Article

Alcohol and Coronary Heart Disease: Drinking Patterns and Mediators of Effect

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  • Harvard T.H. Chan School of Public Health
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Abstract

An inverse association between alcohol consumption and coronary heart disease (CHD) has been shown in epidemiologic studies for more than 30 years; beneficial changes in high-density lipoprotein (HDL) cholesterol, clotting factors, insulin sensitivity, and inflammation provide biological plausibility. Recently, the importance of including drinking patterns in defining “moderate drinking” has been appreciated. A recent meta-analysis raised questions about systematic misclassification error in observational studies because of inclusion among “nondrinkers” of ex-drinkers and/or occasional drinkers. However, misclassification among a small percentage of nondrinkers cannot fully explain the inverse relation, and there is substantial evidence to refute the “sick quitter” hypothesis. Furthermore, it has been shown that moderate alcohol consumption reduces CHD and mortality in individuals with hypertension, diabetes, and existing CHD. To address the issue of residual confounding by healthy lifestyle in drinkers, in a large prospective study we restricted analysis to only “healthy” men (who did not smoke, exercised, ate a good diet, and were not obese). Within this group, men who drank moderately had a relative risk for CHD of 0.38 (95% CI, 0.16–0.89) compared with abstainers, providing further evidence to support the hypothesis that the inverse association of alcohol to CHD is causal, and not confounded by healthy lifestyle behaviors.

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... 6,7 Enquanto sua influência em óbitos por causas externas e na morbimortalidade de neoplasias é constantemente descrita, 8 o impacto do consumo leve a moderado de álcool no prognóstico da DAC ainda se mantém incerto. 6,8 Estudos recentes descreveram o consumo moderado de álcool como cardioprotetor, [7][8][9][10][11] embora tal associação tenha sido contestada. [12][13][14][15] A definição de consumo moderado possui ampla variação (de 5 a 60 gramas de etanol por dia), porém é comumente atribuída a não mais que uma dose de bebida alcoólica por dia para mulheres e até duas doses diárias de bebida alcoólica para homens. ...
... [12][13][14][15] A definição de consumo moderado possui ampla variação (de 5 a 60 gramas de etanol por dia), porém é comumente atribuída a não mais que uma dose de bebida alcoólica por dia para mulheres e até duas doses diárias de bebida alcoólica para homens. 10,11 Mais especificamente, uma dose de bebida alcoólica pode ser definida como cerca de 330 mL de cerveja comum, 100 mL de vinho ou 30 mL de destilado. 16 A ecocardiografia sob estresse é um método não invasivo estabelecido para a avaliação da isquemia miocárdica em pacientes com DAC suspeita ou conhecida, para determinação do diagnóstico e prognóstico, e para auxílio às decisões terapêuticas. ...
... Uma dose de bebida alcoólica pode ser definida como 330 mL de cerveja comum, 100 mL de vinho ou 30 mL de bebidas destiladas. 10,16 Com base nesses parâmetros e nos relatos colhidos na entrevista, foram realizadas as estimativas do consumo médio diário de cada paciente. ...
Article
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Background: The impact of alcohol consumption on the development of myocardial ischemia remains uncertain. Studies diverge whether low to moderate alcohol consumption provides cardioprotection or whether it is a risk factor for myocardial ischemia. Objective: To study the relationship between low to moderate alcohol consumption and myocardial ischemia on exercise stress echocardiography (ESE). Methods: Cross-sectional study with 6,632 patients with known or suspected coronary artery disease undergoing ESE between January/2000 and December/2015. The patients were divided into two groups: G1, composed of 2,130 (32.1%) patients whose report showed maximal consumption of 1 drink per day on average for women or of 2 drinks per day for men; G2, composed of individuals denying any alcohol consumption. For comparing between the groups, Student t test was used for quantitative variables, and chi-square test or Fisher exact test, for categorical variables. The significance level adopted was p < 0.05. Logistic regression was also used to evaluate independent risk factors for myocardial ischemia. Results: G1 had a higher number of men (77.1%; p < 0.001), lower mean age (54.8 ± 10.3 years old; p < 0.001) and higher frequency of myocardial ischemia on ESE (p = 0.014). Age, male sex, dyslipidemia, systemic arterial hypertension, diabetes mellitus, smoking and family history were independently associated with myocardial ischemia on ESE. Independent association between low to moderate alcohol consumption and myocardial ischemia on ESE (OR 0.96; 95%CI: 0.83 to 1.11) was not observed. However, age, male sex, smoking and dyslipidemia were associated with alcohol consumption. Conclusion: Low to moderate alcohol consumption was not an independent predictor of myocardial ischemia on ESE. Nevertheless, we observed a predominance of the male sex, dyslipidemia and smoking habit, important predictors of myocardial ischemia, in the group of alcohol consumers.
... [32] "Several other potential factors that may result in misclassification have recently been highlighted for epidemiologic analyses with alcohol including the pattern and frequency of alcohol consumption." [33] Osteoporotic damage due to alcohol consumption appears to be related to the amount and duration of alcohol consumption. [33] Although the damage from previous alcohol use cannot be undone, reports suggest that patients need to stop drinking to prevent further bone damage. ...
... [33] Osteoporotic damage due to alcohol consumption appears to be related to the amount and duration of alcohol consumption. [33] Although the damage from previous alcohol use cannot be undone, reports suggest that patients need to stop drinking to prevent further bone damage. [33,34] Osteoporosis is often not diagnosed because it is asymptomatic and thus goes unnoticed. ...
... [33] Although the damage from previous alcohol use cannot be undone, reports suggest that patients need to stop drinking to prevent further bone damage. [33,34] Osteoporosis is often not diagnosed because it is asymptomatic and thus goes unnoticed. The current gold standard for diagnosing osteoporosis is BMD using Dual-energy X-ray absorptiometry DXA examination. ...
Article
Background: Effect of tobacco, areca nut, and alcohol consumption (vices) on orthopantomogram (OPG) indices. Aims: To assess the relationship between vices on OPG indices in Indian adult males aged 20–60 years. Subjects and Methods: This study was conducted on 172 males with a mean age of 34.2 ± 1 years. OPG was used for measuring mandibular indices and correlated with the history of the presence of vices. Statistical Analysis Used: Data were presented as mean ± SE or frequency (%). Point biserial correlation was used to assess the correlation between OPG indices and vices. Analysis of covariance was used to analyze the differences in age-adjusted OPG indices between males who had vices against males who had no vice. Results: Overall, 21.5% of the males had at least one vice. A significant decrease in antegonial index (AI) values (P < 0.05) was found between tobacco and alcohol consumption. There was a significant decrease in the values of the gonial index (GI) and AI, having at least one vice (P < 0.05). A higher percentage of participants who had at least one adverse habit had low OPG indices score than participants who had no such habits. Conclusions: Orthopantomogram indices specifically AI were negatively affected in males who had vices.
... 40,41 In epidemiological studies, low to moderate alcohol intake has been protective for development of PAD, coronary heart disease, and type 2 diabetes. [42][43][44] Alcohol may promote its beneficial effect on cardiovascular disease and risk factors through beneficial modification of lipids, hemostatic factors and fibrinolysis, inflammatory markers, and glucose control parameters. 43,45 Eating a healthy diet pattern based on the Dietary Guidelines for Americans 46 or following the American Diabetes Association 47 nutrition recommendations for individuals with diabetes is known to prevent or improve adverse cardiovascular disease risk factors and to promote vascular health. ...
... [42][43][44] Alcohol may promote its beneficial effect on cardiovascular disease and risk factors through beneficial modification of lipids, hemostatic factors and fibrinolysis, inflammatory markers, and glucose control parameters. 43,45 Eating a healthy diet pattern based on the Dietary Guidelines for Americans 46 or following the American Diabetes Association 47 nutrition recommendations for individuals with diabetes is known to prevent or improve adverse cardiovascular disease risk factors and to promote vascular health. According to the Dietary Guidelines for Americans, adults should eat a sufficient number and variety of foods from the fruit, vegetables, dairy, grain, and meat groups each day while staying within individual energy needs. ...
Article
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In Brief Peripheral arterial disease (PAD) is a common atherosclerotic disease affecting the quality of life of > 8 million Americans. PAD is characterized by atherosclerotic stenoses of arteries that supply the lower extremities and is associated with a marked increase in the short-term risk of heart attack, stroke, amputation, and death. Adherence to pharmacological therapies and modification of lifestyle factors, including increasing moderate physical activity along with supervised exercise, smoking cessation, and a healthy dietary intake, are central to the successful management of PAD. The improvement of an adverse cardiovascular risk profile is a proven and crucial strategy to lower the risk of major morbid and mortal events for individuals with PAD.
... The beneficial role of moderate alcohol consumption may be explained by the beneficial alterations in, for example, high-density lipoprotein cholesterol, hemostatic factors, inflammatory markers, and glycemic control markers. 21,22 Furthermore, binge and/or heavy drinking is linked with adverse cardiovascular disease risk factors such as elevated blood pressure, adverse changes in fibrinolytic factors, cardiac arrhythmia, cardiomyopathy, and heightened platelet activation. 22,23 Assuming causal associations, a possible explanation for our results is that the effects of physical activity might enhance the positive effects of moderate alcohol consumption on high-density lipoprotein levels in moderate drinkers. ...
... 22,23 Assuming causal associations, a possible explanation for our results is that the effects of physical activity might enhance the positive effects of moderate alcohol consumption on high-density lipoprotein levels in moderate drinkers. 21,22 Furthermore, heavy or binge drinking might increase carcinogenic processes, as physical activity might inhibit these processes, although this is not yet established. 24 One prospective cohort study investigated the joint association of alcohol and physical activity on all-cause mortality and CVM (ischemic heart disease only). ...
Article
Individual associations of alcohol consumption and physical activity with cardiovascular disease are relatively established, but the joint associations are not clear. Therefore, the aim of this study was to examine prospectively the joint associations between alcohol consumption and physical activity with cardiovascular mortality (CVM) and all-cause mortality. Four population-based studies in the United Kingdom were included, the 1997 and 1998 Health Surveys for England and the 1998 and 2003 Scottish Health Surveys. In men and women, respectively, low physical activity was defined as 0.1 to 5 and 0.1 to 4 MET-hours/week and high physical activity as ≥5 and ≥4 MET-hours/week. Moderate or moderately high alcohol intake was defined as >0 to 35 and >0 to 21 units/week and high levels of alcohol intake as >35 and >21 units/week. In total, there were 17,410 adults without prevalent cardiovascular diseases and complete data on alcohol and physical activity (43% men, median age 55 years). During a median follow-up period of 9.7 years, 2,204 adults (12.7%) died, 638 (3.7%) with CVM. Cox proportional-hazards models were adjusted for potential confounders such as marital status, social class, education, ethnicity, and longstanding illness. In the joint associations analysis, low activity combined with high levels of alcohol (CVM: hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.28 to 2.96, p = 0.002; all-cause mortality: HR 1.64, 95% CI 1.32 to 2.03, p <0.001) and low activity combined with no alcohol (CVM: HR 1.93, 95% CI 1.35 to 2.76, p <0.001; all-cause mortality: HR 1.50, 95% CI 1.24 to 1.81, p <0.001) were linked to the highest risk, compared with moderate drinking and higher levels of physical activity. Within each given alcohol group, low activity was linked to increased CVM risk (e.g., HR 1.48, 95% CI 1.08 to 2.03, p = 0.014, for the moderate drinking group), but in the presence of high physical activity, high alcohol intake was not linked to increased CVM risk (HR 1.32, 95% CI 0.52 to 3.34, p = 0.555). In conclusion, high levels of drinking and low physical activity appear to increase the risk for cardiovascular and all-cause mortality, although these data suggest that physical activity levels are more important.
... (4) Similarly, moderate alcohol consumption is assumed to contribute to a reduced risk to experience cardiovascular disease, (35) which has been explained mainly by its HDL(2)-elevating effect. (36) Although intervention studies on the cardioprotective effect of moderate alcohol intake are lacking so far, a causative effect of moderate alcohol consumption on reduction of CVD incidence is well accepted. (8,11,37) Of note, in the current study alcohol intake within moderate limits was associated with an increase of HDL2 and a drop of the sdLDL-C/HDL2-C ratio at the highest measured effect size, even higher than that associated with the effect of age or BMI. ...
Article
Full-text available
So far, little is known about the effect of nutrition and lifestyle on the composition of circulating lipoprotein subfractions. In the current study, we measured the correlations among physical activity, nutrient intake, smoking, body�mass index (BMI), and age with the concentration of triglycerides, cholesterol, phospholipids, and apolipoproteins (ApoA1, ApoA2 and ApoB) in subfractions of LDL and HDL in 265 healthy working men. Concentrations of cholesterol, phospholipids, and ApoB in small, dense atherogenic LDL particles (sdLDL) correlated negatively (p<0.001) with those of cholesterol, phospholipids, and ApoA1 in HDL2, respectively. Age correlated positively with sdLDL while increasing BMI correlated with an atherogenic shift of cholesterol, phospholipids, and ApoB from large, buoyant LDL (lbLDL) to sdLDL and decreasing concen�trations of HDL2 constituents. Physical activity and alcohol intake correlated negatively with sdLDL constituents and positively with HDL2 components. Consumption of monounsaturated fatty acids (MUFA) correlated with a lower ratio of sdLDL to HDL2 cholesterol. A favorable lipoprotein subfraction profile linked to a reduced risk of cardiovascular disease in men was associated with physical activity, moderate alcohol consumption, and dietary intake of MUFA, which might be exploited in future interventions for pre�vention of age� and BMI�associated atherogenic shifts of lipo�protein subfractions.
