Alcohol, cardiovascular disease, and cancer: treat with caution

Affiliation of authors: Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD.
Journal of the National Cancer Institute (Impact Factor: 12.58). 03/2009; 101(5):282-3. DOI: 10.1093/jnci/djp006
Source: PubMed
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    ABSTRACT: Alcohol is an important determinant of the high and fluctuating adult mortality rates in Russia, but cause-specific detail is lacking. Our case-control study investigated the effects of alcohol consumption on male and female cause-specific mortality. In three Russian industrial cities with typical 1990s mortality patterns (Tomsk, Barnaul, Biysk), the addresses of 60,416 residents who had died at ages 15-74 years in 1990-2001 were visited in 2001-05. Family members were present for 50,066 decedents; for 48,557 (97%), the family gave proxy information on the decedents' past alcohol use and on potentially confounding factors. Cases (n=43,082) were those certified as dying from causes we judged beforehand might be substantially affected by alcohol or tobacco; controls were the other 5475 decedents. Case versus control relative risks (RRs; calculated as odds ratios by confounder-adjusted logistic regression) were calculated in ever-drinkers, defining the reference category by two criteria: usual weekly consumption always less than 0.5 half-litre bottles of vodka (or equivalent in total alcohol content) and maximum consumption of spirits in 1 day always less than 0.5 half-litre bottles. Other ever-drinkers were classified by usual weekly consumption into three categories: less than one, one to less than three, and three or more (mean 5.4 [SD 1.4]) bottles of vodka or equivalent. In men, the three causes accounting for the most alcohol-associated deaths were accidents and violence (RR 5.94, 95% CI 5.35-6.59, in the highest consumption category), alcohol poisoning (21.68, 17.94-26.20), and acute ischaemic heart disease other than myocardial infarction (3.04, 2.73-3.39), which includes some misclassified alcohol poisoning. There were significant excesses of upper aerodigestive tract cancer (3.48, 2.84-4.27) and liver cancer (2.11, 1.64-2.70). Another five disease groups had RRs of more than 3.00 in the highest alcohol category: tuberculosis (4.14, 3.44-4.98), pneumonia (3.29, 2.83-3.83), liver disease (6.21, 5.16-7.47), pancreatic disease (6.69, 4.98-9.00), and ill-specified conditions (7.74, 6.48-9.25). Although drinking was less common in women, the RRs associated with it were generally more extreme. After correction for reporting errors, alcohol-associated excesses accounted for 52% of all study deaths at ages 15-54 years (men 8182 [59%] of 13968, women 1565 [33%] of 4751) and 18% of those at 55-74 years (men 3944 [22%] of 17,536, women 1493 [12%] of 12 302). Allowance for under-representation of extreme drinkers would further increase alcohol-associated proportions. Large fluctuations in mortality from these ten strongly alcohol-associated causes were the main determinants of recent fluctuations in overall mortality in the study region and in Russia as a whole. Alcohol-attributable mortality varies by year; in several recent years, alcohol was a cause of more than half of all Russian deaths at ages 15-54 years. Alcohol accounts for most of the large fluctuations in Russian mortality, and alcohol and tobacco account for the large difference in adult mortality between Russia and western Europe. UK Medical Research Council, Cancer Research UK, British Heart Foundation, International Agency for Research on Cancer, and European Commission Directorate-General for Research.
    The Lancet 07/2009; 373(9682):2201-14. DOI:10.1016/S0140-6736(09)61034-5 · 45.22 Impact Factor
  • Current Oncology Reports 11/2009; 11(6):417-20. DOI:10.1007/s11912-009-0068-5 · 2.89 Impact Factor
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    ABSTRACT: OBJECTIVE: to study a correlation of alcohol consumption (AC) by married couples according to the results of a screening, as well as a trend in AC in relation to the altered AC by husbands and wives according to the data of a 17-year prospective study. SUBJECTS AND METHODS: The rate of AC was studied among 425 married couples during the first screening (1988-1991). The 17-year study investigated a trend in AC among men and women in relation to that among their spouses. The study covered 319 married couples who had completed both screenings. RESULTS: Among the male alcohol nonusers, their wives who did not use alcohol there were more frequent (38.2%) than those of the men who used alcohol several times a week (8.8%; p<0.01). Among the women who consumed alcohol several times weekly, their husbands with the same frequency of AC were more common (50%) than those of the female non-alcohol users (3.5%; p<0.001). Among the female non-alcohol users, their husbands who consume no alcohol were more frequent (14.9%) than those of the women ingested alcohol once weekly or less (3.0%; p<0.05). During the 17-year study, among the women who increased the frequency of AC there were more husbands who also began using alcohol more frequently (49.3%) than those of the women who made no change in the frequency of AC (33.7%; p<0.05) and who reduced AC (10.5%; p<0.01). Among the men who decreased AC, there were more wives who also reduced the frequency of AC (15.8%) as compared with those of men who increase AC (2.0%; p<0.01). Conclusion. There was some regularity in the similarity of AC by the married couples. Increased AC by a wife favors an AC increase by her husband whereas reduced AC by a wife lessens AC by her spouse. Higher AC by a husband does not affect the frequency of AC by his wife; however, less AC by a husband may favor decreased AC by his spouse.
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