Alcohol and Coronary Heart

Alcohol and Coronary Heart Disease

( pubs.niaaa.nih.gov news ) Heart attacks and other forms of coronary heart disease (CHD) result in approximately 500,000 deaths annually (1), accounting for 25 percent of the Nation's total mortality (2). Research has revealed an association between moderate alcohol consumption1 and lower risk for CHD. This Alcohol Alert reviews epidemiologic evidence for this association, explores lifestyle factors and physiological mechanisms that might suggest ways to explain alcohol's apparent protective effects, and presents available data on the balance between alcohol's beneficial and harmful effects on health.
Epidemiologic Evidence

With few exceptions, epidemiologic data from at least 20 countries in North America, Europe, Asia, and Australia demonstrate a 20- to 40-percent lower CHD incidence among drinkers compared with nondrinkers (3,4). Moderate drinkers exhibit lower rates of CHD-related mortality than both heavy drinkers and abstainers (3,4). Such studies range from comparisons of nationwide population data to retrospective analyses of health and drinking patterns within communities.

The most persuasive epidemiologic evidence for alcohol's possible protective effects on CHD comes from prospective studies, in which participants provide information on their drinking habits and health-related practices before the onset of disease. Participants' subsequent health histories are evaluated through a series of followup interviews. Large-scale prospective investigations confirm an association between moderate drinking and lower CHD risk. The specific studies described here represent a total population of more than 1 million men and women of different ethnicities. Followup periods average 11 years,2 the longest being the 24-year prospective phase of the Framingham CHD mortality study (5). The two largest of these studies were conducted by the American Cancer Society, one including 276,800 men (6) and the other including 490,000 men and women (7).

Other large prospective investigations that associate moderate drinking with lower risk for CHD include a series of studies by Kaiser-Permanente analyzing CHD hospitalization (8,9) and death rates (10,11) in both men and women; studies of CHD incidence (12) and mortality (13) among female nurses; and studies of CHD incidence (14,15) and mortality (16) among male physicians. Results of these American studies are confirmed by data from similar investigations conducted in England (17), Denmark (18), China (19), and other countries (1,4). In addition, a smaller 12-year study found an association between moderate drinking and lower risk of CHD-related death among older persons (average age of 69) with late-onset diabetes, a population at high risk for CHD (20). However, a recent 21-year prospective study from Scotland found no association between moderate drinking and lower risk for CHD among 6,000 working men ages 35 to 64 (21).
Is Alcohol's Role Causal or Incidental?

An association between moderate drinking and lower risk for CHD does not necessarily mean that alcohol itself is the cause of the lower risk. For example, a review of population studies indicates that the higher mortality risk among abstainers may be attributable to shared traits other than participants' nonuse of alcohol (22). Substantial evidence (1) has discounted speculation that abstainers include a large proportion of former heavy drinkers with pre-existing health problems (i.e., "sick quitters"). Nevertheless, health-related lifestyle factors that correlate consistently with drinking level could account for some of the association between alcohol and lower risk for CHD (4). Among the most widely studied of these factors are exercise and diet.

Few studies have adjusted for subjects' levels of physical activity, despite evidence that exercise protects against CHD occurrence and mortality. In a comprehensive review of published studies, Berlin and Colditz (23) concluded that risk for CHD was proportionately lower at higher exercise levels. Measures of activity level vary among studies. Studies evaluate factors such as job-related physical requirements, frequency of participation in unspecified sports, estimated vigorousness of given activities, calculations of energy expended, and tests of cardiovascular fitness (23). Results of a community survey indicated that the prevalence of regular exercise was higher among moderate and heavy drinkers than among nondrinkers (24). Regular exercise was defined as any form of nonoccupational physical activity performed at least three times per week. The role of exercise in the alcohol-CHD association requires additional study.

Diet is one of the strongest influences on CHD-related death among men ages 50 to 70 (25). International comparisons, laboratory data, and prospective studies suggest that diets high in saturated fat and cholesterol increase the risk for CHD (26). Epidemiologic data suggest that moderate drinkers may consume less fat and cholesterol than heavier drinkers (14) and abstainers (27), potentially accounting for a portion of the lower CHD risk associated with alcohol. However, results of other prospective studies indicate that alcohol's association with lower CHD risk is independent of nutritional factors (12-14).
The Role of Beverage Choice

Some studies report that wine (particularly red wine) affords more CHD protection than beer or liquor at equivalent levels of alcohol consumption (28). This finding suggests that the association between alcohol consumption and CHD risk may result from the effects of beverage ingredients other than alcohol itself. Epidemiologic and laboratory studies investigating this hypothesis have produced conflicting results.

A comparison of data from 21 developed countries concluded that wine consumption was more strongly correlated with lower CHD risk than was consumption of other alcoholic beverages (29). However, large-scale prospective studies have not found any difference in the incidence of CHD associated with beverage type (1,9). Red wine has been shown to contain certain nonalcoholic ingredients that could hypothetically interfere with the progression of CHD (30). However, research has not yet demonstrated a significant role for these chemicals in arresting CHD development in humans (30,31).

Evidence suggests that a preference for wine over other alcoholic beverages is associated with a lifestyle that includes other favorable health-related practices. For example, drinkers who prefer wine tend to smoke less and drink less (10,11,32) and have a more healthful diet (33) than those who prefer beer or liquor.
How Might Alcohol Lower Risk for CHD?