... Based on title and abstract, 50 articles were retrieved for full-text review. Of these, 37 papers were excluded due to the following reasons: written in another language than mastered by any of the authors (Masquelier, 1978;Budlovsky, 1979;Itokawa, 2000;Bogh-Sorensen et al., 2009;Ma et al., 2011), duplicate publication (Klipstein-Grobusch et al., 2002, no original data (Meilgaard, 1978;Gronbaek and Sorensen, 2002;Gronbaek, 2007), study population did not fulfill inclusion criteria (animals, alcoholics) (Register et al., 1972;Morgan and Levine 1988;Price et al., 1989;Sangwan and Khetarpaul, 2000), alcohol consumption was not specified into beverage type or preference (Windham et al., 1983;Teufel, 1994;Mannisto et al., 1996;Kesse et al., 2001;Breslow et al., 2010;Liangpunsakul, 2010Yeomans, 2010, diet was not the studied outcome (Criqui and Ringel, 1994;Klipstein-Grobusch et al., 1999;Gronbaek et al., 2000;Marques-Vidal et al., 2000;Klipstein-Grobuschl et al., 2002;Sieri et al., 2002;Wannamethee et al., 2005, Adamkova et al., 2011, or both exposure and outcome did not match the inclusion criteria (Halkjaer et al., 2004;Deshmukh-Taskar et al., 2007;Rimm and Moats, 2007;Carels et al., 2008;Deshmukh-Taskar et al., 2009;XXXX, 2011), and one article could not be retrieved (XXXXX, 2001). Thus, 13 articles were included in the review. ...
Article
Introduction: The aim of this review is to systematically and critically evaluate the existing literature into the association between alcoholic beverage preference and dietary habits in adults. Methods: A literature search was conducted in the databases of Medline (PubMed), ISI Web of Knowledge, and PsycINFO for studies published up to March 2013. From a total of 4,345 unique hits, 16 articles were included in this systematic review. Two independent reviewers extracted relevant data for each study and assessed study quality. Results: 14 cross-sectional and two ecological studies from the United States and several European countries were included. Across different study populations and countries, persons with a beer preference displayed in general less healthy dietary habits. A preference for wine was strongly associated with healthier dietary habits in Western study populations, whereas studies in Mediterranean populations did not observe this. Dietary habits of persons with another preference or who were abstinent were less reported. Conclusion: This review has shown that the preference for a specific alcoholic beverage is associated with diet. Thus, it might not be the alcoholic beverage but the underlying dietary patterns that are related to health outcomes.
... 2007). On kuitenkin osoitettu, että pelkästään sairaampien osittainen valikoituminen täysraittiisiin ei selitä alkoholin kohtuukäytön ja alemman sydän-ja verisuonitautisairastavuuden välistä kausaalista yhteyttä (Rimm & Moats 2007). ...
... In a 2007 paper, 46 Eric B. Rimm and Caroline Moats from Harvard University also concluded that although there is enough evidence (30 years' worth, in their opinion) to suggest an inverse association of alcohol with coronary heart disease, it is causal and not confounded by healthy lifestyle behaviours (i.e. alcohol has a positive association with CHD and this is not disproved by those who also lead healthy lifestyles). ...
... However, some research findings are still presented in terms of rates of health outcomes in whole groups of women (such as for injuries and suicidality; Landberg 2010; Ramstedt 2005), which can be misleading if these results are used to draw conclusions about the effects of drinking on individuals. Finally, research on long-term health effects of women’s drinking can measure only some of the lifestyle characteristics (such as eating patterns and exercise) that may be associated with how women drink and that may account for some of the apparent effects of drinking (Mukamal et al. 2010; Rimm & Moats 2007). ...
Article
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Although light-to-moderate drinking among women is associated with reduced risks of some cardiovascular problems, strokes, and weakening of bones, such levels of drinking also are associated with increased risks of breast cancer and liver problems, and heavy drinking increases risks of hypertension and bone fractures and injuries. Women's heavy-drinking patterns and alcohol use disorders are associated with increased likelihood of many psychiatric problems, including depression, posttraumatic stress disorder, eating disorders, and suicidality, as well as increased risks of intimate partner violence and sexual assault, although causality in the associations of drinking with psychiatric disorders and with violence remains unclear. It is important for women to be aware of the risks associated with alcohol use, especially because gaps between U.S. men's and women's drinking may have narrowed. However, analyses of health risks and benefits need mprovement to avoid giving women oversimplified advice about drinking.
... Like many other studies of the general adult population [55,56], we identified a "healthy drinker" effect with survivors reporting any level of alcohol consumption being at lower risk of poor health relative to former drinkers and lifetime abstainers. Importantly for breast cancer survivors, there are mixed data linking alcohol consumption to breast cancer recurrence that should be considered when deciding whether or not to consume alcohol [21]. ...
Article
Purpose: Rural US adults have increased risk of poor outcomes after cancer, including increased cancer mortality. Rural-urban differences in health behaviors have been identified in the general population and may contribute to cancer health disparities, but have not yet been examined among US survivors. We examined rural-urban differences in health behaviors among cancer survivors and associations with self-reported health and health-related unemployment. Methods: We identified rural (n = 1,642) and urban (n = 6,162) survivors from the cross-sectional National Health Interview Survey (2006-2010) and calculated the prevalence of smoking, physical activity, overweight/obesity, and alcohol consumption. Multivariable models were used to examine the associations of fair/poor health and health-related unemployment with health behaviors and rural-urban residence. Results: The prevalence of fair/poor health (rural 36.7 %, urban 26.6 %), health-related unemployment (rural 18.5 %, urban 10.6 %), smoking (rural 25.3 %, urban 15.8 %), and physical inactivity (rural 50.7 %, urban 38.7 %) was significantly higher in rural survivors (all p < .05); alcohol consumption was lower (rural 46.3 %, urban 58.6 %), and there were no significant differences in overweight/obesity (rural 65.4 %, urban 62.6 %). All health behaviors were significantly associated with fair/poor health and health-related unemployment in both univariate and multivariable models. After adjustment for behaviors, rural survivors remained more likely than urban survivors to report fair/poor health (OR = 1.21, 95 % CI 1.03-1.43) and health-related unemployment (OR = 1.49, 95 % CI 1.18-1.88). Conclusions: Rural survivors may need tailored, accessible health promotion interventions to address health-compromising behaviors and improve outcomes after cancer.
... The most reported health benefit is that moderate or light alcohol consumption has a protective effect against coronary heart disease and/or other cardio-related diseases (Ahlawat & Siwach, 1994;Bagnardi, Zatonski, Scotti, La Vecchia, & Corrao, 2008;Cleophas, 1999;Doll et al., 1994;Ebbert, Janney, Sellers, Folsom, & Cerhan, 2005;Gigleux et al., 2006;Gronbaek, 2004;Gronbaek et al., 2000;Hennekens, Rosner, & Cole, 1978;Ikehara et al., 2008;Jackson, Scragg, & Beaglehole, 1991;Kannel & Ellison, 1996;Keil, Chambless, Doring, Filipiak, & Stieber, 1997;Kitamura et al., 1998;Langer, Criqui, & Reed, 1992;Lindeman et al., 1999;Mäkelä, Valkonen, & Poikolainen, 1997;Mann & Folts, 2004;Marmota, 2001;Meister, Whelan, & Kava, 2000;Miller, Beckles, Maude, & Carson, 1990;Moore & Pearson, 1986;Mukamal, Chiuve, & Rimm, 2006;Rehm, Bondy, Sempos, & Vuong, 1997;Rigaud, 2000;Rimm et al., 1991;Rimm, Klatsky, Grobbee, & Stampfer, 1996;Rimm & Moats, 2007;Rimm, Williams, Fosher, Criqui, & Stampfer, 1999;Sacco et al., 1999;Shaper, Wannamethee, & Walker, 1994;Shaper & Wannamethee, 2000;Suh, Shaten, Cutler, & Kuller, 1992;Tolstrup et al., 2006;Valmadrid, Klein, Moss, Klein, & Cruickshanks, 1999;Vogel, 2002;Younis, Cooper, Miller, Humphries, & Talmud, 2005), and this effect might be especially applicable to diabetic patients (Ajani et al., 2000;Koppes, Dekker, Hendriks, Bouter, & Heine, 2006;Solomon et al., 2000;Tanasescu, Hu, Willett, Stampfer, & Rimm, 2001). ...
Article
Adolescent alcohol use, especially at a young age, has many negative consequences, both on the individual and the societal level. After an introduction describing a conceptual model of predictors and consequences of adolescent alcohol use, the first two chapters in this dissertation report on two studies on alcohol intoxication related admissions of adolescents in Dutch hospitals. Data collected in 2007 and 2008 underline the societal relevance of the problem of adolescent alcohol use. The number of adolescents with alcohol intoxication increases and the symptoms become more severe. In the remaining seven chapters, predictors of adolescent alcohol use are the main topic. The social context of alcohol use is explored in a qualitative study in which adolescents described severe alcohol related incidents they had experienced. In the next study, parents were asked about their support for governmental alcohol control policies. Then an experimental study is described into the impact of alcohol commercials and alcohol product placement in a soap series. The last four studies involve three types of alcohol availability. Regarding economic availability, the prevalence and effects of price discounts in the catering industry were explored. The role of physical availability of alcohol was investigated in a study of private drinking places, focusing their national prevalence and the characteristics of their visitors. A third part of this study involves a large sample questionnaire in which alcohol consumption of adolescent visitors and non-visitors were compared. The last two studies focus on legal availability. These studies involve the shop floor compliance with age restrictions for alcohol sales. The first study investigates compliance levels in the Netherlands in general; the second study addresses the effects of a feedback letter intervention to improve compliance.
... An issue that has not been addressed by this or most previous epidemiological studies concerns the mechanisms underlying the potential effects of alcohol on the heart. Chronic consumption of alcohol is accompanied by changes in various biomarkers [18] of which HDL cholesterol has been considered the most important mediator of the possible beneficial effects [19]. HDL cholesterol has also been shown to increase in controlled studies of alcohol intake usually lasting between 1 and 3 months [20,21]. ...
... These studies provide no indication that moderate consumption levels could be associated with a reduced likelihood of AMD. A similar situation has been observed for heart disease; aggregate studies provide no indication that moderate consumption could exert a beneficial effect on heart disease, while individual-level studies do (cf., Hemstrom, 2001;Rimm & Moats, 2007). Hemstrom (2001) has emphasized, based on this discrepancy, that great caution is needed in considering basing alcohol policy on supposed beneficial effects of alcohol. ...
Article
We examine the effects of alcohol consumption and problem drinking on probable anxiety and mood disorder (AMD). Data were taken from the 2000-2006 CAMH Monitor (N = 15,653) general population survey of Ontario adults. Scoring 4+ on the 12-item General Health Questionnaire defined probable AMD, as suggested by recent research. Logistic regression showed that respondents with alcohol problems had significantly increased odds of probable AMD, but those reporting moderate daily alcohol consumption (up to 2 drinks) had decreased odds of probable AMD compared to abstainers. These data replicate other recent research in suggesting that the relationship between alcohol and adverse psychological states, such as psychological distress and probable anxiety and mood disorder, may not be monotonic. Several ways in which selection bias could account for these findings are discussed, as well as other possible causative mechanisms.
... Drinking moderate amounts of alcohol (30-40 g/day) can increase HDL-C levels and decrease CHD risk independent of other factors [18,19]. In addition, drinking 30-40 g/day of alcohol for 3 weeks has been reported to increase HDL-C levels by a maximum of 12% regardless of the type of alcohol [20]. General recommendations suggest no more than 2 and 1 glasses/day of alcohol for men and women, respectively [21]. ...
Article
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Objective: The aim of the present study was to clarify the significance of high levels of high-density lipoprotein cholesterol (HDL-C) in Japanese women receiving an annual health check-up. Methods: A total of 1879 women who were not taking medication for hypertension, diabetes or dyslipidemia, with no prior history of ischemic heart disease, cerebrovascular disease or chronic renal failure were analyzed. First, the association between HDL-C and homeostasis model assessment of insulin resistance (HOMA-IR) was studied. Next, the association between HDL-C and the number of metabolic syndrome (MetS) risk factors, including HOMA-IR, was determined. In addition, clinical parameters including HOMA-IR, number of MetS risk factors, smoking, exercise, and alcohol consumption habits were compared according to HDL-C level. Results: HOMA-IR was lower in subjects with elevated HDL-C. Additionally, a lower body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG), and triglycerides (TG) were observed in subjects with higher HDL-C. Moreover, the proportion of subjects who were obese, or those who had high FPG, high TG, and a high number of MetS risk factors was lower in subjects with higher HDL-C. Both obesity and smoking were associated with reduced HDL-C levels. Increasing levels of alcohol consumption, from < 25 g/day, to 25 -< 50 g/day, to 50 -< 75 g/day, were associated with a progressive increase in HDL-C level, but a progressive reduction in HOMA-IR. However, this apparent benefit of alcohol intake on HDL-C and HOMA-IR disappeared in subjects who drank ≥ 75 g/day. Conclusions: Female subjects who were not obese, did not smoke, and drank < 75 g alcohol/day had elevated HDL-C levels, which were associated with improved insulin sensitivity. Drinking alcohol in excess of 75 g/day appeared to provide no advantages in terms of HDL-C or HOMA-IR levels. Thus, it might be important for females to keep their alcohol intake below 75 g/day.
... Furthermore, aspects of when and how drinking is measured and how these measurements relate to when and how cognitive decline is measured are important sources of variability that need to be borne in mind in these studies. In fact, the definition of moderate drinking has a very broad range (from 5 to 60 g of alcohol per day) depending on the study population and the tool used for assessment (Rimm and Moats, 2007). In the definition suggested by the 2010 USDA Dietary Guidelines (U.S. ...
