increases the risk of these cardiovascular events. These relationships can be partially explained by alcohol's effects on various risk factors for CVD, including cholesterol and other lipid levels, diabetes, or blood pressure. In HIV-infected people, both the infection itself and its treatment using combination anti retroviral therapy may contribute to an increased risk of CVD by altering blood lipid levels, inducing inflammation, and impacting blood-clotting processes, all of which can enhance CVD risk. Coinfection with the hepatitis C virus also may exacerbate CVD risk. Excessive alcohol use can further enhance CVD risk in HIV-infected people through either of the mechanisms described above. In addition, excessive alcohol use (as well as HIV infection) promote microbial translocation the leaking of bacteria or bacterial products from the intestine into the blood stream, where they can induce inflammatory and immune reactions that damage the cardiovascular system.

Gaffo AL; Roseman JM; Jacobs DR; Lewis CE; Shikany JM; Mikuls TR et al. Serum urate and its relationship with alcoholic beverage intake in men and women: Findings from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort. Annals of the Rheumatic Diseases 69(11): 1965-1970, 2010. (34 refs.)

Objective To investigate if beer, liquor (spirits), wine and total alcohol intakes have different associations with serum urate (SU) concentrations at different ages in a cohort of young men and women. Methods Data from 3123 participants at baseline and follow-up at 20 years were used, with balanced proportions of Caucasians and African Americans. The relationships of SU with categories of beer, liquor, wine and total alcohol intake referent to no intake were examined in sex-specific, cross-sectional analyses. Results Mean age (SD) at the beginning of follow-up was 25.1 (3.6) years. Compared with non-drinkers, significant associations between higher SU concentrations and greater beer intake were observed among men and women, with more pronounced and consistent associations for women. An association between greater liquor intake and higher SU concentrations was only seen for men at the year 20 evaluation. Wine intake was not associated with SU in either sex and total alcohol was associated with higher SU concentrations in both men and women. The magnitude of the associations between alcoholic beverages intake and SU was modest (<= 0.03 mg/dl/alcoholic beverage serving). Conclusion An association between higher SU concentrations and greater beer intake was consistent and pronounced among women, but also present in men. Despite the small magnitude of the increases in SU associated with alcohol intake, clinical implications in conditions such as cardiovascular disease and gout in young adults who are moderate and heavy drinkers cannot be ruled out.

Hansel B; Thomas F; Pannier B; Bean K; Kontush A; Chapman MJ et al. Relationship between alcohol intake, health and social status and cardiovascular risk factors in the urban Paris-Ile-De-France Cohort: is the cardioprotective action of alcohol a myth? European Journal of Clinical Nutrition 64(6): 561-568, 2010. (39 refs.)

Background/Objectives: Observational studies document the inverse relationship between cardiovascular disease (CVD) and moderate alcohol intake. However, the causal role for alcohol in cardioprotection remains uncertain as such protection may be caused by confounders and misclassification. The aim of our study was to evaluate potential confounders, which may contribute to putative cardioprotection by alcohol. Subjects/Methods: We evaluated clinical and biological characteristics, including cardiovascular (CV) risk factors and health status, of 149 773 subjects undergoing examination at our Center for CVD Prevention (The Urban Paris-Ile-de-France Cohort). The subjects were divided into four groups according to alcohol consumption: never, low (<= 10 g/day), moderate (10-30 g/day) and high (>30 g/day); former drinkers were analyzed as a separate group. Results: After adjustment for age, moderate male drinkers were more likely to display clinical and biological characteristics associated with lower CV risk, including low body mass index, heart rate, pulse pressure, fasting triglycerides, fasting glucose, stress and depression scores together with superior subjective health status, respiratory function, social status and physical activity. Moderate female drinkers equally displayed low waist circumference, blood pressure and fasting triglycerides and low-density lipoprotein-cholesterol. Alcohol intake was strongly associated with plasma high-density lipoprotein-cholesterol in both sexes. Multivariate analysis confirmed that moderate and low drinkers displayed better health status than did never drinkers. Importantly, few factors were causally related to alcohol intake. Conclusions: Moderate alcohol drinkers display a more favorable clinical and biological profile, consistent with lower CV risk as compared with nondrinkers and heavy drinkers. Therefore, moderate alcohol consumption may represent a marker of higher social level, superior health status and lower CV risk.

Howe M; Leidal A; Montgomery D; Jackson E. Role of cigarette smoking and gender in acute coronary syndrome events. American Journal of Cardiology 108(10): 1382-1386, 2011. (17 refs.)

Cigarette smoking has been associated with lower mortality after an acute coronary event. We hypothesized that the improved survival in smokers is related to demographic differences and sought to further evaluate the gender disparities in smokers after an acute coronary event. A prospective cohort of 3,588 patients hospitalized at a single center from 1999 to 2006 was identified. Smoking status, in-hospital and 6-month follow-up death, and cardiovascular events (i.e., myocardial infarction, stroke, cardiac-related rehospitalization, and unscheduled revascularization) were assessed. The prevalence of smoking in men increased over time. The smokers were younger at presentation with fewer co-morbidities than nonsmokers. Male smokers had lower mortality (3.2% vs 5.4%, p = 0.04) and fewer cardiovascular events (33.1% vs 42.4%, p = 0.003) at 6 months than nonsmokers. However, after adjusting for age and co-morbidities, smoking was not an independent predictor of events (odds ratio 0.88, 95% confidence interval 0.67 to 1.17). Female smokers had mortality (5.6% vs 8.4%, p = 0.15) and cardiovascular events (54.5% vs 49.7%, p = 0.28) at 6 months similar to that of nonsmokers, with a nonsignificant trend toward increased risk after adjustment (odds ratio 1.31, 95% confidence interval 0.90 to 1.93). Among smokers, female gender remained a significant risk factor for cardiovascular events at 6 months (odds ratio 2.35, 95% confidence interval 1.58 to 3.50), even after adjustment for age and co-morbidities. In conclusion, smokers experienced acute coronary event events earlier than did nonsmokers. Younger age and fewer co-morbidities likely account for most observed survival benefit in smokers, although female smokers are more likely to experience cardiovascular complications by 6 months than male smokers.

Hvidtfeldt UA; Tolstrup JS; Jakobsen MU; Heitmann BL; Gronbaek M; O'Reilly E et al. Alcohol Intake and Risk of Coronary Heart Disease in Younger, Middle-Aged, and Older Adults. Circulation 121(14): 1589-1597, 2010. (42 refs.)

