Alcohol, mortality and cardiovascular events in a 35 year follow-up of a nationwide representative cohort of 50,000 Swedish conscripts up to age 55.
ABSTRACT To assess the association between drinking patterns and mortality, and cardiovascular disease in a large cohort of young- and middle-aged men and to assess whether the net balance of harm and protective effect implies protective effect or not.
Information from health examinations, psychological assessments and alcohol use background in a nationally representative birth cohort of 49,411 male military conscripts aged 18-20 years in 1969/1970, were linked to mortality and hospitalization data through 2004. Cox regression analyses were conducted and attributable proportions (APs) calculated. Confounders (baseline social status, intelligence, personality and smoking) were taken into account.
Increasing alcohol use was associated with increasing mortality (2614 deceased) and with decreasing risk for myocardial infarction (MI). The hazard ratio (HR) for mortality was 1.42 [95% confidence interval (CI) 1.10-1.82] with a consumption corresponding to 30 g 100% ethanol/day or more in multivariate analysis. The risk for non-fatal MI was significantly reduced at 60 g 100% ethanol/day (HR 0.37, 95% CI 0.15-0.90), not reduced for fatal MI, and non-significantly reduced for total MI. There was a marked association between alcohol use at conscription and mortality and hospitalization with alcohol-related diagnosis. APs indicate that alcohol caused 420 deaths, 61 cases of non-fatal stroke and protected from 154 cases on non-fatal MI.
Many more deaths were caused by alcohol than cases of non-fatal MI prevented. From a strict health perspective, we find no support for alcohol use in men below 55 years.
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ABSTRACT: Alcohol intake is inconsistently associated with the risk of stroke morbidity and mortality. The purpose of this study was to summarize the evidence regarding this relationship by using a dose-response meta-analytic approach. We performed electronic searches of PubMed, EMBASE, and the Cochrane Library to identify relevant prospective studies. Only prospective studies that reported effect estimates with 95% confidence intervals (CIs) of stroke morbidity and mortality for more than 2 categories of alcohol intake were included. We included 27 prospective studies reporting data on 1,425,513 individuals. Low alcohol intake was associated with a reduced risk of total stroke (risk ratio [RR], 0.85; 95% CI: 0.75-0.95; P=0.005), ischemic stroke (RR, 0.81; 95% CI: 0.74-0.90; P<0.001), and stroke mortality (RR, 0.67; 95% CI: 0.53-0.85; P=0.001), but it had no significant effect on hemorrhagic stroke. Moderate alcohol intake had little or no effect on the risks of total stroke, hemorrhagic stroke, ischemic stroke, and stroke mortality. Heavy alcohol intake was associated with an increased risk of total stroke (RR, 1.20; 95% CI: 1.01-1.43; P=0.034), but it had no significant effect on hemorrhagic stroke, ischemic stroke, and stroke mortality. Low alcohol intake is associated with a reduced risk of stroke morbidity and mortality, whereas heavy alcohol intake is associated with an increased risk of total stroke. The association between alcohol intake and stroke morbidity and mortality is J-shaped.International journal of cardiology 04/2014; · 6.18 Impact Factor
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ABSTRACT: BACKGROUND: -While moderate alcohol use is associated with protection against myocardial infarction (MI), it is not known whether this effect is generalizable to populations worldwide. It is also uncertain whether differences in the pattern of alcohol use (and in particular heavy episodic consumption) between different regions negates any beneficial effect. METHODS AND RESULTS: -We included 12,195 cases of first MI and 15,583 age- and sex-matched controls from 52 countries. Current alcohol use was associated with a reduced risk of MI (compared to non-users, adjusted odds ratio 0.87; 95% CI 0.80-0.94, p=0.001), however the strength of this assocation was not uniform across different regions (region-alcohol interaction p<0.001). Heavy episodic drinking (>/=6 drinks) within the preceding 24 hours was associated with an increased risk of MI (odds ratio 1.4; 95% CI 1.1-1.9, p=0.01). This risk was particularly elevated in older individuals (for age >65 years, odds ratio 5.3; 95% CI 1.6-18, p=0.008). CONCLUSIONS: -In most participants, low levels of alcohol use are associated with a moderate reduction in the risk of MI, however the strength of this association may not be uniform across different countries. An episode of heavy drinking is associated with an increased risk of acute MI in the subsequent 24 hours, particularly in older individuals.Circulation 07/2014; · 14.95 Impact Factor
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ABSTRACT: Abstract Objective. Our aims were to investigate the natural history of biopsy-proven non-alcoholic fatty liver disease (NAFLD) in Sweden, its associated complications, the clinical and biochemical factors associated with more advanced liver disease and the survival rate with a mean follow-up time of 27 years. Material and methods. All subjects participating in the population-based prospective cohort study Malmö Preventive Project (MPP) from 1974 to 1992 who had undergone liver biopsy with the diagnosis of NAFLD were included. The remaining MPP cohort was used as a control group. Subjects with other liver diseases and alcohol overconsumption were excluded. A panel of blood tests was analyzed in the MPP cohort. Follow-up of the NAFLD patients included studies of medical records, pathology records and mortality rates from the Swedish National Board of Health and Welfare's register until the end of 2011. Results. A total of 36 patients were diagnosed with biopsy-proven NAFLD. Median follow-up time was 27.0 years (6.32-35.3). Nine patients (25%) were diagnosed with cirrhosis and five (14%) with hepatocellular cancer, all with a previous diagnosis of cirrhosis. There were significant differences in liver function tests, insulin resistance (as homeostasis model assessment of insulin resistance) and body mass index (BMI) in patients with NAFLD compared with the control group. Mortality in the NAFLD group was significantly higher, 58.3% compared to 33.8% (p = 0.004). Hepatocellular cancer accounted for 23.8% of all deaths in the NAFLD group, compared to 0.7% (p = 0.000). Conclusions. NAFLD can progress to advanced liver disease, including cirrhosis, with a higher than expected mortality and incidence of hepatocellular cancer.Scandinavian Journal of Gastroenterology 07/2014; · 2.33 Impact Factor