Article
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Objective: In several longitudinal studies, light-to-moderate drinking of alcoholic beverages has been proposed as being protective against the development of age-related changes in cognitive function, predementia syndromes, and cognitive decline of degenerative (Alzheimer's disease, AD) or vascular origin (vascular dementia). However, contrasting findings also exist. Method: The English literature published in this area before September 2011 was evaluated, and information relating to the various factors that may impact upon the relationship between alcohol consumption and dementia or predementia syndromes is presented in the succeeding texts. Results: Light-to-moderate alcohol consumption may be associated with a reduced risk of incident overall dementia and AD; however, protective benefits afforded to vascular dementia, cognitive decline, and predementia syndromes are less clear. The equivocal findings may relate to many of the studies being limited to cross-sectional designs, restrictions by age or gender, or incomplete ascertainment. Different outcomes, beverages, drinking patterns, and study follow-up periods or possible interactions with other lifestyle-related (e.g., smoking) or genetic factors (e.g., apolipoprotein E gene variation) may all contribute to the variability of findings. Conclusion: Protective effects of moderate alcohol consumption against cognitive decline are suggested to be more likely in the absence of the AD-associated apolipoprotein E ε4 allele and where wine is the beverage. At present, there is no indication that light-to-moderate alcohol drinking would be harmful to cognition and dementia, and attempts to define what might be deemed beneficial levels of alcohol intake in terms of cognitive performance would be highly problematic and contentious. Copyright
... Recently, Rimm and Moats calculated that HDL-C is the most important of the investigated biomarkers explaining the benefit of alcohol in both men and women. 8 HDL-C is of particular interest, because controlled experimental repeated intake of alcohol is known to increase the serum concentration of this lipoprotein. 9 Some studies have suggested that up to 50% of the cardioprotective effect of alcohol consumption can be explained by changes in the serum level of HDL-C. 10 -12 However, in the Helsinki Heart Study, HDL-C only explained 16% of the effect. ...
Article
This study tested the hypothesis that moderate alcohol intake exerts its cardioprotective effect mainly through an increase in the serum level of high-density lipoprotein cholesterol. In the Cohort of Norway (CONOR) study, 149 729 adult participants, recruited from 1994 to 2003, were followed by linkage to the Cause of Death Registry until 2006. At recruitment, questionnaire data on alcohol intake were collected, and the concentration of high-density lipoprotein cholesterol in serum was measured. Using Cox regression, we found that the adjusted hazard ratio for men for dying from coronary heart disease was 0.52 (95% confidence interval, 0.39-0.69) when consuming alcohol more than once a week compared with never or rarely. The ratio changed only slightly, to 0.55 (0.41-0.73), after the regression model included the serum level of high-density cholesterol. For women, the corresponding hazard ratios were 0.62 (0.32-1.23) and 0.68 (0.34-1.34), respectively. Alcohol intake is related to a reduced risk of death from coronary heart disease in the follow-up of a large, population-based Norwegian cohort study with extensive control for confounding factors. Our findings suggest that the serum level of high-density cholesterol is not an important intermediate variable in the possible causal pathway between moderate alcohol intake and coronary heart disease.
... 86 Thus, clinical advice to abstainers to initiate daily alcohol consumption to increase HDL-C levels is not recommended. 87 Despite these evidences, achieving change in lifestyle is still a challenge in both primary and secondary prevention. Thus, there is an unmet need for new, safe and effective pharmacological treatments in cardiovascular medicine. ...
Article
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High-density lipoprotein cholesterol (HDL-C) is a strong and independent predictor of major cardiovascular events in a wide range of patients. The relationship between HDL-C cholesterol and cardiovascular risk appears to be linear, continuous, negative and independent of other risk factors such as blood pressure, smoking and BMI. In addition, the inverse relationship between HDL-C and cardiovascular events does not depend on low-density lipoprotein cholesterol (LDL-C) levels, so a substantial residual cardiovascular risk is maintained also in individuals with LDL-C levels below the target recommended by scientific guidelines. Furthermore, a strong relationship among HDL-C levels, progression of atherosclerosis and risk of cardiovascular diseases has been also demonstrated. Treatments that increase HDL-C levels have been shown to be effective in reducing incidence of cardiovascular diseases both in primary and secondary prevention settings. However, proof that increasing HDL-C levels by pharmacological treatment is able to confer a reduction in major cardiovascular outcomes independent of changes in LDL-C or triglycerides levels is not completely defined. Among currently available compounds, statins do not seems to have a sufficient effect on HDL-C profile. Studies on fibrates have shown inconclusive results. Although niacin has been demonstrated to reduce the incidence of major cardiovascular events paralleling the regression of atherosclerosis, significant side-effects still limit its use. The potential benefit of cholesterol ester transfer protein inhibition is still under investigation. The combination therapy of fibrates with statins is also controversial. Thus, despite the potentially favorable effect of raising HDL-C levels, the available guidelines still do not consider HDL-C levels as a specific target for therapy. Further studies are needed to assess the role of new compounds to raise HDL-C levels or modify HDL composition and functionality.
... En lo que respecta al tabaquismo y al consumo de alcohol, su frecuencia es similar entre sí y mayor en el grupo de los hombres, comparado con el de las mujeres, con perfiles similares a lo hallado por otros autores (23). Esto puede explicarse por la influencia que genera el entorno cultural, lo cual coincide con lo expresado en la Encuesta Nacional de Adicciones 2002 cuando se afirma que "desde la adolescencia, el consumo de alcohol empieza a ser mucho más frecuente en hombres que en mujeres" (24), y en jóvenes, el incremento de riesgo por su consumo es significativamente mayor que en adultos (25), aun cuando las evidencias actuales todavía son controversiales (26). ...
Article
Introducción. Algunos estudios de gran alcance sugieren que los individuos con alto riesgo cardiovascular en la mediana edad pueden ser identificados por una mayor presencia de factores de riesgo en edades tempranas. Objetivos. Estimar la prevalencia y la agrupación de factores de riesgo biológicos y de comportamiento de enfermedad cardiovascular en adultos jóvenes en un barrio de Cartagena de Indias. Materiales y métodos. Se llevó a cabo un estudio descriptivo de corte transversal en 207 personas de 20 a 44 años, con aplicación de entrevistas, mediciones antropométricas y tomas de muestras sanguíneas para evaluar la glucemia y el perfil lipídico. Resultados. El 80% (IC95% 73,6-86,4) presentó historia familiar de enfermedades cardiovasculares. Se halló una prevalencia de 37% (IC95% 30,4-43,6) para factores de riesgo conductuales, como la inactividad física, y de 66% (IC95% 59,5-72,5) para el consumo de dieta aterogénica. El consumo de alcohol y tabaco fue significativamente mayor en los varones. La prevalencia de factores de riesgo biológicos fue de 42% (IC95% 35,3-48,7) para cHDL (high-density lipid cholesterol) bajo, de 39% (IC95% 32,4-45,6) para hipertrigliceridemia, de 34% (IC95% 27,5-40,5) para cLDL (low density lipid cholesterol) elevado y de 21% (IC95% 15,5-26,5) para síndrome metabólico. Se observó presencia de tres o más factores de riesgo biológico en el 30% (IC95% 23,8-36,2); de uno o dos, en el 54% (IC95% 47,2-60,8), y el 16% (IC95 % 11,0-21,0) de los participantes no presentó ninguno de ellos. Conclusión. La alta prevalencia de factores de riesgo cardiovascular en adultos jóvenes subraya la importancia de las políticas encaminadas a reducirlos mediante estrategias de prevención.
... On the other hand, substantial epidemiological evidence suggests that alcohol intake has beneficial effects on the cardiovascular system, causing a lower risk of coronary heart disease among light to moderate alcohol drinkers compared with abstainers [4, 5]. The beneficial effect is believed mainly to be due to increasing levels of high-density lipoprotein cholesterol, decreased fibrinogen and increased insulin sensitivity678. ...
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Although a light to moderate alcohol intake is associated with a lower risk of acute coronary syndrome (ACS), alcohol is also associated with risk of hypertension, which in turn is a strong risk factor of ACS. We examined whether middle-aged men and women with hypertension also benefit from a light to moderate alcohol intake in relation to risk of ACS and overall mortality. We used data from 57,053 men and women, aged 50-64, who participated in the Danish Diet, Cancer and Health study. Information on alcohol intake (amount and frequency) was reported by the participants. Hypertension status was assessed at baseline by combining blood pressure measurements and self-reports. During follow-up, 860 and 271 ACS events occurred among men and women. Irrespective of alcohol intake, participants with hypertension had a higher risk than participants with normal blood pressure. Alcohol intake was associated with a lower risk of ACS among participants both with and without hypertension and there was no evidence of interaction between alcohol intake and hypertension. Those who drank moderately had a lower mortality than abstainers and those who drank heavily; and for all levels of alcohol intake, participants with hypertension had a higher risk than participants with normal blood pressure. Results were similar for men and women. These findings indicate that a light to moderate alcohol intake has similar effects on the risk of ACS in men and women with and without hypertension.
... Our results suggest that a pattern similar to that observed for IHD may be present also in case of HF, namely that greater drinking frequency with limited quantity consumed per drinking day may be most favorable among light-to-moderate drinkers [7,33]. Furthermore, findings from earlier studies on IHD have consistently suggested that binge drinking (i.e., heavy episodic drinking in a short period of time [34]) has a detrimental health effect [33,35]. We could not explicitly examine binge drinking in this study, but found that the apparently lower risk of HF among moderate drinkers was completely absent among those who indicated drinking problems on the CAGE questionnaire. ...
... Studies looking at the relationship between alcohol consumption and specific illnesses have similar findings, in that moderate consumers of alcohol are at lower risk. Wannamethee and Shaper (1999); Rimm and Moats (2007), Bryson et al. (2006), and Klatsky et al. (2005) find this in relation to coronary heart disease. Becker et al. (1996) finds this in relation to liver disease, and Berger et al. (1999), Mukamal (2007), and Klatsky et al. (2001) find this in relation to the risk of stroke. ...
Article
This paper presents a study of the effects of alcohol consumption on household income in Ireland using the Slán National Health and Lifestyle Survey 2007 dataset, accounting for endogeneity and selection bias. Drinkers are categorised into one of four categories based on the recommended weekly drinking levels by the Irish Health Promotion Unit; those who never drank, non-drinkers, moderate and heavy drinkers. A multinomial logit OLS Two Step Estimate is used to explain individual's choice of drinking status and to correct for selection bias which would result in the selection into a particular category of drinking being endogenous. Endogeneity which may arise through the simultaneity of drinking status and income either due to the reverse causation between the two variables, income affecting alcohol consumption or alcohol consumption affecting income, or due to unobserved heterogeneity, is addressed. This paper finds that the household income of drinkers is higher than that of non-drinkers and of those who never drank. There is very little difference between the household income of moderate and heavy drinkers, with heavy drinkers earning slightly more. Weekly household income for those who never drank is €454.20, non-drinkers is €506.26, compared with €683.36 per week for moderate drinkers and €694.18 for heavy drinkers.
... Whilst the first MR study on HDL-C appeared before the first large HDL-C raising trial was reported [32], the highly cited MR paper was a latter collaborative analysis across a large number of studies [30]. In their work, by contrast, MSR have simply assumed that HDL-C protects against CHD, seeing it as mediating substantial components of the apparently beneficial effects of alcohol and HRT on CHD [25,26,[33][34][35]. ...
Article
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We respond to criticisms of Mendelian randomization (MR) by Mukamal, Stampfer and Rimm (MSR). MSR consider that MR is receiving too much attention and should be renamed. We explain how MR links to Mendel’s laws, the origin of the name and our lack of concern regarding nomenclature. We address MSR’s substantive points regarding MR of alcohol and cardiovascular disease, an issue on which they dispute the MR findings. We demonstrate that their strictures with respect to population stratification, confounding, weak instrument bias, pleiotropy and confounding have been addressed, and summarise how the field has advanced in relation to the issues they raise. We agree with MSR that “the hard problem of conducting high-quality, reproducible epidemiology” should be addressed by epidemiologists. However we see more evidence of confrontation of this issue within MR, as opposed to conventional observational epidemiology, within which the same methods that have demonstrably failed in the past are simply rolled out into new areas, leaving their previous failures unexamined.
... The lower mortality risk among moderate drinkers is thought to be mainly explained by its effects on several cardio-protective pathways. Numerous experimental studies have shown beneficial changes in high-density lipoprotein cholesterol, clotting factors, endothelial function, insulin sensitivity, and inflammation [47,48]. All these findings support biological plausibility of beneficial effects of moderate alcohol consumption as shown in observational studies. ...
Article
For almost a century, the scientific community is aware of the J-shaped curve between alcohol consumption and all-cause mortality. Moderate drinkers seem to live longer than both abstainers and heavy drinkers. These epidemiological observations regarding moderate alcohol consumption and beneficial health effects have been incessantly scrutinised for confounding and bias. This viewpoint discusses previous and recent criticisms regarding the J-shaped curve between alcohol consumption and total mortality risk. The controversies regarding the J-shaped curve between alcohol consumption and mortality are ongoing, as well as the debate among scientists in this area of research, resulting in conflicting messages in media and in different alcohol guidelines. Although it appears quite difficult to come up with a position statement only based on the currently available scientific data, it is imperative to fairly inform the public, without creating confusion and, worst case, disbelief in science.
... They should take into account a sufficient numbers of individuals so that the risks were reliably estimated in the subgroups, which should be classified according to age, gender and smoking (Thun et al. 1997). Ten years later, Rimm and Moats (2007) highlighted the existence of substantial epidemiological evidence from geographical comparisons, large cohort studies, and many meta-analyses, with a more cautious approach to the relevance of standards of consumption, frequency, quantity and type of alcoholic beverage ingested, considering physical and health conditions and alcohol intake during the adult life of the participants analysed. More recent publications consider the observational character of epidemiology, but agree that the exact magnitude of the protective effect of alcohol is associated with patterns of consumption of individuals and populations, and therefore these conditions should be considered (Rehm & Roerecke 2017). ...