Background-Light to moderate alcohol consumption is associated with a reduced risk of coronary heart disease. This protective effect of alcohol, however, may be confined to middle-aged or older individuals. Coronary heart disease incidence is low in men <40 years of age and in women <50 years of age; for this reason, study cohorts rarely have the power to investigate the effects of alcohol on coronary heart disease risk in younger adults. This study examined whether the beneficial effect of alcohol on coronary heart disease depends on age. Methods: and Results-In this pooled analysis of 8 prospective studies from North America and Europe including 192 067 women and 74 919 men free of cardiovascular diseases, diabetes, and cancers at baseline, average daily alcohol intake was assessed at baseline with a food frequency or diet history questionnaire. An inverse association between alcohol and risk of coronary heart disease was observed in all age groups; hazard ratios among moderately drinking men (5.0 to 29.9 g/d) 39 to 50, 50 to 59, and >= 60 years of age were 0.58 (95% confidence interval [CI], 0.36 to 0.93), 0.72 (95% CI, 0.60 to 0.86), and 0.85 (95% CI, 0.75 to 0.97) compared with abstainers. However, the analyses indicated a smaller incidence rate difference between abstainers and moderate consumers in younger adults (incidence rate difference, 45 per 100 000; 90% CI, 8 to 84) than in middle-aged (incidence rate difference, 64 per 100 000; 90% CI, 24 to 102) and older (incidence rate difference, 89 per 100 000; 90% CI, 44 to 140) adults. Similar results were observed in women. Conclusion-Alcohol is also associated with a decreased risk of coronary heart disease in younger adults; however, the absolute risk was small compared with middle-aged and older adults.

Juvela S. Prevalence of and risk factors for intracranial aneurysms. (editorial). Lancet Neurology 10(7): 595-597, 2011. (11 refs.)

This editorial is a commentary on an article by Vlak in this isses, that presents the findings from a meta-analyis of 68 studies on the prevalence of unruptured intracrancial aneurysms. Among the risk factors are smoking and alcohol consumtion.

Kerr WC; Karriker-Jaffe K; Subbaraman M; Ye Y. Per capita alcohol consumption and ischemic heart disease mortality in a panel of US states from 1950 to 2002. Addiction 106(2): 313-322, 2011. (41 refs.)

Aims: To estimate the overall impact of alcohol on ischemic heart disease (IHD) mortality in the United States using aggregate-level models and to consider beverage-specific effects that may represent more effectively the changes in drinking patterns over time that are related to both harmful and protective impacts of alcohol consumption on IHD. Design: Several model specifications are estimated, including state-specific autoregressive integrated moving average (ARIMA) models and generalized least squares (GLS) panel models on first-differenced data. Setting: US states from 1950 to 2002. Participants: US general population. Measurements: Per capita alcohol sales and cigarette sales, age-standardized IHD and cirrhosis mortality rates. Findings: Apparent consumption of total alcohol was associated with a significant overall increase of IHD of about 1% mortality per litre of ethanol. Beverage-specific models found that spirits consumption was significantly positively related to IHD mortality overall, for both genders and in three regions defined by drinking culture (or 'wetness'), while beer was found to have a significant protective relationship overall and in the wet region. The results for wine also suggest a protective relationship, but only marginally significant effects were found. Cirrhosis mortality rates were consistently positively related to IHD mortality. Combined results from state-specific ARIMA models including both cigarette sales and cirrhosis rates were generally consistent with the GLS results. Conclusions: Population-level models confirm individual-level findings of both harmful and protective relationships between alcohol use patterns and ischemic heart disease mortality. However, an overall harmful impact of per capita alcohol consumption on IHD mortality was found.

Klatsky AL. Alcohol and cardiovascular mortality: Common sense and scientific truth. Journal of the American College of Cardiology 55(13): 1336-1338, 2010. (15 refs.)

Anstie, a prominent public health activist, promulgated Anstie's Rule of a "sensible limit" of 45 ml of ethyl alcohol/dray or approximately 3 standard-sized drinks. The use of "sensible" rather than "safe" acknowledges that no amount of alcohol is safe for everyone. The author reviews the growing scientific evidence, as well as the findings of a national trial confirming a U-shaped relationship between alcohol intake and CV mortality. As expected, most of the apparent benefit in light-moderate drinkers is due to lower risk of CAD death. However, it is noted that absolute proof that persons at CAD risk obtain benefits form light-moderate drinking will not appear soon. In the 21st century a universal sensible limit would not accommodate serious public health issues such as the increased risk of female breast cancer risk associated with even moderate drinking or the consequences of the mixture of youthful drinking with the motor vehicle. The risks of moderate drinking differ by sex, age, personal history, and family history. As is often the case in medical practice, advice about lifestyle must be based on something less than certainty. There is no substitute for balanced judgment by a knowledgeable, objective health professional. What is required is a synthesis of common sense and the best available scientific facts.

Lee MY; Kim MY; Kim SY; Kim JH; Kim BH; Shin JY et al. Association between alcohol intake amount and prevalence of metabolic syndrome in Korean rural male population. Diabetes Research and Clinical Practice 88(2): 196-202, 2010. (50 refs.)

Moderate alcohol consumption is known to be associated with a reduced risk of cardiovascular disease and mortality. However, few studies reported that long-term alcohol drinking may increase the prevalence of central obesity, and cardiovascular disease. We examined the association between metabolic syndrome, nutritional factors and alcohol intake amount in Korean male rural population. We performed a cross-sectional analysis on data from Korean Rural Genomic Cohort (KRGC) study. We used multiple logistic regression analysis to estimate the adjusted odds ratio of metabolic syndrome according to alcohol intake amount categories (never, 0-16 g/day, 16-40 g/day, and >40 g/day). The age adjusted odds ratio for the prevalence of metabolic syndrome was significantly increased in the quartile with the highest alcohol consumption compared to the non-alcohol drinking group (1.33; C.I., 1.11-1.59). These results were similar in the high energy intake group, but not in the low energy intake group. Waist circumference, blood pressure, and serum triglyceride levels were significantly higher in the quartile with the highest alcohol consumption compared to the non-alcohol drinking group. These results suggest that large alcohol consumption is associated with metabolic syndrome and may be a modifiable risk factor of metabolic syndrome especially in subjects with high calorie intake.

Lesna IK; Suchanek P; Stavek P; Poledne R. May alcohol-induced increase of HDL be considered as atheroprotective? Physiological Research 59(3): 407-413, 2010 , 2010. (29 refs.)