Article
In order to establish a clear limit between protective and harmful effects of alcohol consumption, it is necessary to define patterns of consumption. However, there is no universally recognized quantitative classification for patterns of consumption by alcohol doses. This is because the pattern of alcohol consumption does not only describe how much alcohol was consumed, but also takes into account a number of boundary conditions. This review deals with variabilities in the definitions of standard alcohol doses and patterns of alcohol consumption. These terms are being discussed with respect to the benefits and harms associated with alcohol consumption as well as the risks intrinsic to studies of such a complex phenomenon as the effect of alcoholic beverages on human health.
... Much of the discussion around the evidence base for the alcohol-CHD association has focussed on design limitations in observational studies, such as the failure to distinguish between non-drinkers and former drinkers [12,13]. The decision to stop drinking could be influenced by the onset of ill health, and such sick quitters could potentially bias estimates of disease risk in lifelong abstainers if not analysed independently [14]. ...
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Background: Studies have shown that alcohol intake trajectories differ in their associations with biomarkers of cardiovascular functioning, but it remains unclear if they also differ in their relationship to actual coronary heart disease (CHD) incidence. Using multiple longitudinal cohort studies, we evaluated the association between long-term alcohol consumption trajectories and CHD. Methods: Data were drawn from six cohorts (five British and one French). The combined analytic sample comprised 35,132 individuals (62.1% male; individual cohorts ranging from 869 to 14,247 participants) of whom 4.9% experienced an incident (fatal or non-fatal) CHD event. Alcohol intake across three assessment periods of each cohort was used to determine participants' intake trajectories over approximately 10 years. Time to onset for (i) incident CHD and (ii) fatal CHD was established using surveys and linked medical record data. A meta-analysis of individual participant data was employed to estimate the intake trajectories' association with CHD onset, adjusting for demographic and clinical characteristics. Results: Compared to consistently moderate drinkers (males: 1-168 g ethanol/week; females: 1-112 g ethanol/week), inconsistently moderate drinkers had a significantly greater risk of incident CHD [hazard ratio (HR) = 1.18, 95% confidence interval (CI) = 1.02-1.37]. An elevated risk of incident CHD was also found for former drinkers (HR = 1.31, 95% CI = 1.13-1.52) and consistent non-drinkers (HR = 1.47, 95% CI = 1.21-1.78), although, after sex stratification, the latter effect was only evident for females. When examining fatal CHD outcomes alone, only former drinkers had a significantly elevated risk, though hazard ratios for consistent non-drinkers were near identical. No evidence of elevated CHD risk was found for consistently heavy drinkers, and a weak association with fatal CHD for inconsistently heavy drinkers was attenuated following adjustment for confounding factors. Conclusions: Using prospectively recorded alcohol data, this study has shown how instability in drinking behaviours over time is associated with risk of CHD. As well as individuals who abstain from drinking (long term or more recently), those who are inconsistently moderate in their alcohol intake have a higher risk of experiencing CHD. This finding suggests that policies and interventions specifically encouraging consistency in adherence to lower-risk drinking guidelines could have public health benefits in reducing the population burden of CHD. The absence of an effect amongst heavy drinkers should be interpreted with caution given the known wider health risks associated with such intake. Trial registration: ClinicalTrials.gov, NCT03133689 .
... Lastly, apart from pathobiologic explanations of paradoxical relationships between HDL-C and events, residual and reverse confounding must also be addressed. Prior reports of increased mortality among those with elevated HDL-C have been confounded by alcohol intake, which tends to raise HDL-C levels and is linked to cancer and increased all-cause mortality (23)(24)(25). In the present study, a continuous measure of self-reported alcohol intake explained 5% of the variance in HDL-C levels, behind only triglyceride levels and body mass index. ...
... Studies looking at the relationship between alcohol consumption and specific illnesses have similar findings, in that moderate consumers of alcohol are at lower risk. Wannamethee and Shaper (1999); Rimm and Moats (2007), Bryson et al. (2006), and Klatsky et al. (2005) find this in relation to coronary heart disease. Becker et al. (1996) finds this in relation to liver disease, and Berger et al. (1999), Mukamal (2007), and Klatsky et al. (2001) find this in relation to the risk of stroke. ...
Article
This paper presents a study of the effect of alcohol consumption on individual health status and health care utilization in Ireland using the 2007 Slán National Health and Lifestyle Survey, while accounting for the endogenous relationship between alcohol and health. Drinkers are categorized as those who never drank, non-drinkers, moderate drinkers, or heavy drinkers, based on national recommended weekly drinking levels in Ireland. The drinking-status equation is estimated using an ordered probit model. Predicted values for the inverse mills ratio are generated, which are then included in the health and health-care utilization equations. Differences in health status for each category of drinker are examined, and the relationship between both alcohol consumption and health with a host of other personal and socio-economic variables is also identified. Given that the measure of health status available is self-assessed, the effect of alcohol consumption on health-care utilization is also analyzed as an alternative measure of health. Findings show that in Ireland, moderate drinkers enjoy the best health status. More moderate drinkers report having very good or excellent health compared with heavy drinkers, non-drinkers, or those who never drank. While heavy drinkers do not report having as good a health status as moderate drinkers, they are better off in terms of health when compared with non-drinkers and those who are lifetime abstainers.
... The consumption of 1-2 drinks/d (generally 10-30 g alcohol/d) has been associated with a 20-25% decrease in risk of CVD (3)(4)(5); however, greater alcohol consumption increased the risk of CVD and total mortality (4,5). The beneficial effects of moderate drinking could be attributed to more-favorable inflammation and fibrinolytic status but are primarily a result of an increased HDL concentration (6,7). It was estimated that a higher HDL concentration could explain w50% of the coronary heart disease preventive effect of alcohol consumption (8). ...
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Background: In cross-sectional studies and short-term clinical trials, it has been suggested that there is a positive dose-response relation between alcohol consumption and HDL concentrations. However, prospective data have been limited.Objective: We sought to determine the association between total alcohol intake, the type of alcohol-containing beverage, and the 6-y (2006-2012) longitudinal change in HDL-cholesterol concentrations in a community-based cohort.Design: A total of 71,379 Chinese adults (mean age: 50 y) who were free of cardiovascular diseases and cancer and did not use cholesterol-lowering agents during follow-up were included in the study. Alcohol intake was assessed via a questionnaire in 2006 (baseline), and participants were classified into the following categories of alcohol consumption: never, past, light (women: 0-0.4 servings/d; men: 0-0.9 servings/d), moderate (women: 0.5-1.0 servings/d; men: 1-2 servings/d), and heavy (women: >1.0 servings/d; men: >2 servings/d). HDL-cholesterol concentrations were measured in 2006, 2008, 2010, and 2012. We used generalized estimating equation models to examine the associations between baseline alcohol intake and the change in HDL-cholesterol concentrations with adjustment for age, sex, smoking, physical activity, obesity, hypertension, diabetes, liver function, and C-reactive protein concentrations.Results: An umbrella-shaped association was observed between total alcohol consumption and changes in HDL-cholesterol concentrations. Compared with never drinkers, past, light, moderate, and heavy drinkers experienced slower decreases in HDL cholesterol of 0.012 mmol · L(-1) · y(-1) (95% CI: 0.008, 0.016 mmol · L(-1) · y(-1)), 0.013 mmol · L(-1) · y(-1) (95% CI: 0.010, 0.016 mmol · L(-1) · y(-1)), 0.017 mmol · L(-1) · y(-1) (95% CI: 0.009, 0.025 mmol · L(-1) · y(-1)), and 0.008 mmol · L(-1) · y(-1) (95% CI: 0.005, 0.011 mmol · L(-1) · y(-1)), respectively (P < 0.0001 for all), after adjustment for potential confounders. Moderate alcohol consumption was associated with the slowest increase in total-cholesterol:HDL-cholesterol and triglyceride:HDL-cholesterol ratios. We observed a similar association between hard-liquor consumption and the HDL-cholesterol change. In contrast, greater beer consumption was associated with slower HDL-cholesterol decreases in a dose-response manner.Conclusion: Moderate alcohol consumption was associated with slower HDL-cholesterol decreases; however, the type of alcoholic beverage had differential effects on the change in the HDL-cholesterol concentration.
... In recent years, the relationship between moderate alcohol intake and health outcomes has obtained increasing attention [1,2]. Some scientific evidence has been reported in the literature showing that moderate alcohol consumption is positively associated with lower mortality [3], fewer cardiovascular events [4][5][6], diabetes [7,8], functional limitation [1], inflammatory status [9,10] and positive effects on health during the aging process [11,12]. ...
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Purpose This work was aimed to study the relationships of moderate alcohol intake and the type of beverages consumed with health behaviors and quality of life in elderly people. Methods In this observational study, 231 subjects (55–85 years) voluntarily answering to advertisements were enrolled and divided in three study groups: abstainers and occasional consumers (ABS; n = 98), moderate drinkers of beer (BEER; n = 63) and moderate drinkers of all sorts of alcoholic beverages (MIXED; n = 70). Variables assessed included physical activity, activities of daily living, Mediterranean diet-adherence score, tobacco consumption, quality of sleep, body composition, medication and perception of health through the SF-36 questionnaire. Their relationship with alcohol consumption was assessed through general linear models including confounding variables (age, sex, chronic disease prevalence and socioeconomic status). ABS were also compared to moderate drinkers (MOD = BEER + MIXED). Results The mean daily alcohol consumption in each group was (mean ± SD): ABS: 0.7 ± 1.1; BEER: 12.7 ± 8.1; MIXED: 13.9 ± 10.2 g/day. MOD and MIXED showed significantly higher physical activity (metabolic standard units; METs) than ABS (p = 0.023 and p = 0.004, respectively). MOD spent significantly less time doing housework activities than ABS (p = 0.032). Daily grams of alcohol consumption were significantly associated with METs (B = 21.727, p = 0.023). Specifically, wine consumption (g/day) was associated with METs (B = 46.196, p = <0.001) and showed borderline significant relationships with mental health (B = 0.245, p = 0.062) and vitality perception (B = 0.266, p = 0.054). Conclusion Moderate alcohol consumption, and in particular wine consumption, is associated with a more active lifestyle and better perception of own health in the Spanish elderly subjects studied.
... [21] Longitudinal studies have sought to control for this bias by distinguishing lifetime abstainers from former drinkers, as the latter group are potentially sick quitters. [5,22,23] However, this distinction may not be sufficient to confirm causality. Studies need to consider that lifetime non-drinkers may also be selected for poor health, [24] and healthy drinkers suffer mortality before old age. ...
Article
Background: Older people who drink have been shown to have better health than those who do not. This might suggest that moderate drinking is beneficial for health, or, as considered here, that older people modify their drinking as their health deteriorates. The relationship between how often older adults drink and their health is considered for two heath states: self-rated health (SRH) and depressive symptoms. Methods: Data were analysed from the English Longitudinal Study of Ageing (ELSA), a prospective cohort study of older adults, using multilevel ordered logit analysis. The analysis involved 4741 participants present at wave 0, (1998/1999 and 2001), wave 4 (2008/2009) and wave 5 (2010/2011). The outcome measure was frequency of drinking in last year recorded at all three time points. Results: Older adults with fair/poor SRH at the onset of the study drank less frequently compared with adults with good SRH (p<0.05). Drinking frequency declined over time for all health statuses, though respondents with both continual fair/poor SRH and declining SRH experienced a sharper reduction in the frequency of their drinking over time compared with older adults who remained in good SRH or whose health improved. The findings were similar for depression, though the association between depressive symptoms and drinking frequency at the baseline was not significant after adjusting for confounding variables. Conclusions: The frequency of older adults' drinking responds to changes in health status and drinking frequency in later life may be an indicator, rather than a cause, of health status.
Article
Studies based on a cost of illness method frequently assert large social costs from a variety of risky activities, the harms from which most typically fall upon the risk-taker himself. Many of these costs are inadmissible in a standard economic framework; consequently, figures derived by the cost of illness method are not comparable with other economic notions of cost and are of very limited policy use.
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The objective was to clarify the significance of high high-density lipoprotein cholesterol (HDL-C) levels in the metabolic syndrome (MetS). The evaluation focused on insulin resistance as an indicator of early-stage MetS. Of 2705 men who first underwent an annual health check-up at Tokai University Hachioji Hospital, 2129 men were included in this study, after exclusion of those on medication for hypertension, diabetes or dyslipidemia, and those with a prior history of ischemic heart disease, cerebrovascular disease or chronic renal failure. MetS risk factors include the following five parameters: waist circumference, blood pressure, plasma glucose, triglycerides and HDL-C. The correlations between HDL-C and number of MetS risks with homeostasis model assessment of insulin resistance (HOMA-IR) were analyzed. HOMA-IR, number of risks, habits of smoking, exercise and drinking alcohol, stratified by HDL-C levels, were compared in MetS subjects. In cases with ≤2 risk factors, the higher the HDL-C, the lower the HOMA-IR. However, with ≥3 risk factors for MetS, the HOMA-IR increased when HDL-C was ≥90 mg/dL. In MetS subjects, the rate of alcohol intake ≥75 g/day was high when HDL-C was ≥90 mg/dL. In MetS subjects with high HDL-C levels, insulin resistance was increased. Therefore, in persons with high HDL-C levels, it is important to monitor the amount of alcohol consumption and reduce alcohol consumption to <75 g/day.
Article
This thesis is about the social determinants of alcohol consumption. More specifically, the aims were to study how some circumstances of life, working and social environment may exert an influence on changes in drinking behaviours over time.The analyses were conducted within the Gazel cohort, including more than 20 000 subjects(15 000 men and 5 000 women) employees of EDF‐GDF, the French national utility company,aged 35‐50 at the inception of the cohort in 1989, which were followed‐up since that period.The main determinants that were studied are the working conditions, the marital status of women, and retirement. The main findings showed that the occupational, familial and social environment play a role in the changes in drinking behaviours over time, and that their effects are socially patterned
These review discusses the effects of ethanol on lipoprotein levels and function as related to atherosclerosis and cardiovascular disease (CVD), with special emphasis on recent publications. Ethanol's effects on high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG), and other CVD risk factors recently have been explored. Other new data address genetic and demographic predictors and mechanisms of these responses. Not surprisingly, the results of some recent studies corroborate, whereas others differ from, earlier seemingly well-established findings. Prior and recent evidence shows favorable changes in HDL, other CVD risk factors, and CVD event rates with moderate, regular ethanol intake, and recent publications have explored the mechanisms of this relationship. Application of these findings in clinical practice remains problematic, however, due to the lack of randomized, controlled clinical trials of ethanol and due to the potential hazards of ethanol consumption.
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The polynomial chaos (PC) method has been widely adopted as a computationally feasible approach for uncertainty quantification (UQ). Most studies to date have focused on non-stiff systems. When stiff systems are considered, implicit numerical integration requires the solution of a non-linear system of equations at every time step. Using the Galerkin approach the size of the system state increases from n to S × n, where S is the number of PC basis functions. Solving such systems with full linear algebra causes the computational cost to increase from O(n3) to O(S3n3). The S3-fold increase can make the computation prohibitive. This paper explores computationally efficient UQ techniques for stiff systems using the PC Galerkin, collocation, and collocation least-squares (LS) formulations. In the Galerkin approach, we propose a modification in the implicit time stepping process using an approximation of the Jacobian matrix to reduce the computational cost. The numerical results show a run time reduction with no negative impact on accuracy. In the stochastic collocation formulation, we propose a least-squares approach based on collocation at a low-discrepancy set of points. Numerical experiments illustrate that the collocation least-squares approach for UQ has similar accuracy with the Galerkin approach, is more efficient, and does not require any modification of the original code.
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We estimated the burden of disease attributable to alcohol in Germany and Switzerland for the year 2002. We calculated disease-specific attributable fractions for diseases and conditions based on relative risk estimates from meta-analyzes, prevalence of exposure from the Global Alcohol Database and large, representative surveys, and obtained mortality and burden of disease data from the World Health Organization. Comparatively high alcohol consumption in Switzerland caused substantial burden, in particular among Swiss women. Although alcohol consumption was high among women in Germany and Europe as well, the burden among women was much less compared to Switzerland. For men in both countries comparable burden of disease was estimated. Both detrimental and beneficial effects of alcohol consumption were considered in this analysis. Because effective and cost-effective interventions are available, the burden of disease due to alcohol should be a focus of public health policy development. Specific measures are discussed.
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Objectives While older age and ill health are known to be associated with polypharmacy, this paper aims to identify whether wealth, body mass index (BMI), smoking and alcohol consumption are also associated with polypharmacy (5–9 prescribed medications) and hyperpolypharmacy prevalence (≥10 prescribed medications), among older people living in England. Design Cross-sectional study. Setting The English Longitudinal Study of Ageing Wave 6 (2012–2013). Participants 7730 participants aged over 50 years. Data synthesis Two multivariate models were created. HR with corresponding 95% CI, for polypharmacy and hyperpolypharmacy, were calculated after adjusting for gender, age, wealth, smoking, alcohol consumption, BMI, self-rated health and the presence of a chronic health condition. Results Lower wealth (lowest wealth quintile vs highest wealth quintile, adjusted HR 1.28; 95% CI 1.04 to 1.69, P=0.02) and obesity (adjusted HR 1.81; 95% CI 1.53 to 2.15, p<0.01) were significantly associated with polypharmacy. Increasing age (50–59 years vs 70–79 years, adjusted HR 3.42; 95% CI 2.81 to 4.77, p<0.01) and the presence of a chronic health condition (adjusted HR 2.94; 95% CI 2.55 to 3.39, p<0.01) were also associated with polypharmacy. No statistically significant association between smoking and polypharmacy (adjusted HR 1.06; 95% CI 0.86 to 1.29, P=0.56) was established; while, very frequent alcohol consumption (consuming alcohol >5 times per week) was inversely associated with polypharmacy (never drank alcohol vs very frequently, adjusted HR 0.64; 95% CI 0.52 to 0.78, p<0.01). The adjusted HR for hyperpolypharmacy was accentuated, compared with polypharmacy. Conclusion This study has identified that lower wealth, obesity, increasing age and chronic health conditions are significantly associated with polypharmacy and hyperpolypharmacy prevalence. The effect of these factors, on polypharmacy and especially hyperpolypharmacy prevalence, is likely to become more pronounced with the widening gap in UK wealth inequalities, the current obesity epidemic and the growing population of older people. The alcohol findings contribute to the debate on the relationship between alcohol consumption and health.
Article
There has been lack of studies that investigate the causal impact of alcohol consumption on health and mortality in middle-aged and older populations in China. This cohort study aims to investigate whether alcohol use increases poor health and mortality risk in middle-aged and older Chinese population. The study is a cohort study design that was based on the China Health and Retired Longitudinal study (CHARLS). Measures of poor health and alcohol use are self-rated poor/very poor and alcohol use. Competing Cox proportional hazard regression model (CPHM) was used to model the data and the hazards ratio (HR) of poor health, mortality for current and former drinkers versus nondrinkers and current drinkers versus former drinkers was estimated using CPHM after adjusting for deign-effects and covariates. This study found significantly increased risk of all-cause mortality among current (adjusted HR = 1.54 and P = 0.0423) and former drinkers (Adjusted HR = 1.52 and P = 0.0096) compared to lifetime nondrinkers among middle-aged and senior Chinese people; significantly increased hazard of poor health among current drinkers (Adjusted HR = 1.26 and P = 0.0443) compared with lifetime nondrinkers. The hazards of all-cause mortality and self-rated poor health increased with the amount and frequency of alcohol drinking, and drinking years. This study found that either former or current drinkers self-rated having a poor health and had a significantly increased risk of all-cause mortality compared with nondrinkers. Heavy drinkers had poor health status and higher risk of mortality compared with those who drank light or moderate amount of alcohol in middle-aged and senior Chinese population.
Article
Zusammenfassung. Ziel: Darstellung von Haufigkeit, Risiken und Folgen des Gebrauchs und Missbrauchs von Alkohol im hoheren Alter und Aufzeigen von Moglichkeiten der Intervention. Methodik: Es wurde zu den einzelnen Themen an bereits vorhandene systematisch recherchierte, einschlagige Uberblicksarbeiten angeknupft, die um neuere Arbeiten erganzt wurden. Diese wurden durch Recherchen in den einschlagigen Datenbanken und Literaturverzeichnissen der in Deutschland fuhrenden epidemiologischen Forschungsinstitute auf diesem Gebiet ermittelt. Ergebnisse: Im hoheren Alter zeigt sich ein deutlicher Ruckgang riskanten Konsums sowie ein Anstieg der Alkoholabstinenz. Manner weisen dabei einen hoheren riskanten Konsum und geringere Abstinenzraten auf. Neben dem Geschlecht sind mit riskantem Alkoholkonsum im hoheren Alter assoziiert: Tabakrauchen, hoheres Einkommen, hohere Bildung sowie hoherer sozialer Status. Bei alkoholbezogenen Storungen, schadlichem Gebrauch/Missbrauch von Alkohol und Alkoholabhangigkeit, weisen d...
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The potential of hormesis as the default model to assess and manage chemicals is considered in relation to micronutrients. It is pointed out that micronutrients, despite their well-known U-shaped dose-response curve, are assessed and managed only with excess-exposure in mind. Hereby a schism between health and safety is unjustifiably realized. This proves to be the conundrum of basically all chemicals regulation. It is proposed that hormesis could in principle address this conundrum.
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Alcohol consumption is common in both young and older populations. In the United States, 65 % of the adult population reports current alcohol consumption and about 5 % report heavy drinking. While moderate alcohol drinking has been associated with cardiovascular benefits in both younger and older populations, heavy alcohol use is associated with adverse metabolic and cardiovascular effects. In this chapter, we summarize known effects of alcohol consumption on the cardiovascular system overall and among elderly populations.
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A statistically significant negative association between alcohol consumption and a subsequent first myocardial infarction in 464 patients, was found in a study that was well controlled for cigarette smoking and 5 other established risk factors. There was a larger proportion of teetotalers among those who had a myocardial infarction (P < 0.01), as well as a smaller proportion of moderate (2 or less drinks per day) and heavy (3 or more drinks per day) consumers of alcoholic beverages. Alcohol consumption and cigarette smoking were strongly correlated habits. The lower consumption of alcohol by persons who subsequently had a myocardial infarction apparently was not the result of intake reduction because of known heart disease, or risk factor related diseases such as hypertension and diabetes mellitus. Possible explanations include indirect association of drinking habits with ethnic origin, psychological traits or other unknown risk factors for myocardial infarction, or a protective effect of alcohol.
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Studies in men suggest that light-to-moderate alcohol intake is associated with a reduction in overall mortality, due primarily to a reduced risk of coronary heart disease. Among women with similar levels of alcohol consumption, an increased risk of breast cancer has been noted that complicates the balance of risks and benefits. We conducted a prospective study among 85,709 women, 34 to 59 years of age and without a history of myocardial infarction, angina, stroke, or cancer, who completed a dietary questionnaire in 1980. During the 12-year follow-up period, 2658 deaths were documented. The relative risks of death in drinkers as compared with nondrinkers were 0.83 (95 percent confidence interval, 0.74 to 0.93) for women who consumed 1.5 to 4.9 g of alcohol per day (one to three drinks per week), 0.88 (95 percent confidence interval, 0.80 to 0.98) for those who consumed 5.0 to 29.9 g per day, and 1.19 (95 percent confidence interval, 1.02 to 1.38) for those who consumed 30 g or more per day, after adjustment for other predictors of mortality. Light-to-moderate drinking (1.5 to 29.9 g per day) was associated with a decreased risk of death from cardiovascular disease; heavier drinking was associated with an increased risk of death from other causes, particularly breast cancer and cirrhosis. The benefit associated with light-to-moderate drinking was most apparent among women with risk factors for coronary heart disease and those 50 years of age or older. Among women, light-to-moderate alcohol consumption is associated with a reduced mortality rate, but this apparent survival benefit appears largely confined to women at greater risk for coronary heart disease.
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To review the effect of specific types of alcoholic drink on coronary risk. Systematic review of ecological, case-control, and cohort studies in which specific associations were available for consumption of beer, wine, and spirits and risk of coronary heart disease. 12 ecological, three case-control, and 10 separate prospective cohort studies. Alcohol consumption and relative risk of morbidity and mortality from coronary heart disease. Most ecological studies suggested that wine was more effective in reducing risk of mortality from heart disease than beer or spirits. Taken together, the three case-control studies did not suggest that one type of drink was more cardioprotective than the others. Of the 10 prospective cohort studies, four found a significant inverse association between risk of heart disease and moderate wine drinking, four found an association for beer, and four for spirits. Results from observational studies, where alcohol consumption can be linked directly to an individual's risk of coronary heart disease, provide strong evidence that all alcoholic drinks are linked with lower risk. Thus, a substantial portion of the benefit is from alcohol rather than other components of each type of drink.
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To assess the relation between regular alcohol consumption and insulin sensitivity, and to estimate the importance of insulin in the association of alcohol with multiple vascular risk factors and cardiovascular disease. Prospective and cross sectional study of a large randomly selected population sample. Part of the Bruneck study 1990-5 (Bolzano province, Italy). 820 health, non-diabetic women and men aged 40-79 years. Concentrations of fasting and post-glucose insulin, cholesterol, apolipoproteins, triglycerides, Lp(a) lipoprotein glucose, fibrinogen, and antithrombin III; blood pressure; insulin resistance estimated by the homeostasis model assessment. Fasting insulin concentrations in those who did not drink alcohol and subjects reporting low (1-50 g/day), moderate (51-99 g/day), and heavy (> or = 100 g/day) alcohol intake were 12.4, 10.0, 8.7, and 7.1 mU/l (P < 0.001). Likewise, post-glucose insulin concentrations and estimates for insulin resistance assessed by the homeostasis model assessment decreased significantly with increasing amounts of regular alcohol consumption. These trends were independent of sex, body mass index, physical activity, cigarette smoking, medication, and diet (P < 0.001). Regular alcohol intake predicted multiple changes in vascular risk factors over a five year period including increased concentrations of high density lipoprotein cholesterol and apolipoprotein A I; higher blood pressure; and decreased concentration of antithrombin III. These associations were in part attributable to the decrease in insulin concentrations observed among alcohol consumers. Low to moderate amounts of alcohol, when taken on a regular basis, improve insulin sensitivity. Insulin is a potential intermediate component in the association between alcohol consumption and vascular risk factors (metabolic syndrome).