It is well known that the consumption of moderate doses of alcohol leads to the increase of HDL-cholesterol (HDL-C). Atheroprotectivity of HDL particles is based primarily on their role in reverse cholesterol transport (RCT). In the study with a crossover design 13 male volunteers were studied in two different regimens: i) drinking of 36 g alcohol daily and ii) drinking only non-alcoholic beverages, to test whether alcohol-induced increase of HDL cholesterol can affect cholesterol efflux (CHE) from cell culture of labeled human macrophages. Alcohol consumption induced significant (p<0.05) increases of HDL cholesterol from 1.25+/-0.32 to 1.34+/-0.38 mmol/l and Apo A1 from 1.34+/-0.16 to 1.44+/-0.19 g/l. These changes were combined with a slight increase of cholesterol efflux from 13.8+/-2.15 to 14.9+/-1.85 % (p=0.059). There were significant correlations between individual changes of HDL-C and Apo A1 concentrations and individual changes of CHE (0.51 and 0.60, respectively). In conclusion, moderate alcohol consumption changes the capacity of plasma to induce CHE only at a border line significance.

Lippi G; Franchini M; Favaloro EJ; Targher G. Moderate red wine consumption and cardiovascular disease risk: Beyond the "French Paradox". Seminars in Thrombosis and Hemostasis 36(1): 59-70, 2010. (85 refs.)

The term French paradox was coined in 1992 to describe the relatively low incidence of cardiovascular disease in the French population, despite a relatively high dietary intake of saturated fats, and potentially attributable to the consumption of red wine. After nearly 20 years, several studies have investigated the fascinating, overwhelmingly positive biological and clinical associations of red wine consumption with cardiovascular disease and mortality. Light to moderate intake of red wine produces a kaleidoscope of potentially beneficial effects that target all phases of the atherosclerotic process, from atherogenesis (early plaque development and growth) to vessel occlusion (flow-mediated dilatation, thrombosis). Such beneficial effects involve cellular signaling mechanisms, interactions at the genomic level, and biochemical modifications of cellular and plasma components. Red wine components, especially alcohol, resveratrol, and other polyphenolic compounds, may decrease oxidative stress, enhance cholesterol efflux from vessel walls (mainly by increasing levels of high-density lipoprotein cholesterol), and inhibit lipoproteins oxidation, macrophage cholesterol accumulation, and foam-cell formation. These components may also increase nitric oxide bioavailability, thereby antagonizing the development of endothelial dysfunction, decrease blood viscosity, improve insulin sensitivity, counteract platelet hyperactivity, inhibit platelet adhesion to fibrinogen-coated surfaces, and decrease plasma levels of von Willebrand factor, fibrinogen, and coagulation factor VII. Light to moderate red wine consumption is also associated with a favorable genetic modulation of fibrinolytic proteins, ultimately increasing the surface-localized endothelial cell fibrinolysis. Overall, therefore, the "French paradox'' may have its basis within a milieu containing several key molecules, so that favorable cardiovascular benefits might be primarily attributable to combined, additive, or perhaps synergistic effects of alcohol and other wine components on atherogenesis, coagulation, and fibrinolysis. Conversely, chronic heavy alcohol consumption and binge drinking are associated with increased risk of cardiovascular events. In conclusion, although mounting evidence strongly supports beneficial cardiovascular effects of moderate red wine consumption (one to two drinks per day; 10-30 g alcohol) in most populations, clinical advice to abstainers to initiate daily alcohol consumption has not yet been substantiated in the literature and must be considered with caution on an individual basis.

Mahalik JR; Burns SM. Predicting health behaviors in young men that put them at risk for heart disease. Psychology of Men & Masculinity 12(1): 1-12, 2011. (49 refs.)

There were 161 young adult men who completed measures assessing their health beliefs, masculinity, perceptions of the normativeness of health behaviors in other men, and heart healthy behaviors (i.e., diet, exercise, alcohol abuse, tobacco use, and medical screenings). Men's heart-healthy behaviors were predicted by beliefs of benefits to healthy behavior, barriers, health knowledge, normativeness of men's health-promoting behavior, and interaction between masculinity and barriers. The discussion addresses how the Health Belief model applied to men's heart healthy behaviors may be enhanced through greater consideration of sociocontextual variables such as gender role conformity and social norms. The authors suggest that future research might address multi-modal interventions aimed at improving men's heart health that address both beliefs and men's social context.

Mukamal KJ; Chen CM; Rao SR; Breslow RA. Alcohol consumption and cardiovascular mortality among US Adults, 1987 to 2002. Journal of the American College of Cardiology 55(13): 1328-1335, 2010. (53 refs.)

Objectives: The aim of this study was to determine the association of alcohol consumption and cardiovascular mortality in the U. S. population. Background:Alcohol consumption has been associated with a lower risk of cardiovascular disease in cohort studies, but this association has not been prospectively examined in large, detailed, representative samples of the U. S. population. Methods: We analyzed 9 iterations of the National Health Interview Survey, an annual survey of a nationally representative sample of U. S. adults between 1987 and 2000. Exposures of interest included usual volume, frequency, and quantity of alcohol consumption and binge drinking. Mortality was ascertained through linkage to the National Death Index through 2002. Relative risks were derived from random-effects meta-analyses of weighted, multivariable-adjusted hazard ratios for cardiovascular mortality from individual survey administrations. Results: Light and moderate volumes of alcohol consumption were inversely associated with cardiovascular mortality. Compared with lifetime abstainers, summary relative risks were 0.95 (95% confidence interval [CI]: 0.88 to 1.02) among lifetime infrequent drinkers, 1.02 (95% CI: 0.94 to 1.11) among former drinkers, 0.69 (95% CI: 0.59 to 0.82) among light drinkers, 0.62 (95% CI: 0.50 to 0.77) among moderate drinkers, and 0.95 (95% CI: 0.82 to 1.10) among heavy drinkers. The magnitude of lower risk was similar in subgroups of sex, age, or baseline health status. There was no simple relation of drinking pattern with risk, but risk was consistently higher among those who consumed >= 3 compared with 2 drinks/drinking day. Conclusions: In 9 nationally representative samples of U. S. adults, light and moderate alcohol consumption were inversely associated with CVD mortality, even when compared with lifetime abstainers, but consumption above recommended limits was not.

Nicoll R; Henein MY. Alcohol and the heart. (commentary). Alcoholism: Clinical and Experimental Research 35(10): 1737-1738, 2011. (17 refs.)

Alcohol consumption and disease or mortality display a J-shaped curve, with moderate amounts of alcohol being more protective than abstention, binge drinking, or heavy drinking. Red wine appears to be particularly protective for cardiovascular disease and associated conditions such as type 2 diabetes. There are, however, controversies concerning the effect of red wine on hypertension, in which there may be significant gender and ethnic differences. Overall, it seems that both ethanol and the polyphenols in red wine may contribute to the protective effect.