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Epidemiologic studies indicate that light to moderate alcohol consumption from beer, wine, or spirits is associated with a reduction in all-cause mortality, owing primarily to a reduced risk of coronary heart disease (CHD). To find out whether this protective effect of small to moderate amounts of alcohol could be confirmed in Germany, where much of the alcohol consumed is taken in the form of beer, we studied the relation between alcohol and CHD and total mortality in a population of southern Germany. We conducted a prospective cohort study from 1984 to 1992 among 1,071 men and 1,013 women, age 45-64 years at baseline, from the Augsburg region. Eighty-seven per cent of men and 56% of women reported drinking alcohol at baseline. Among drinkers, men had an average alcohol intake of 42 gm per day, of which 33 gm per day came from beer. Women who drank had an average alcohol intake of 16 gm per day and derived about half of it from beer and the other half from wine. During the 8 years of follow-up, 96 deaths (all causes) and 62 incident CHD events (nonfatal and fatal) occurred in men, and 45 deaths (all causes) occurred in women. Adjusting for a number of potential confounders, in men the adjusted hazard rate ratio (HRR) of CHD events for drinkers as compared with nondrinkers was 0.51 [95% confidence interval (CI) = 0.27-0.95]; this protective effect starts with the 0.1-19.9 gm per day alcohol category and does not change much with higher intake. In men, the adjusted total mortality HRR for drinkers as compared with nondrinkers was 0.59 (95% CI = 0.36-0.97). The total mortality HRRs for the different alcohol groups compared with nondrinkers show a U-shaped curve, with the lowest HRR of 0.46 (95% CI = 0.20-0.80) for the 20-39.9 gm per day alcohol group and an HRR of 1.04 (95% CI = 0.54-2.00) for the > or = 80 gm per day alcohol group. In women, the total mortality HRR for those drinking up to 19.9 gm per day as compared with nondrinkers was 0.46 (95% CI = 0.22-0.96).
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To examine the relation between alcohol intake and the incidence of coronary heart disease among Japanese, the authors analyzed data from a prospective study of 8,476 Japanese male employees, who were 40-59 years old at baseline (between 1975 and 1984) and worked for 13 urban companies in Osaka, Japan. These men were followed until the end of 1993, on average, an 8.8-year follow-up. Eighty-three coronary heart disease events (54 myocardial infarction, 32 angina pectoris) occurred during the employment period under study. Compared with the risk of coronary heart disease for never drinkers, the age-adjusted relative risk for those with an increased ethanol intake was lower, but the risk did not appear to be reduced further with the intake of > or = 69 g of ethanol per day. The multivariate relative risk adjusted for age, serum total cholesterol, cigarette smoking, body mass index, left ventricular hypertrophy, and a history of diabetes mellitus was 0.83 (95% confidence interval (CI) 0.24-2.86) in exdrinkers, 0.69 (95% CI 0.37-1.29) in drinkers of 1-22 g/day of ethanol, 0.55 (95% CI 0.29-1.05) in drinkers of 23-45 g/day, 0.41 (95% CI 0.19-0.88) in drinkers of 46-68 g/day, and 0.59 (95% CI 0.23-1.51) in drinkers of > or = 69 g/day. The inverse association with alcohol intake was similar between myocardial infarction and angina pectoris. Alcohol intake seemed to prevent the premature incidence of coronary heart disease among urban Japanese middle-aged men.
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To summarise quantitatively the association between moderate alcohol intake and biological markers of risk of coronary heart disease and to predict how these changes would lower the risk. Meta-analysis of all experimental studies that assessed the effects of moderate alcohol intake on concentrations of high density lipoprotein cholesterol, apolipoprotein A I, fibrinogen, triglycerides, and other biological markers previously found to be associated with risk of coronary heart disease. Men and women free of previous chronic disease and who were not dependent on alcohol. Studies were included in which biomarkers were assessed before and after participants consumed up to 100 g of alcohol a day. Alcohol as ethanol, beer, wine, or spirits. Changes in concentrations of high density lipoprotein cholesterol, apolipoprotein A I, Lp(a) lipoprotein, triglycerides, tissue type plasminogen activator activity, tissue type plasminogen activator antigen, insulin, and glucose after consuming an experimental dose of alcohol for 1 to 9 weeks; a shorter period was accepted for studies of change in concentrations of fibrinogen, factor VII, von Willebrand factor, tissue type plasminogen activator activity, and tissue type plasminogen activator antigen. 61 data records were abstracted from 42 eligible studies with information on change in biological markers of risk of coronary heart disease. An experimental dose of 30 g of ethanol a day increased concentrations of high density lipoprotein cholesterol by 3.99 mg/dl (95% confidence interval 3.25 to 4.73), apolipoprotein A I by 8.82 mg/dl (7.79 to 9.86), and triglyceride by 5.69 mg/dl (2.49 to 8.89). Several haemostatic factors related to a thrombolytic profile were modestly affected by alcohol. On the basis of published associations between these biomarkers and risk of coronary heart disease 30 g of alcohol a day would cause an estimated reduction of 24.7% in risk of coronary heart disease. Alcohol intake is causally related to lower risk of coronary heart disease through changes in lipids and haemostatic factors.
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Using data from a 12-year prospective study, we determined the importance of the pattern of alcohol consumption as a risk factor for type 2 diabetes in a cohort of 46,892 U.S. male health professionals who completed biennial postal questionnaires. Overall, 1,571 new cases of type 2 diabetes were documented. Compared with zero alcohol consumption, consumption of 15-29 g/day of alcohol was associated with a 36% lower risk of diabetes (RR = 0.64; 95% CI 0.53-0.77). This inverse association between moderate consumption and diabetes remained if light drinkers rather than abstainers were used as the reference group (RR = 0.60, CI 0.50-0.73). There were few heavy drinkers, but the inverse association persisted to those drinking >/=50 g/day of alcohol (RR = 0.60, CI 0.43-0.84). Frequency of consumption was inversely associated with diabetes. Consumption of alcohol on at least 5 days/week provided the greatest protection, even when less than one drink per drinking day was consumed (RR = 0.48, CI 0.27-0.86). Compared with infrequent drinkers, for each additional day per week that alcohol was consumed, risk was reduced by 7% (95% CI 3-10%) after controlling for average daily consumption. There were similar and independent inverse associations for beer, liquor, and white wine. Our findings suggested that frequent alcohol consumption conveys the greatest protection against type 2 diabetes, even if the level of consumption per drinking day is low. Beverage choice did not alter risk.
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Epidemiologic data demonstrate that moderate alcohol intake is associated with improved insulin sensitivity in nondiabetic individuals. No controlled-diet studies have addressed the effects of daily moderate alcohol consumption on fasting insulin and glucose concentrations and insulin sensitivity. To determine whether daily consumption of low to moderate amounts of alcohol influences fasting insulin and glucose concentrations and insulin sensitivity in nondiabetic postmenopausal women. Randomized controlled crossover trial of 63 healthy postmenopausal women, conducted at a clinical research center in Maryland between 1998 and 1999. Participants were randomly assigned to consume 0, 15, or 30 g/d of alcohol for 8 weeks each as part of a controlled diet. All foods and beverages were provided during the intervention. An isocaloric beverage was provided in the 0-g/d arm. Energy intake was adjusted to maintain constant body weight. Fasting insulin, triglyceride, and glucose concentrations, measured at the end of each dietary period; insulin sensitivity, estimated with a published index of glucose disposal rate corrected for fat-free mass based on fasting insulin and fasting triglyceride concentrations, compared among treatments with a mixed-model analysis of variance. A complete set of plasma samples was collected and analyzed for 51 women who completed all diet treatments. Consumption of 30 g/d of alcohol compared with 0 g/d reduced fasting insulin concentration by 19.2% (P =.004) and triglyceride concentration by 10.3% (P =.001), and increased insulin sensitivity by 7.2% (P =.002). Normal-weight, overweight, and obese individuals responded similarly. Only fasting triglyceride concentration was significantly reduced when comparing 0 and 15 g/d of alcohol (7.8%; P =.03), and no difference was found between consumption of 15 and 30 g/d of alcohol; however, there was a significant linear trend (P =.001). Fasting glucose concentrations were not different across treatments. Consumption of 30 g/d of alcohol (2 drinks per day) has beneficial effects on insulin and triglyceride concentrations and insulin sensitivity in nondiabetic postmenopausal women.
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This study examines the relation between alcohol and type II diabetes and the possible mediating effects of HDL-cholesterol and serum insulin. Prospective study of 5221 men aged 40-59 years with no history of coronary heart disease, diabetes, or stroke drawn from general practices in 18 British towns. During the mean follow up of 16.8 years there were 198 incident cases of type II diabetes. Occasional drinkers were the reference group. A non-linear relation was seen between alcohol intake and age adjusted risk of diabetes, with risk lowest in light and moderate drinkers and highest in heavy drinkers (quadratic trend p=0.03). Further adjustment for body mass index decreased risk in heavy drinkers. After additional adjustment for physical activity, smoking, and (undiagnosed) pre-existing coronary heart disease, only moderate drinkers showed significantly lower risk than occasional drinkers (RR=0.66 95% CI 0.44 to 0.99). Alcohol intake was inversely associated with serum insulin and positively associated with HDL-cholesterol. Adjustment for these factors reduced the "protective" effect in moderate drinkers (adjusted RR=0.73 95% CI 0.48 to 1.10) but the quadratic trend remained significant (p=0.02). There is a non-linear relation between alcohol intake and the risk of type II diabetes. Serum insulin and HDL-cholesterol explained a small amount (20%) of the reduction in risk of type II diabetes associated with moderate drinking. The adverse effect of heavy drinking seemed to be partially mediated through its effect on body weight.
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Although moderate drinking confers a decreased risk of myocardial infarction, the roles of the drinking pattern and type of beverage remain unclear. We studied the association of alcohol consumption with the risk of myocardial infarction among 38,077 male health professionals who were free of cardiovascular disease and cancer at base line. We assessed the consumption of beer, red wine, white wine, and liquor individually every four years using validated food-frequency questionnaires. We documented cases of nonfatal myocardial infarction and fatal coronary heart disease from 1986 to 1998. During 12 years of follow-up, there were 1418 cases of myocardial infarction. As compared with men who consumed alcohol less than once per week, men who consumed alcohol three to four or five to seven days per week had decreased risks of myocardial infarction (multivariate relative risk, 0.68 [95 percent confidence interval, 0.55 to 0.84] and 0.63 [95 percent confidence interval, 0.54 to 0.74], respectively). The risk was similar among men who consumed less than 10 g of alcohol per drinking day and those who consumed 30 g or more. No single type of beverage conferred additional benefit, nor did consumption with meals. A 12.5-g increase in daily alcohol consumption over a four-year follow-up period was associated with a relative risk of myocardial infarction of 0.78 (95 percent confidence interval, 0.62 to 0.99). Among men, consumption of alcohol at least three to four days per week was inversely associated with the risk of myocardial infarction. Neither the type of beverage nor the proportion consumed with meals substantially altered this association. Men who increased their alcohol consumption by a moderate amount during follow-up had a decreased risk of myocardial infarction.
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To examine the relationship between alcohol consumption and the incidence of type 2 diabetes mellitus among relatively young and middle-aged women. In a prospective study, 109 690 women, aged 25 to 42 years, without a history of coronary heart disease, stroke, cancer, or diabetes mellitus completed a detailed lifestyle and medical history questionnaire in 1989. During 10 years of follow-up, we documented 935 incident cases of type 2 diabetes mellitus. We found a nonlinear relationship between alcohol consumption and risk of type 2 diabetes mellitus after adjustment for multiple confounders, including body mass index, smoking, physical activity, and family history of diabetes mellitus (quadratic trend P =.003). Compared with lifelong abstainers, the adjusted relative risks (95% confidence intervals) were 0.80 (0.66-0.96) for those consuming 0.1 to 4.9 g/d, 0.67 (0.50-0.89) for those consuming 5.0 to 14.9 g/d, 0.42 (0.20-0.90) for those consuming 15.0 to 29.9 g/d, and 0.78 (0.34-1.78) for those consuming 30.0 g/d or more. Further adjustment for dietary factors, including glycemic load, trans-fatty acid, polyunsaturated fat, and total fiber intake, did not appreciably alter these findings. The inverse association with light to moderate drinking was most apparent in women who reported wine or beer drinking. Women who reported 30.0 g/d or more of liquor intake showed a significantly increased risk of diabetes mellitus compared with those who did not report liquor intake (adjusted relative risk, 2.50; 95% confidence interval, 1.00-6.23). Light to moderate alcoholic beverage consumption may be associated with a lower risk of type 2 diabetes mellitus among women aged 25 to 42 years, although this benefit may not persist at higher levels.
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This meta-analysis was undertaken to obtain insight regarding the shape and strength of the relationship between alcohol consumption and the risk of type 2 diabetes, the effects of adjustment for confounders, and the effect of modification by type 2 diabetes definition, sex, and BMI. The 15 original prospective cohort studies that were included comprise 11,959 incident cases of type 2 diabetes in 369,862 individuals who, on average, were followed for 12 years. After pooling the data, a U-shaped relationship was found. Compared with nonconsumers, the relative risk (RR) for type 2 diabetes in those who consumed </=6 g/day alcohol was 0.87 (95% CI 0.79-0.95). For the moderate consumption ranges of 6-12, 12-24, and 24-48 g/day, RRs of 0.70 (0.61-0.79), 0.69 (0.58-0.81), and 0.72 (0.62-0.84) were found, respectively. The risk of type 2 diabetes in heavy drinkers (>/=48 g/day) was equal to that in nonconsumers (1.04 [0.84-1.29]). In general, nonsignificant trends for larger RR reduction associated with moderate alcohol consumption were observed for women compared with men, for crude compared with multivariate-adjusted analyses, and for studies that used self-reports instead of testing for type 2 diabetes definition. No differences in RR reductions were found between individuals with low or high BMI. The present evidence from observational studies suggests an approximately 30% reduced risk of type 2 diabetes in moderate alcohol consumers, whereas no risk reduction is observed in consumers of >/=48 g/day.