Roerecke M; Greenfield TK; Kerr WC; Bondy S; Cohen J; Rehm J. Heavy drinking occasions in relation to ischaemic heart disease mortality: An 11-22 year follow-up of the 1984 and 1995 US National Alcohol Surveys. International Journal of Epidemiology 40(5): 1401-1410, 2011. (46 refs.)

Background: The relationship between alcohol consumption and ischaemic heart disease (IHD) risk is complex and several issues remain unresolved because many studies used rather crude exposure measures often based on one or two questions. The objective of this study was to investigate the association between heavy drinking occasions and IHD mortality while controlling for average daily alcohol intake and separating former drinkers from lifetime abstainers. Methods: Cox regression analyses were used with IHD mortality as the outcome in a sample of 9934 participants of the US National Alcohol Surveys conducted in 1984 and 1995. Results: To the end of 2006, 326 deaths from IHD were recorded in the 11- to 22-year follow-up period. Any past heavy drinking occasions in former drinkers [hazard ratio (HR) = 2.06; 95% confidence interval (95% CI): 1.10-3.85] compared with former drinkers without such drinking occasions, and any heavy drinking occasion in current drinkers at baseline (HR = 2.05; 95% CI: 1.03-3.98) compared with current drinkers with average daily intake of one to two drinks, were associated with higher IHD mortality in men and any heavy drinking occasions among drinkers of up to 1 drink average consumption in women with similar effect size. Confounding effects from age, race, education, employment, income, marital status, geographical region, depression score, survey period or other drug use were small. Conclusions: Among former and current drinkers, heavy drinking occasions should be taken into account when examining the complex association of alcohol consumption on IHD mortality risk.

Parry CD; Patra J; Rehm J. Alcohol consumption and non-communicable diseases: Epidemiology and policy implications. Addiction 106(10): 1718-1724, 2011. (47 refs.)

Aims This paper summarizes the relationships between different patterns of alcohol consumption and various on non-communicable disease (NCD) outcomes and estimates the percentage of NCD burden that is attributable to alcohol. Methods A narrative review, based on published meta-analyses of alcohol consumption-disease relations, together with an examination of the Comparative Risk Assessment estimates applied to the latest available revision of Global Burden of Disease study. Results: Alcohol is causally linked (to varying degrees) to eight different cancers, with the risk increasing with the volume consumed. Similarly, alcohol use is related detrimentally to many cardiovascular outcomes, including hypertension, haemorrhagic stroke and atrial fibrillation. For other cardiovascular outcomes the relationship is more complex. Alcohol is furthermore linked to various forms of liver disease (particularly with fatty liver, alcoholic hepatitis and cirrhosis) and pancreatitis. For diabetes the relationship is also complex. Conservatively, of the global NCD-related burden of deaths, net years of life lost (YLL) and net disability adjusted life years (DALYs), 3.4%, 5.0% and 2.4%, respectively, can be attributed to alcohol consumption, with the burden being particularly high for cancer and liver cirrhosis. This burden is especially pronounced in countries of the former Soviet Union. Conclusions: There is a strong link between alcohol and non-communicable diseases, particularly cancer, cardiovascular disease, liver disease, pancreatitis and diabetes, and these findings support calls by the World Health Organization to implement evidence-based strategies to reduce harmful use of alcohol.

Perissinotto E; Buja A; Maggi S; Enzi G; Manzato E; Scafato E et al. Alcohol consumption and cardiovascular risk factors in older lifelong wine drinkers: The Italian Longitudinal Study on Aging. Nutrition, Metabolism, and Cardiovascular Diseases 20(9): 647-655, 2010. (38 refs.)

Background and aims: A protective effect of moderate alcohol consumption on the cardiovascular system has consistently been reported, but limited evidence has been produced on the association of alcohol with metabolic factors in the elderly. The aim of this study was to investigate the association between different levels of current alcohol consumption and cardiovascular risk factors in a representative sample of elderly Italian men, mainly wine drinkers. Methods: and results: This is a cross-sectional multi-centre study on a population-based sample of Italian men aged 65-84 years, drawn from the Italian Longitudinal Study on Aging (ILSA) cohort. The analyses included 1896 men. Almost all the drinkers (98%) drank wine as a lifelong habit. Adjusted ORs for risk levels for cardiovascular factors (BMI, waist circumference, fibrinogen, alpha 2 protein, white blood cells, HDL cholesterol, Apo A-I, total cholesterol, Apo B-I, triglycerides, LDL, glycated hemoglobin, insulin, fasting plasma glucose, HOMA IR, systolic and diastolic blood pressure) were estimated, comparing drinkers with teetotalers using multivariate logistic regression models. We found alcohol consumption in older age associated with healthier hematological values of fibrinogen, HDL cholesterol, Apo A-I lipoprotein and insulin, but it was also associated with a worse hematological picture of total, LDL cholesterol levels, and systolic pressure. Conclusion: Our results indicated in elderly moderate wine drinkers a noticeably safe metabolic, inflammatory and glycemic profile that might balance higher blood pressure, leading to a net benefit. These findings however need to be placed in relation to the known adverse social and health effects of heavy drinking.

Radisauskas R; Prochorskas R; Grabauskas V; Bernotiene G; Tamosiunas A; Veryga A. Recent heavy alcohol consumption at death certified as ischaemic heart disease: Correcting mortality data from Kaunas (Lithuania). Alcohol and Alcoholism 46(5): 614-619, 2011. (18 refs.)

Aims: To assess the proportion of deaths assigned to ischaemic heart disease (IHD) which in fact were caused by the toxic effects of alcohol, and how this may affect the official statistics of mortality from IHD in Lithuania. Methods: Using the IHD register in Kaunas, Lithuania, and verifying underlying causes of death using standard international methodology, 3061 cases were found in Kaunas city who had died from IHD at age 25-64 during 1993-2007. Out-of-hospital sudden deaths accounted for 2467 cases (81%), including 1498 where forensic autopsy was conducted and post-mortem concentration of alcohol in blood and urine was available. Results: In total, 78.4% of all initial IHD diagnoses were verified, while in 8.7% of deaths the underlying cause of death was corrected into an alcohol-related cause and in 12.9% to other diseases. Alcohol was found in about half (50.3%) of out-of-hospital death cases subjected to autopsy. In 18.0% of cases, the alcohol concentration was 3.5% or higher. Alcohol was more likely to be present in winter months and at weekends. Conclusion: A significant number of alcohol-attributable deaths in Lithuania were misclassified as coronary deaths, accounting for almost one-tenth of officially registered deaths from IHD in ages 25-64. A high prevalence of positive post-mortem blood or urine alcohol tests suggests that the proportion of alcohol-related deaths among out-of-hospital IHD deaths may be actually even higher. A similar situation may be present in some other countries where high levels of alcohol consumption and binge drinking patterns are observed.