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This study aimed to investigate the relation between alcohol consumption and type 2 diabetes among older women. Between 1993 and 1997, 16,330 women aged 49-70 years and free from diabetes were enrolled in one of the Dutch Prospect-EPIC (European Prospective Study Into Cancer and Nutrition) cohorts and followed for 6.2 years (range 0.1-10.1). At enrollment, women filled in questionnaires and blood samples were collected. During follow-up, 760 cases of type 2 diabetes were documented. A linear inverse association (P = 0.007) between alcohol consumption and type 2 diabetes risk was observed, adjusting for potential confounders. Compared with abstainers, the hazard ratio for type 2 diabetes was 0.86 (95% CI 0.66-1.12) for women consuming 5-30 g alcohol per week, 0.66 (0.48-0.91) for 30-70 g per week, 0.91 (0.67-1.24) for 70-140 g per week, 0.64 (0.44-0.93) for 140-210 g per week, and 0.69 (0.47-1.02) for >210 g alcohol per week. Beverage type did not influence this association. Lifetime alcohol consumption was associated with type 2 diabetes in a U-shaped fashion. Our findings support the evidence of a decreased risk of type 2 diabetes with moderate alcohol consumption and expand this to a population of older women.
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This systematic review examines the relationship between alcohol consumption and long-term complications of type 2 diabetes. Meta-analyses could only be performed for total mortality, mortality from CHD, and CHD incidence, because the availability of articles on other complications was too limited. A PubMed search through to September 2005 was performed and the reference lists of relevant articles examined. Among the relevant articles there were six cohort studies reporting on the risk of total mortality and/or fatal and/or incident CHD in alcohol non-consumers and in at least two groups of alcohol consumers. Statistical pooling showed lower risks in alcohol consumers than in non-consumers (the reference category). The relative risk (RR) of total mortality was 0.64 (95% CI 0.49-0.82) in the <6 g/day category. In the higher alcohol consumption categories (6 to <18, and > or =18 g/day), the RRs of total mortality were not significant. Risks of fatal and total CHD were significantly lower in all three categories of alcohol consumers (<6, 6 to <18 and > or =18 g/day) than in non-consumers, with RRs ranging from 0.34 to 0.75. This meta-analysis shows that, as with findings in the general population, moderate alcohol consumption is associated with a lower risk of mortality and CHD in type 2 diabetic populations.
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Heavy alcohol consumption increases risk for hypertension, which is in itself a strong risk factor for cardiovascular disease (CVD). However, data on the association between alcohol consumption and CVD among individuals with hypertension are scarce. To assess whether alcohol consumption is inversely associated with CVD among men with hypertension. Prospective cohort study. United States. 11,711 men with hypertension from the Health Professionals Follow-Up Study. Alcohol consumption was assessed every 4 years by using a food-frequency questionnaire. Incident cases of nonfatal myocardial infarction (MI), fatal coronary heart disease, and stroke were documented from 1986 to 2002. During follow-up, 653 patients with MI were documented. Compared with patients abstaining from alcohol, the hazard ratio for participants with MI consuming 0.1 to 4.9 grams of alcohol per day was 1.09 (95% CI, 0.86 to 1.37); consuming 5 to 9.9 grams of alcohol per day was 0.81 (CI, 0.60 to 1.08 g/d); consuming 10 to 14.9 grams of alcohol per day was 0.68 (CI, 0.51 to 0.91 g/d); consuming 15 to 29.9 grams of alcohol per day was 0.72 (CI, 0.54 to 0.97 g/d); consuming 30 to 49.9 grams of alcohol per day was 0.67 (CI, 0.48 to 0.94 g/d); and consuming 50 or more grams of alcohol per day was 0.41 (CI, 0.22 to 0.77 g/d) (P < 0.001 for trend). Associations were similar for fatal and nonfatal MI. Alcohol consumption was not associated with total death or death due to CVD. Risks for total and ischemic stroke for patients consuming 10 to 29.9 g of alcohol per day were 1.40 (CI, 0.93 to 2.12) and 1.55 (CI, 0.90 to 2.68) compared with that of abstainers. When corrected for measurement error in alcohol consumption, dietary variables, and body mass index, the hazard ratio for participants with MI per 12.5 grams per day increment of alcohol intake was 0.68 (CI, 0.46 to 1.00). Hypertension, alcohol consumption, and CVD risk factors were assessed by self-report. Available data used to correct for measurement error were primarily restricted to dietary variables. In this population of men with hypertension, moderate alcohol consumption was associated with a decreased risk for MI but not with risks for total death or death due to CVD. As in the general population, men with hypertension who drink moderately and safely may not need to change their drinking habits.
Article
We showed that coronary heart disease (CHD) in a population of male health professionals could be prevented by the following healthy lifestyle, defined as not smoking, maintaining a healthy body weight, exercising daily, adhering to a healthy diet, and moderate alcohol intake, we also found that a healthy lifestyle was associated with a lower risk of CHD even among men taking lipid-lowering or antihypertensive medications.
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Insulin resistance and subsequent hyperinsulinemia are risk markers for diabetes and have been implicated in the development of cardiovascular disease; therefore, modifiable determinants of the serum insulin level are of interest. Several studies have suggested that certain dietary components, particularly fat and alcohol, may be associated with both fasting and postprandial insulin concentrations independent of obesity. The relation of dietary intake, assessed by a modified version of the Willett 61-item food frequency questionnaire, to fasting serum insulin was examined in 13,167 nondiabetic men and women, aged 45-64. Univariately, fasting insulin was associated positively (p<0.01) with energy intake. After adjustment for gender, race, age, energy intake, body mass index, waist-to-hip ratio, smoking, and physical activity in multivariate models, alcohol was negatively associated with insulin, with the predicted difference in insulin for the interquartile range being 5.0% (95% CI = 6.3%-3.6%). A significant inverse association was also observed between dietary fiber and insulin among women, but not men. Total fat, saturated fat, monounsaturated fat, and carbohydrates were associated positively (p<0.05) with fasting insulin, but the magnitude of these associations was small. The predicted percent difference in insulin for persons at the 25th versus the 75th percentile of total fat, saturated fat, monounsaturated fat, and carbohydrates was 2.3%, 2.3%, 2.2%, and 1.4%, respectively. These data suggest that dietary composition may have modest effects on fasting insulin level, beyond the contributions of energy imbalance and obesity.
Article
Background: Heavy alcohol consumption increases risk for hypertension, which is in itself a strong risk factor for cardiovascular disease (CVD). However, data on the association between alcohol consumption and CVD among individuals with hypertension are scarce. Objective: To assess whether alcohol consumption is inversely associated with CVD among men with hypertension. Design: Prospective cohort study. Setting: United States. Participants: 11 711 men with hypertension from the Health Professionals Follow-Up Study. Measurements: Alcohol consumption was assessed every 4 years by using a food-frequency questionnaire. Incident cases of nonfatal myocardial infarction (MI), fatal coronary heart disease, and stroke were documented from 1986 to 2002. Results: During follow-up, 653 patients with MI were documented. Compared with patients abstaining from alcohol, the hazard ratio for participants with MI consuming 0.1 to 4.9 grams of alcohol per day was 1.09 (95% CI, 0.86 to 1.37); consuming 5 to 9.9 grams of alcohol per day was 0.81 (CI, 0.60 to 1.08 g/d); consuming 10 to 14.9 grams of alcohol per day was 0.68 (CI, 0.51 to 0.91 g/d); consuming 15 to 29.9 grams of alcohol per day was 0.72 (CI, 0.54 to 0.97 g/d); consuming 30 to 49.9 grams of alcohol per day was 0.67 (CI, 0.48 to 0.94 g/d); and consuming 50 or more grams of alcohol per day was 0.41 (CI, 0.22 to 0.77 g/d) (P < 0.001 for trend). Associations were similar for fatal and nonfatal MI. Alcohol consumption was not associated with total death or death due to CVD. Risks for total and ischemic stroke for patients consuming 10 to 29.9 g of alcohol per day were 1.40 (CI, 0.93 to 2.12) and 1.55 (CI, 0.90 to 2.68) compared with that of abstainers. When corrected for measurement error in alcohol consumption, dietary variables, and body mass index, the hazard ratio for participants with MI per 12.5 grams per day increment of alcohol intake was 0.68 (CI, 0.46 to 1.00). Limitations: Hypertension, alcohol consumption, and CVD risk factors were assessed by self-report. Available data used to correct for measurement error were primarily restricted to dietary variables. Conclusions: In this population of men with hypertension, moderate alcohol consumption was associated with a decreased risk for MI but not with risks for total death or death due to CVD. As in the general population, men with hypertension who drink moderately and safely may not need to change their drinking habits. © 2007 American College of Physicians.
Article
Context: Studies have found that individuals who consume 1 alcoholic drink every 1 to 2 days have a lower risk of a first acute myocardial infarction (AMI) than abstainers or heavy drinkers, but the effect of prior drinking on mortality after AMI is uncertain. Objective: To determine the effect of prior alcohol consumption on long-term mortality among early survivors of AMI. Design and setting: Prospective inception cohort study conducted at 45 US community and tertiary care hospitals between August 1989 and September 1994, with a median follow-up of 3.8 years. Patients: A total of 1913 adults hospitalized with AMI between 1989 and 1994. Main outcome measure: All-cause mortality, compared by self-reported average weekly consumption of beer, wine, and liquor during the year prior to AMI. Results: Of the 1913 patients, 896 (47%) abstained from alcohol, 696 (36%) consumed less than 7 alcoholic drinks/wk, and 321 (17%) consumed 7 or more alcoholic drinks/wk. Compared with abstainers, patients who consumed less than 7 drinks/wk had a lower all-cause mortality rate (3.4 vs 6.3 deaths per 100 person-years; hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.43-0.71) as did those who consumed 7 or more drinks/wk (2.4 vs 6.3 deaths per 100 person-years; HR, 0.38; 95% CI, 0.25-0.55; P<.001 for trend). After adjusting for propensity to drink and other potential confounders, increasing alcohol consumption remained predictive of lower mortality for less than 7 drinks/wk, with an adjusted HR of 0.79 (95% CI, 0.60-1.03), and for 7 or more drinks/wk, with an adjusted HR of 0.68 (95% CI, 0.45-1.05; P =.01 for trend). The association was similar for total and cardiovascular mortality, among both men and women, and among different types of alcoholic beverages. Conclusion: Self-reported moderate alcohol consumption in the year prior to AMI is associated with reduced mortality following infarction.
Article
The majority of prospective studies on alcohol use and mortality risk indicates that abstainers are at increased risk of mortality from both all causes and coronary heart disease (CHD). This meta-analysis of 54 published studies tested the extent to which a systematic misclassification error was committed by including as 'abstainers' many people who had reduced or stopped drinking, a phenomenon associated with ageing and ill health. The studies judged to be error free found no significant all-cause or cardiac protection, suggesting that the cardiac protection afforded by alcohol may have been over-estimated. Estimates of mortality from heavier drinking may also be higher than previously estimated.
Article
Several epidemiological studies have shown light-to-moderate alcohol consumption to have a net protective effect on the incidence of coronary heart disease (CHD). Major components of this effect, both positive and negative, may be explored using models that include both alcohol and variables expected to mediate the observed alcohol effect. Such modeling in a cohort of men of Japanese descent followed in the Honolulu Heart Program indicates that about half of the observed protection against CHD afforded by moderate alcohol consumption is mediated by an increase in high density lipoprotein cholesterol. An additional 18% of this protection is attributable to a decrease in low density lipoprotein cholesterol, but it is counterbalanced by a 17% increase in risk due to increased systolic blood pressure. The explanation for the residual 50% benefit attributable to alcohol is unknown but may include interference with thrombosis. The results in this population replicate those in the Lipid Research Clinics cohort studied earlier with the same analytic technique. The consistency of these findings across populations, along with the demonstration of reasonable biological pathways for this effect of alcohol, provides strong support for the hypothesis that light-to-moderate alcohol intake is protective against heart disease in men.
Article
Although an inverse association between alcohol consumption and risk of coronary artery disease has been consistently found in several types of studies, some have argued that the association is due at least partly to the inclusion in the non-drinking reference group of men who abstain because of pre-existing disease. The association between self-reported alcohol intake and coronary disease was studied prospectively among 51,529 male health professionals. In 1986 the participants completed questionnaires about food and alcohol intake and medical history, heart disease risk factors, and dietary changes in the previous 10 years. Follow-up questionnaires in 1988 sought information about newly diagnosed coronary disease. 350 confirmed cases of coronary disease occurred. After adjustment for coronary risk factors, including dietary intake of cholesterol, fat, and dietary fibre, increasing alcohol intake was inversely related to coronary disease incidence (p for trend less than 0.001). Exclusion of 10,302 current non-drinkers or 16,342 men with disorders potentially related to coronary disease (eg, hypertension, diabetes, and gout) which might have led men to reduce their alcohol intake, did not substantially affect the relative risks. These findings support the hypothesis that the inverse relation between alcohol consumption and risk of coronary disease is causal.
Article
Lower cardiovascular mortality rates in lighter drinkers (versus abstainers or heavier drinkers) in population studies have been substantially due to lower coronary artery disease (CAD) mortality. Controversy about this U-shaped curve focuses on whether alcohol protects against CAD or, because of other traits, whether abstainers are at increased risk. Inclusion of ex-drinkers among abstainers in some studies has led to speculation that this might be the trait increasing the risk of abstainers. This new prospective study among 123,840 persons with 1,002 cardiovascular (600 CAD) deaths showed that ex-drinkers had higher cardiovascular and CAD mortality risks than lifelong abstainers in unadjusted analyses, but not in analyses adjusted for age, gender, race, body mass index, marital status and education. Use of alcohol was associated with higher risk of mortality from hypertension, hemorrhagic stroke and cardiomyopathy, but with lower risk from CAD, occlusive stroke and nonspecific cardiovascular syndromes. Subsets free of baseline cardiovascular or CAD risk had U-shaped alcohol-CAD curves similar to subsets with baseline risk. Among ex-drinkers, maximal past intake and reasons for quitting (medical versus non-medical) were unrelated to cardiovascular or CAD mortality. These data show that: (1) alcohol has disparate relations to cardiovascular conditions; (2) higher cardiovascular mortality rates among ex-drinkers are due to confounding traits related to past alcohol use; and (3) the U-shaped alcohol-CAD relation is not due to selective abstinence by persons at higher risk. The findings indirectly support a protective effect of lighter drinking against CAD.