Ramstedt M. Commentary on Kerr, et al. (2011): Good or bad news - and for whom? (commentary). Addiction 106(2): 323-323, 2011. (5 refs.)

Rehm J; Roerecke M. Alcohol, the heart and the cardiovascular system: What do we know and where should we go? (editorial). Drug and Alcohol Review 30(4): 335-337, 2011. (33 refs.)

Roerecke M; Rehm J. Ischemic heart disease mortality and morbidity rates in former drinkers: A meta-analysis. (review). American Journal of Epidemiology 173(3): 245-258, 2011. (88 refs.)

Current abstainers from alcohol have been identified as an inadequate reference group in epidemiologic studies of the effects of alcohol, because inclusion of former drinkers might lead to overestimation of the protective effects and underestimation of the detrimental effects of drinking alcohol. The authors' objective in the current study was to quantify this association for ischemic heart disease (IHD). Electronic databases were systematically searched for relevant case-control or cohort studies published from 1980 to 2010. Thirty-eight articles fulfilled the inclusion criteria, contributing a total of 5,613 IHD events and 12,097 controls among case-control studies and 1,387 events with combined endpoints and 7,183 events stratified by endpoint among 232,621 persons at risk among cohort studies. Pooled estimates for the subset stratified by sex and endpoint showed a significantly increased risk among former drinkers compared with long-term abstainers for IHD mortality ( among men; relative risk = 1.25, 95% confidence interval: 1.15, 1.36; among women relative risk = 1.54, 95% confidence interval: 1.17, 2.03). For IHD morbidity, the estimates for both sexes were close to unity and not statistically significant. Results were robust in several sensitivity analyses. In future studies, researchers should separate former drinkers from the reference category to obtain unbiased effect estimates. Implications for the overall beneficial and detrimental effects of alcohol consumption on IHD are discussed.

Romanowicz M; Schmidt JE; Bostwick JM; Mrazek DA; Karpyak VM. Changes in heart rate variability associated with acute alcohol consumption: Current knowledge and implications for practice and research. Alcoholism: Clinical and Experimental Research 35(6): 1092- 1105, 2011. (63 refs.)

Alcohol consumption is associated with a broad array of physiologic and behavioral effects including changes in heart rate. However, the physiologic mechanisms of alcohol effects and the reasons for individual differences in the cardiac response remain unknown. Measuring changes in resting heart rate (measured as beats/min) has not been found to be as sensitive to alcohol's effects as changes in heart rate variability (HRV). HRV is defined as fluctuations in interbeat interval length which reflect the heart's response to extracardiac factors that affect heart rate. HRV allows simultaneous assessment of both sympathetic and parasympathetic activity and the interplay between them. Increased HRV has been associated with exercise and aerobic fitness, while decreased HRV has been associated with aging, chronic stress, and a wide variety of medical and psychiatric disorders. Decreased HRV has predictive value for mortality in general population samples and patients with myocardial infarction and used as an indicator of altered autonomic function. A significant inverse correlation was found between HRV and both the severity of depression and the duration of the depressive episode. HRV analysis provides insights into mechanisms of autonomic regulation and is extensively used to clarify relationships between depression and cardiovascular disease. This article will review the methodology of HRV measurements and contemporary knowledge about effects of acute alcohol consumption on HRV. Potential implications of this research include HRV response to alcohol that could serve as a marker for susceptibility to alcoholism. At present however there is almost no research data supporting this hypothesis.

Ruidavets JB; Ducimetiere P; Evans A; Montaye M; Haas B; Bingham A et al. Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). British Medical Journal 341: e-article 6077, 2010. (47 refs.)

Objective: To investigate the effect of alcohol intake patterns on ischaemic heart disease in two countries with contrasting lifestyles, Northern Ireland and France. Design Cohort data from the Prospective Epidemiological Study of Myocardial Infarction (PRIME) were analysed. Weekly alcohol consumption, incidence of binge drinking (alcohol >50 g on at least one day a week), incidence of regular drinking (at least one day a week, and alcohol under 50 g if on only one occasion), volume of alcohol intake, frequency of consumption, and types of beverage consumed were assessed once at inclusion. All coronary events that occurred during the 10 year follow-up were prospectively registered. The relation between baseline characteristics and incidence of hard coronary events and angina events was assessed by Cox's proportional hazards regression analysis. Setting One centre in Northern Ireland (Belfast) and three centres in France (Lille, Strasbourg, and Toulouse). Participants 9778 men aged 50-59 free of ischaemic heart disease at baseline, who were recruited between 1991 and 1994. Main outcome measures Incident myocardial infarction and coronary death ("hard" coronary events), and incident angina pectoris. Results: A total of 2405 men from Belfast and 7373 men from the French centres were included in the analyses, 1456 (60.5%) and 6679 (90.6%) of whom reported drinking alcohol at least once a week, respectively. Among drinkers, 12% (173/1456) of men in Belfast drank alcohol every day compared with 75% (5008/6679) of men in France. Mean alcohol consumption was 22.1 g/day in Belfast and 32.8 g/day in France. Binge drinkers comprised 9.4% (227/2405) and 0.5% (33/7373) of the Belfast and France samples, respectively. A total of 683 (7.0%) of the 9778 participants experienced ischaemic heart disease events during the 10 year follow-up: 322 (3.3%) hard coronary events and 361 (3.7%) angina events. Annual incidence of hard coronary events per 1000 person years was 5.63 (95% confidence interval 4.69 to 6.69) in Belfast and 2.78 (95% CI 2.41 to 3.20) in France. After multivariate adjustment for classic cardiovascular risk factors and centre, the hazard ratio for hard coronary events compared with regular drinkers was 1.97 (95% CI 1.21 to 3.22) for binge drinkers, 2.03 (95% CI 1.41 to 2.94) for never drinkers, and 1.57 (95% CI 1.11 to 2.21) for former drinkers for the entire cohort. The hazard ratio for hard coronary events in Belfast compared with in France was 1.76 (95% CI 1.37 to 2.67) before adjustment, and 1.09 (95% CI 0.79 to 1.50) after adjustment for alcohol patterns and wine drinking. Only wine drinking was associated with a lower risk of hard coronary events, irrespective of the country. Conclusions: Regular and moderate alcohol intake throughout the week, the typical pattern in middle aged men in France, is associated with a low risk of ischaemic heart disease, whereas the binge drinking pattern more prevalent in Belfast confers a higher risk.

Samokhvalov AV; Irving HM; Rehm J. Alcohol consumption as a risk factor for atrial fibrillation: A systematic review and meta-analysis. (review). European Journal of Cardiovascular Prevention & Rehabilitation 17(6): 706-712, 2010. (39 refs.)

Background: Alcohol exposure is one of the major risk factors for global burden of disease, but atrial fibrillation (AF) had not yet been included in these estimates. The purpose of this contribution was to examine the dose-response relationship between alcohol consumption and AF and to explore potential causal pathways. Design and methods Systemematic literature review and meta-analyses. Results: Overall, a consistent dose-response relationship between the amount of alcohol consumed daily and the probability of the onset of AF was found. Women consuming 24, 60 and 120 g of alcohol daily had relative risks of 1.07 [95% confidence interval (CI): 1.04-1.10], 1.42 (95% CI: 1.23-1.64) and 2.02 (95% CI: 1.60-2.97), respectively, relative to nondrinkers. Among men, the corresponding relative risks were 1.08 (95% CI: 1.04-1.11), 1.44 (95% CI: 1.23-1.69) and 2.09 (95% CI: 1.52-2.86). Based on the categorical analyses, we could not exclude the existence of a threshold (three drinks a day for men and two drinks a day for women). Several pathogenic mechanisms for the development of AF in alcohol users were identified. Conclusion: Epidemiological criteria for causality were met to conclude a causal impact of alcohol consumption on the onset of AF with a monotonic dose-response relationship. However, the impact of light drinking is not clear.

Schroeder SA. Depression, smoking, and heart disease: How can psychiatrists be effective? (editorial). American Journal of Psychiatry 168(9): 876-878, 2011. (11 refs.)

Sinforiani E; Zucchella C; Pasotti C; Casoni F; Bini P; Costa A. The effects of alcohol on cognition in the elderly: From protection to neurodegeneration. (review). Functional Neurology 26(2): 103-106, 2011. (50 refs.)

The effects of chronic alcohol abuse on cognition are well known. Memory and executive functions appear to be the cognitive domains primarily impaired, and prefrontal and frontal damage is reported on neuroimaging studies both at micro- and macrostructural levels. Abstinence can partially reverse these alterations through mechanisms of neuroplasticity. Alcohol acts in a dose-dependent fashion, and a light-to-moderate consumption indeed has protective effects on cardiovascular risk factors and promotes anti-inflammatory and anti-oxidative processes. In the elderly on such a regimen, several epidemiological studies have reported a decreased risk of both coronary and cerebrovascular disease and of dementia. However, because of data heterogeneity and the presence of several confounding variables, further studies are needed to clarify these findings. In addition, the complexity of alcohol neurobiology (interaction of alcohol effects with genetic predisposition and environmental factors) and the occurrence of age-related changes should also be taken into account. As dementia, stroke and cardiovascular disease are the leading causes of mortality in older people in developed countries, a better knowledge of the mechanisms underlying the effects of alcohol intake may be helpful from the perspective not only of medical management but also of social health policy.

Sidorenkov O; Nilssen O; Grjibovski AM. Determinants of cardiovascular and all-cause mortality in northwest Russia: A 10-year follow-up study. Annals of Epidemiology 22(1): 57-65, 2012. (32 refs.)

PURPOSE: To study conventional and novel risk factors associated with high cardiovascular disease (CVD) and all-cause mortality in Russia. METHODS: A prospective cohort study of 3704 adults was performed in Arkhangelsk. The baseline examination was conducted in 1999-2000. The average follow-up was 10.2 years. Information on lifestyle and marital, educational, and psychosocial status was self-reported in a questionnaire. Data on risk factors were collected in a medical examination that included the drawing of blood samples. RESULTS: By October 2010 a total of 147 male and 95 female deaths had occurred. In 59 male and 20 female deaths in which a diagnosis was made by a forensic pathologist, the autopsy data were studied to extract information on post-mortem blood alcohol concentration. A positive blood alcohol concentration was found in 21 (36%) male and 6 (30%) female forensic autopsies. Women reporting consumption of at least 80 g of alcohol monthly and consumption of 5 or more alcohol units during one drinking episode had a greater risk of cardiovascular death than abstainers; relative risk (RR) was 5.06 (95% confidence interval [95% CI], 1.54-16.7) and 3.21 (95% CI, 1.07-9.58), respectively. ApoB/ApoA1-ratio was the strongest predictor of CVD and all-cause death in men (RR, 7.62; 95% CI, 3.15-18.4; and RR, 4.39; 95% CI, 2.22-8.68, respectively) and CVD death in women (RR 3.12; 95% CI, 1.08-8.98). Men who were obese and had obtained a university education had a 40% lower risk of all-cause death. Low serum albumin was associated with high mortality in both genders. CONCLUSIONS: Hazardous alcohol consumption is an independent risk factor of CVD mortality in women. The mechanisms behind its damaging effect are not yet clear. Nutritional factors such as serum albumin are important predictors of all-cause mortality in both genders.

Sull JW; Yi SW; Nam CM; Choi K; Ohrr H. Binge drinking and hypertension on cardiovascular disease mortality in Korean men and women: A Kangwha cohort study. Stroke 41(10): 2157-2162, 2010. (21 refs.)

Background and Purpose-The purpose of this study was to examine combined effects of hypertension and binge drinking on the risk of mortality from cardiovascular disease in Koreans. Methods-This study followed a cohort of 6100 residents in Kangwha County, aged >= 55 years as of March 1985, for cardiovascular mortality for 20.8 years up to December 31, 2005. We calculated hazard ratios (HRs) for cardiovascular mortality by blood pressure and binge drinking habits using the Cox proportional hazard model. Binge drinkers and heavy binge drinkers were defined as having >= 6 drinks on 1 occasion and >= 12 drinks on 1 occasion. Results-After adjusting for total alcohol consumption, male heavy binge drinkers with Grade 3 hypertension had a 12-fold increased risk of cardiovascular mortality (HR, 12.7; 95% CI, 3.47 to 46.5), whereas male binge drinkers with Grade 3 hypertension had a 4-fold increased risk of cardiovascular mortality (HR, 4.41; 95% CI, 1.38 to 14.1) when compared with nondrinkers with normal blood pressure. However, in considering separate effects of heavy binge drinking and hypertension on the risk of cardiovascular mortality, HRs were rather low (HR of heavy binge drinkers, 1.88, 1.10 to 3.20; HR of hypertensives, 2.00, 1.70 to 2.35) compared with nondrinkers with normal blood pressure. Conclusions-Binge drinkers and heavy binge drinkers with Grade 3 hypertension showed a marked increase in cardiovascular mortality risk. Even after adjusting for total alcohol consumption, the former revealed 4.41 and the latter indicated 12.7 of HR for the risk of cardiovascular mortality.