Article
In a prospective study of 7735 middle-aged 7 British men, 504 of whom died in a follow-up period of 7.5 years, there was a U-shaped relationship between alcohol intake and total mortality and an inverse relationship with cardiovascular mortality, even after adjustment for age, cigarette smoking, and social class. These mortality patterns were seen in all smoking categories (with ex-smoking non-drinkers having the highest mortality) and were observed in manual but not in non-manual workers. The alcohol-mortality relationships (total and cardiovascular) were present only in men with cardiovascular or cardiovascular-related doctor-diagnosed illnesses at initial examination. The data suggest that the observed alcohol-mortality relationships are produced by pre-existing disease and by the movement of men with such disease into non-drinking or occasional-drinking categories. The concept of a "protective" effect of drinking on mortality, ignoring the dynamic relationship between ill-health and drinking behaviour, is likely to be ill founded.
Article
The relationship between ethanol consumption and coronary heart disease was examined in the original Framingham Heart Study cohort (1948) with a 24-year follow-up from exam 2 (2,106 males and 2,639 females). Ethanol consumption shows a strong U-shaped relationship with coronary heart disease mortality for male nonsmokers and heavy smokers both in the raw age-adjusted data and in the Cox regression analyses, where ethanol consumption is modeled quadratically. No ethanol effects were found for female nonsmokers. The age-adjusted data suggest a U-shape curve for female smokers, although this was not confirmed by the Cox analysis. Separate analyses relating alcohol consumption to mortality from all causes showed similar effects except that the reduction in mortality for males was much less. For male coronary heart disease mortality, ethanol consumption was subdivided into beer, wine, and spirits consumption. These beverages were also modeled quadratically in the Cox analyses, and all showed strong U-shaped curves for both nonsmokers and heavy smokers. In nonsmokers, beer and wine show greater reductions in coronary heart disease mortality than spirits.
Article
Our specific aim in the 16 year prospective NHANES I epidemiologic follow-up study (NHEFS) was to assess the important roles of modifiable dietary and behavioral factors in causation and prevention of deaths and hospitalizations for coronary heart disease (CHD). Using NHEFS 16 year follow-up data (1971 to 1987), we studied 5811 subjects, 1958 with and 3853 without CHD events, using logistic regression. In age groups 40 to 49, 50 to 59, 60 to 69, and 70 to 74 years (at study entry in 1971-4), the numbers of men and women were respectively 597 and 1019, 570 and 619, 932 and 1042, and 486 and 546. The following factors were independently positively associated (p < .05) with CHD: age, serum cholesterol, body mass index, cigarette use, and region (Midwest, Northeast). The following factors were independently negatively associated (p < .05) with CHD: gender (female), race (black), fish intake, alcohol, high school education, moderate exercise, and moderate and heavy habitual physical activity. Subjects with serum cholesterol > 249 mg/dl benefitted less (p = .04) from fish intake than those with 209 to 249 or < 209, and benefitted less (p = .03) from alcohol intake (CHD incidence [%]): [see text] These associations emphasize the important role of modifiable dietary and behavioral factors in the causation and prevention of CHD.
Article
Variation in diet associated with drinking patterns may explain why wine seems to reduce ischemic heart disease mortality. Our objective was to study the association between intake of different alcoholic beverages and selected indicators of a healthy diet. This was a cross-sectional study conducted in Copenhagen and Aarhus, Denmark, from 1995 to 1997, and included 23 284 men and 25 479 women aged 50-64 y. The main outcome measures were groups of selected foods that were indicators of a healthy dietary pattern. Wine, as compared with other alcoholic drinks, was associated with a higher intake of fruit, fish, cooked vegetables, salad, and the use of olive oil for cooking in both men and women. Men who preferred beer and spirits had odds ratios of 0.42 (95% CI: 0.39, 0.45) and 0.51 (95% CI: 0.43, 0.60), respectively, for a high intake of salad compared with those who preferred wine. Higher wine intake was associated with a higher intake of healthy food items compared with intake of < or = 2.5 glasses of wine/mo; odds ratios for drinkers of between 30 and 135 glasses of wine/mo for all the chosen indicators of healthy diet varied between 1.23 and 4.20, and were all strongly significant. Wine drinking is associated with an intake of a healthy diet. This finding may have implications for the interpretation of previous reports of the relation between type of alcoholic beverage and mortality.
Article
This study examined the effects of beer, spirits, and wine drinking on coronary heart disease (CHD) events (fatal and nonfatal) and all-cause mortality. Men aged 40 to 59 years (n = 7735) were drawn at random from one general practice in each of 24 British towns and followed up for an average of 16.8 years. Regular drinkers showed a significantly lower relative risk of CHD, but no all-cause mortality, than occasional drinkers, even after adjustment for potential confounders. The benefit for CHD of regular drinking was seen within both beer drinkers and spirit drinkers but not among men who reported wine drinking. However, all men who reported wine drinking (both occasional and regular) showed significantly lower age-adjusted risks of CHD and all-cause mortality than men drinking beer or spirits; beer and spirit drinkers showed similar risks. The findings suggest that regular intake of all alcoholic drinks is associated with a lower risk of CHD, but not all-cause mortality, than occasional drinking. A large part, but not all, of the greater benefit seen in wine drinkers relative to other drinkers can be attributed to advantageous lifestyle characteristics (e.g., low rates of smoking and obesity).
Article
To evaluate prospectively the health risk of wine and beer drinking in middle-aged men in the area of Nancy, France. Prospective cohort study. A total of 36 250 healthy men who underwent comprehensive health appraisals in a center of preventive medicine between January 1, 1978, and December 31, 1983. Education, professional and leisure activities, and smoking and drinking habits were evaluated using a questionnaire. Blood pressure and mean corpuscular volume and gamma-glutamyltransferase, glucose, and serum cholesterol levels were routinely measured, and electrocardiography was routinely performed. We recorded mortality from all causes and specific causes during a 12- to 18-year follow-up across categories of baseline alcohol consumption. Of the subjects, 28% drank beer, 61% drank wine but no beer, and 11% were abstainers; there was not much difference between social classes. During the follow-up, 3617 subjects died. The relative risk of death was estimated by the Cox proportional hazards model using nondrinkers as the reference and adjusting for 4 or 5 covariables. Moderate intake of both wine and beer was associated with lower relative risk for cardiovascular diseases; the risk was more significant with the intake of wine. For all-cause mortality, only daily wine intake (22-32 g of alcohol) was associated with a lower risk (0.67; 95% confidence interval, 0.58-0.77; P<.001) due to a lower incidence of cardiovascular diseases, cancers, violent deaths, and other causes. In eastern France, moderately drinking only wine was associated with a lower all-cause mortality, although drinking both wine and beer reduced the risk of cardiovascular death.
Article
Studies have found that individuals who consume 1 alcoholic drink every 1 to 2 days have a lower risk of a first acute myocardial infarction (AMI) than abstainers or heavy drinkers, but the effect of prior drinking on mortality after AMI is uncertain. To determine the effect of prior alcohol consumption on long-term mortality among early survivors of AMI. Prospective inception cohort study conducted at 45 US community and tertiary care hospitals between August 1989 and September 1994, with a median follow-up of 3.8 years. A total of 1913 adults hospitalized with AMI between 1989 and 1994. All-cause mortality, compared by self-reported average weekly consumption of beer, wine, and liquor during the year prior to AMI. Of the 1913 patients, 896 (47%) abstained from alcohol, 696 (36%) consumed less than 7 alcoholic drinks/wk, and 321 (17%) consumed 7 or more alcoholic drinks/wk. Compared with abstainers, patients who consumed less than 7 drinks/wk had a lower all-cause mortality rate (3.4 vs 6.3 deaths per 100 person-years; hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.43-0.71) as did those who consumed 7 or more drinks/wk (2.4 vs 6.3 deaths per 100 person-years; HR, 0.38; 95% CI, 0.25-0.55; P<.001 for trend). After adjusting for propensity to drink and other potential confounders, increasing alcohol consumption remained predictive of lower mortality for less than 7 drinks/wk, with an adjusted HR of 0.79 (95% CI, 0.60-1.03), and for 7 or more drinks/wk, with an adjusted HR of 0.68 (95% CI, 0.45-1.05; P =.01 for trend). The association was similar for total and cardiovascular mortality, among both men and women, and among different types of alcoholic beverages. Self-reported moderate alcohol consumption in the year prior to AMI is associated with reduced mortality following infarction.
Article
The goal of this study was to examine the relationship between alcohol intake and risk of coronary heart disease (CHD) among men with type 2 diabetes. Type 2 diabetes is associated with an increased risk of CHD. Emerging evidence suggests that moderate alcohol intake is associated with an important reduction in risk of CHD in individuals with type 2 diabetes. We studied 2,419 men who reported a diagnosis of diabetes at age 30 or older in the Health Professionals' Follow-up study (HPFS). During 11,411 person-years of follow-up after diagnosis, we documented 150 new cases of CHD (81 nonfatal myocardial infarction [MI] and 69 fatal CHD). Relative risks (RR) were estimated from pooled logistic regression adjusting for potential confounders. Alcohol use was inversely associated with risk of CHD in men with type 2 diabetes. The age-adjusted RRs corresponding to intakes of < or =0.5 drinks/day, 0.5 to 2 drinks/day and >2 drinks/day were 0.76 (95% confidence interval: [CI]: 0.52 to 1.12), 0.64 (95% CI: 0.40 to 1.02) and 0.59 (95% CI: 0.32 to 1.09), respectively, as compared with nondrinkers (p for trend = 0.06). When we controlled for body mass index, smoking, family history of MI, hypertension, hypercholesterolemia, duration of diabetes, physical activity level, vitamin E supplements and intake of trans fat, polyunsaturated fat, fiber and folate, RRs were 0.78 (95% CI: 0.52 to 1.15), 0.62 (95% CI: 0.40 to 1.00) and 0.48 (95% CI: 0.25 to 0.94) (p for trend = 0.03). The benefits of moderate consumption did not statistically differ by beverage type. Moderate alcohol consumption is associated with lower risk of CHD in men with type 2 diabetes.
Article
Three decades of research shows that drinking small to moderate amounts of alcohol has cardiovascular benefits. A thorny issue for physicians is whether to recommend drinking to some patients
Article
Background: Heavy alcohol drinking is associated with a dose-dependent increase in blood pressure, but data on the relation between alcohol consumption and mortality in hypertensive patients are sparse. Objective: To assess the relation between light to moderate alcohol consumption and total mortality from cardiovascular disease (CVD) among men with hypertension. Participants and design: From the Physicians' Health Study enrollment cohort of 88,882 men who provided self-reported information on alcohol intake, we identified a group of 14,125 men with a history of current or past treatment for hypertension who were free of myocardial infarction, stroke, cancer, or liver disease at baseline. Main Outcome Measure Comparison of total and CVD mortality among men with hypertension who had reported to be either nondrinkers or rare drinkers, or light to moderate drinkers. Results: During 75,710 person-years of follow-up, there were 1018 deaths, including 579 from CVD. Compared with individuals who rarely or never drank alcoholic beverages, those who reported monthly, weekly, and daily alcohol consumption, respectively, had multivariate adjusted relative risks (RRs) for CVD mortality of 0.83 (95% confidence interval [CI], 0.62-1.13), 0.61 (CI, 0.49-0.77), and 0.56 (CI, 0.44-0.71) (P<.001 for linear trend). In the same groups, RRs for total mortality were respectively 0.86 (CI, 0.67-1.10), 0.72 (CI, 0.60-0.86), and 0.73 (CI, 0.61-0.87) (P<.001 for linear trend). Among men with a systolic blood pressure of 140 mm Hg or higher or a diastolic blood pressure of 90 mm Hg or higher, the RRs for CVD mortality were, respectively, 1.00 (referent), 0.82 (CI, 0.56-1.21), 0.64 (CI, 0.48-0.85), and 0.56 (CI, 0.42-0.75) (P<.001 for linear trend). On the other hand, we found no significant association between moderate alcohol consumption and cancer mortality (P =.8 for linear trend). Conclusion: These results, which require confirmation in other large-scale studies, suggest that light to moderate alcohol consumption is associated with a reduction in risk of total and CVD mortality in hypertensive men.
Article
Alcohol use is related to a wide variety of negative health outcomes including morbidity, mortality, and disability. Research on alcohol-related morbidity and mortality takes into account the varying effects of overall alcohol consumption and drinking patterns. The results from this epidemiological research indicate that alcohol use increases the risk for many chronic health consequences (e.g., diseases) and acute consequences (e.g., traffic crashes), but a certain pattern of regular light-to-moderate drinking may have beneficial effects on coronary heart disease. Several issues are relevant to the methodology of studies of alcohol-related morbidity and mortality, including the measurement of both alcohol consumption and the outcomes studied as well as study design. Broad summary measures that reflect alcohol's possible effects on morbidity, mortality, and disability may be more useful than measures of any one outcome alone.
Article
To examine prospectively the relationship between alcohol and 8-year weight gain in women. A prospective study of 49,324 women 27 to 44 years old who did not have a history of cardiovascular disease, cancer, or diabetes, who were not pregnant during the study period, and who reported weights in 1991 and 1999. In cross-sectional analyses, there was a significant inverse relationship between alcohol and BMI even after adjustment for dietary factors and a wide range of confounders. In multivariate prospective analyses, a nonlinear relationship was seen between alcohol and weight gain (>or=5 kg) in all women. Compared with nondrinkers, the adjusted relative odds [95% confidence interval (CI)] of weight gain according to grams per day were 0.94 (0.89, 0.99