Takeuchi F; Isono M; Nabika T; Katsuya T; Sugiyama T; Yamaguchi S et al. Confirmation of ALDH2 as a major locus of drinking behavior and of its variants regulating multiple metabolic phenotypes in a Japanese population. Circulation Journal 75(4): 911-918, 2011. (39 refs.)

Background: Normative alcohol use (or drinking behavior) influences the risk of cardiovascular disease in a multi-faceted manner. To identify susceptibility gene variants for drinking behavior, a 2-staged genome-wide association study was performed in a Japanese population. Methods and Results: In the stage-1 scan, 733 cases and 729 controls were genotyped with 456,827 SNP markers. The associated loci without redundancy of linkage disequilibrium were further examined in the stage-2 general population panel comprising 2,794 drinkers (>= once per week), 1,521 chance drinkers (Copyright 2011, Japanese Circulation Society

Tolentino NJ; Wierenga CE; Hall S; Tapert SF; Paulus MP; Liu TT et al. Alcohol effects on cerebral blood flow in subjects with low and high responses to alcohol. Alcoholism: Clinical and Experimental Research 35(6): 1034- 1040, 2011. (55 refs.)

Background: Although there are multiple indications that alcohol can alter many physiological brain functions, including cerebral blood flow (CBF), studies of the latter have generally used small- or modest-sized samples. Few investigations have yet evaluated how CBF changes after alcohol relate to subsets of subjects with elevated alcoholism risks, such as those with lower levels of response (LR) to alcohol. This study used arterial spin labeling (ASL) after alcohol administration to evaluate a large sample of healthy young men and women with low and high alcohol responses, and, thus, varying risks for alcohol use disorders (AUD). Methods: Healthy young adult social drinkers with low and high LR (N = 88, 50% women) matched on demography and drinking histories were imaged with whole-brain resting ASL similar to 1 hour after ingesting similar to 3 drinks of ethanol and after a placebo beverage (i.e., 178 ASL sessions). The relationships of CBF changes from placebo to alcohol for subjects with low and high LR were evaluated. Results: CBF increased after alcohol when compared to placebo in 5 frontal brain regions. Despite identical blood alcohol concentrations, these increases with alcohol were less prominent in individuals who required more drinks to experience alcohol-related effects (i.e., had a lower LR to alcohol). The LR group differences remained significant after covarying for recent drinking quantities. Conclusions: The results confirm that alcohol intake is associated with acute increases in CBF, particularly in frontal regions. Less intense CBF changes were seen in subjects with a genetically influenced characteristic, a low LR to alcohol, that relates to the future risk of heavy drinking and alcohol problems.

Tolstrup JS; Hansen JL; Gronbaek M; Vogel U; Tjonneland A; Joensen AM et al. Alcohol drinking habits, alcohol dehydrogenase genotypes and risk of acute coronary syndrome. Scandinavian Journal of Public Health 38(5): 489-494, 2010. (27 refs.)

Aims: The risk of myocardial infarction is lower among light-to-moderate drinkers compared with abstainers. Results from some previous studies, but not all, suggest that this association is modified by variations in genes coding for alcohol dehydrogenase (ADH). We aimed to test this hypothesis, including alcohol as both the amount of alcohol and the frequency of drinking. Methods: we conducted a nested case-cohort study within the Danish Diet, Cancer and Health study, including 1,645 men (770 incident cases of acute coronary syndrome from 1993-1997 through 2004 and 875 randomly selected controls). Results: Higher alcohol intake (measured as amount or drinking frequency) was associated with lower risk of acute coronary syndrome; however, there was no evidence that these finding were modified by ADH1B or ADH1C genotypes. Conclusions: The importance of functional variation in alcohol dehydrogenase for the association between alcohol drinking habits and the risk of developing acute coronary syndrome, if any, is very limited.

Wakabayashi I. Associations between alcohol drinking and multiple risk factors for atherosclerosis in smokers and nonsmokers. Angiology 61(5): 495-503, 2010. (40 refs.)

This study investigated relationships between alcohol intake and multiple risk factors for atherosclerosis in smokers and nonsmokers. Men aged 35 to 54 years (n = 27 005) were divided into 6 groups by ethanol intake. The prevalence of multiple (>= 3 or >= 4) risk factors, including obesity, high blood pressure, high total cholesterol, triglyceride and fasting blood glucose, and low high-density lipoprotein (HDL) cholesterol, was compared among the groups in smokers and nonsmokers. Smokers and nonsmokers showed U- and J-shaped relationships, respectively, between alcohol intake and prevalence of multiple risk factors. Odds ratios of drinkers versus nondrinkers for multiple risk factors were significantly low in very light, light, moderate, and heavy drinkers in smokers and were significantly low in light and moderate drinkers but not in very low and heavy drinkers in nonsmokers. There is a U-or J-shaped relationship between alcohol consumption and multiple risk factors for atherosclerosis, and this relationship is modified by smoking.

Wirtz PH; Redwine LS; Hong SZ; Rutledge T; Dimsdale JE; Greenberg BH et al. Increases in B-Type natriuretic peptide after acute mental stress in heart failure patients are associated with alcohol consumption. Journal of Studies on Alcohol and Drugs 71(5): 786-794, 2010. (51 refs.)

Objective: The aim of this study was to investigate in heart failure (HF) patients whether acute mental stress induces increases in the HF-severity biomarker B-type natriuretic peptide (BNP) and if alcohol consumption is associated with such stress-induced increases. Method: Twenty-one male HF patients and 19 male non-HF controls (M = 56 years, SEM = 2) underwent a 15-minute acute mental stress test combining public speaking and mental arithmetic. Plasma levels of BNP were determined immediately before as well as 2 hours after the stress test. Alcohol consumption was assessed by self-reported number of drinks per month and history of use. Results: HF patients had higher BNP levels before and after stress, F(1, 38) = 23.42, p < .001, and showed greater stress-induced increases in BNP levels, F(1, 38) = 4.52, p = .04, compared with controls. HF status (beta = .32, p = .015, Delta R-2 = .10) and higher alcohol consumption (beta = .61, p < .001, Delta R-2 = .37) were independently associated with higher BNP stress increases. Moreover, higher alcohol consumption moderated the greater BNP stress increases in HF patients but not in controls (beta = .49, p < .001, Delta R-2 = .20), although alcohol consumption did not differ between groups. Conclusions: For individuals with HF, particularly those who drink moderate to more substantial amounts of alcohol, exposure to acute psychological stress leads to increases in circulating levels of BNP, a biomarker which is associated with increased morbidity and mortality in HF.

Xie XA; Ma YT; Yang YN; Li XM; Liu F; Huang D et al. Alcohol consumption and ankle-to-brachial index: Results from the cardiovascular risk survey. PLoS ONE 5(11): e-article 15181, 2010. (43 refs.)

Background and Methodology: A low ankle-to-brachial index (ABI) is a strong correlate of cardiovascular disease and subsequent mortality. The relationship between ABI and alcohol consumption remains unclear. Data are from the Cardiovascular Risk Survey (CRS), a multiple-ethnic, community-based, cross-sectional study of 14 618 Chinese people (5 757 Hans, 4 767 Uygurs, and 4 094 Kazakhs) aged 35 years and over at baseline from Oct. 2007 to March 2010. The relationship between alcohol intake and ABI was determined by use of analysis of covariance and multivariable regressions. Principal Findings: In men, alcohol consumption was significantly associated with ABI (P<0.001). After adjusted for the confounding factors, such as age, sex, ethnicity, body mass index, smoking, work stress, diabetes, and fasting blood glucose, the difference remained significant (P<0.001); either the unadjusted or multivariate-adjusted odds ratio (OR) for peripheral artery disease (PAD) was significantly higher in men who consumed >60.0 g/d [OR = 3.857, (95% CI: 2.555-5.824); OR = 2.797, (95% CI: 1.106-3.129); OR = 2.878, (95% CI: 1.215-4.018); respectively] and was significantly lower in men who consumed 20.1-40.0 g/d [OR = 0.330, (95% CI: 0.181-0.599); OR = 0.484, (95% CI: 0.065-0.894); OR = 0.478, (95% CI: 0.243-1.534); respectively] and 40.1-60.0 g/d [OR = 0.306, (95% CI: 0.096-0.969); OR = 0.267, (95% CI: 0.087-0.886); OR = 0.203, (95% CI: 0.113-0.754); respectively] compared with never drinking, respectively (all P<0.01). Neither in unadjusted nor in multivariate-adjusted model was the association between ABI and alcohol consumption significant (all P>0.05) in women. Similarly, PAD was not correlated with alcohol intake in women (all P>0.05). Conclusions/Significance: Our results indicated that in Chinese men, alcohol consumption was associated with peripheral artery disease, and consumption of less than 60 g/d had an inverse association with peripheral atherosclerosis whereas consumption of 60 g/d or more had a positive association.

Zhang YM; Ren J. ALDH2 in alcoholic heart diseases: Molecular mechanism and clinical implications. (review). Pharmacology & Therapeutics 132(1): 86-95, 2011. (158 refs.)

Alcoholic cardiomyopathy is manifested as cardiac hypertrophy, disrupted contractile function and myofibrillary architecture. An ample amount of clinical and experimental evidence has depicted a pivotal role for alcohol metabolism especially the main alcohol metabolic product acetaldehyde, in the pathogenesis of this myopathic state. Findings from our group and others have revealed that the mitochondrial isoform of aldehyde dehydrogenase (ALDH2), which metabolizes acetaldehyde, governs the detoxification of acetaldehyde formed following alcohol consumption and the ultimate elimination of alcohol from the body. The ALDH2 enzymatic cascade may evolve as a unique detoxification mechanism for environmental alcohols and aldehydes to alleviate the undesired cardiac anomalies in ischemia-reperfusion and alcoholism. Polymorphic variants of the ALDH2 gene encode enzymes with altered pharmacokinetic properties and a significantly higher prevalence of cardiovascular diseases associated with alcoholism. The pathophysiological effects of ALDH2 polymorphism may be mediated by accumulation of acetaldehyde and other reactive aldehydes. Inheritance of the inactive ALDH2*2 gene product is associated with a decreased risk of alcoholism but an increased risk of alcoholic complications. This association is influenced by gene-environment interactions such as those associated with religion and national origin. The purpose of this review is to recapitulate the pathogenesis of alcoholic cardiomyopathy with a special focus on ALDH2 enzymatic metabolism. It will be important to dissect the links between ALDH2 polymorphism and prevalence of alcoholic cardiomyopathy, in order to determine the mechanisms underlying such associations. The therapeutic value of ALDH2 as both target and tool in the management of alcoholic tissue damage will be discussed.

Zyriax BC; Lau K; Klahn T; Boeing H; Volzke H; Windler E. Association between alcohol consumption and carotid intima-media thickness in a healthy population: Data of the STRATEGY study (Stress, Atherosclerosis and ECG Study). European Journal of Clinical Nutrition 64(10): 1199-1206, 2010 , 2010. (44 refs.)

Background/Objectives: Epidemiologic evidence suggests a protective effect of moderate alcohol consumption on cardiovascular events. However, studies assessing the association between alcohol intake and intima-media thickness (IMT) as a marker of subclinical atherosclerosis have provided inconsistent results. The aim of this analysis of the Stress Atherosclerosis and ECG Study (STRATEGY study) was to investigate the relation between alcohol intake and IMT in a selectively healthy population. Subjects/Methods: In a cross-sectional study, laboratory values, anthropometric data, nutrition habits and physical activity were assessed in 106 men and 107 women, evenly distributed between 30 and 70 years. Carotid IMT was determined by B-mode ultrasonography according to the standardized protocol of the Study of Health in Pomerania. Results: In men, a significant positive correlation between daily alcohol consumption and IMT was observed (P<0.0001), whereas in women the positive correlation was not significant. The type of beverage consumed did not affect this finding. The mean IMT was significantly higher in men with an alcohol intake above the upper limit of 20 g/day than in men with an alcohol intake <20 g/day (P<0.001). According to a stepwise linear regression model adjusted for age, conventional risk factors, nutrition and physical activity, the IMT increases by 0.0253 mm per 21.4 g/day intake of alcohol in men (P<0.05). Conclusions: The STRATEGY study revealed a positive association between alcohol consumption and carotid IMT in healthy men aged 30-70 years. This relationship remained significant after adjustment for nutrition, physical activity, anthropometry and conventional cardiovascular risk factors.