To function normally, the muscle tissue that constitutes the bulk of the heart requires a constant supply of oxygen-containing blood. Blood is delivered to the heart muscle through the coronary arteries. Cholesterol and other fatty substances can accumulate within the coronary arteries, partially impeding the flow of blood. This condition underlies the clinical manifestations of CHD, which may range from episodic chest pain to sudden death. The most common serious manifestation of CHD is the heart attack. Heart attacks are generally triggered by the formation of a blood clot within a constricted coronary artery, obstructing blood flow and depriving a portion of the heart muscle of oxygen. The resulting impairment of the heart's pumping ability may cause permanent disability or death, either immediately or through the progressive development of medical complications (2).

Researchers have investigated several theories to explain how alcohol itself might lower risk for CHD. For example, alcohol may protect the heart by preventing the constriction of the coronary arteries, inhibiting clot formation, and enhancing recovery following a heart attack. Most of the evidence supporting these potential mechanisms is derived from experiments using animals or cells isolated from artery walls and grown in the laboratory. Controlled clinical experiments are needed to confirm that the effects observed in such studies can alter the development or progression of CHD in humans.

Results of laboratory research indicate that alcohol administration may help prevent arterial narrowing in mice (34). Such an effect could stem from changes in the blood concentrations of certain fatty substances that influence the deposition of cholesterol within the coronary arteries (35). However, human (36) and animal (34,37) studies indicate that less than one-half of the lower risk for CHD associated with alcohol consumption can be explained by altered blood levels of these fatty substances. Therefore, researchers are investigating additional explanations for alcohol's apparent protective effects.

Alcohol may help prevent clot formation within already narrowed coronary arteries. Clotting occurs partly in response to chemicals released into the blood from the arterial wall. Exposure of these cells to alcohol in the laboratory suppresses the production of substances that promote clotting and stimulates the production and activity of substances that inhibit clotting (38). In addition, analyses of blood samples drawn from human volunteers indicate that alcohol consumption increases blood levels of anticlotting factors (39,40) and decreases the "stickiness" of the specialized blood cells (i.e., platelets) that clump together to form clots (41).

Results of laboratory research suggest that alcohol might help protect against reperfusion injury, a form of damage caused by the sudden restoration of blood flow to heart muscle weakened by previous oxygen deprivation. Alcohol's effects on reperfusion injury have been studied in guinea pigs (42) and rats (43), but not in humans. Heavy alcohol consumption by humans can cause rapid and irregular heartbeat and can impair the heart's pumping ability (41), two of the major causes of death following a heart attack (44). Alcohol may also interact harmfully with medications prescribed to treat heart diseases (45). Thus, although alcohol may help protect against CHD, drinking may increase the risk of adverse health effects after a heart attack (46).
Risks and Benefits

The apparent benefits of moderate drinking on CHD mortality are offset at higher drinking levels by increasing risk of death from other types of heart disease (5,16,32); cancer; liver cirrhosis; and trauma, including trauma from traffic crashes (47). Moderate drinking is not risk free. The trade-offs between risks and benefits can be exemplified by the fact that alcohol's anticlotting ability, potentially protective against heart attack, may increase the risk of hemorrhagic stroke, or bleeding within the brain (12).( patterns http://pubs.niaaa.nih.gov )



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Alcohol Consumption and Risk for Coronary Heart Disease

Alcohol Consumption and Risk for Coronary Heart Disease among Men with Hypertension

research by Joline W.J. Beulens, MSc; Eric B. Rimm, ScD; Alberto Ascherio, MD, DrPH; Donna Spiegelman, ScD; Henk F.J. Hendriks, PhD; and Kenneth J. Mukamal, MD, MPH


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.
patern : www.annals.org

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Alcohol intake in rheumatic disease

Alcohol intake in rheumatic disease: good or bad?

by N. Sofat and A. Keat

( rheumatology news ) Alcohol is a major cause of morbidity and mortality. In 1983 the World Health Organization (WHO) declared alcohol-related problems to be among the world's major health concerns . Recent developments in basic science and clinical research have led to an improved understanding of the mechanisms of the effects of alcohol on musculoskeletal diseases. These vary from the site of action of the cytokine–hormone axis on the development of osteoporosis to the variety of epidemiological studies of alcohol in diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and seronegative arthropathies.

Alcohol might be beneficial in rheumatic disease. There are examples of reduced alcohol-related deaths in RA and SLE . However, acute and chronic alcohol intake is known to result in myopathies, which may lead to falls and consequent fractures . There is a body of data emerging about the link between vertebral osteoporotic fractures and alcohol, particularly in men . Alcohol has also been implicated in the increased death rate from violence and accident-related deaths in ankylosing spondylitis . This review will discuss recent data obtained regarding alcohol intake in the above conditions.

Alcohol can have harmful effects on the musculoskeletal system. It is associated with osteoporosis and an increased incidence of fractures. The strongest link is seen in spinal osteoporosis, where alcoholic men are most at risk. In one study, 38% of mobile chronic alcoholics demonstrated radiological evidence of spinal and/or forearm bone loss . Riggs et al. found the risk of spinal osteoporosis with vertebral fracture was significantly greater among men who drank alcoholic beverages (relative risk=2.4) than those who did not . The risk increased by a factor of 1.007 for each ounce year of cumulative exposure. In this study, a multiple logistic model was used to show a multiplied risk in drinkers who also smoked. An Australian study also found that drinkers had diminished bone formation rates. However, factors such as gonadal status, body mass and physical activity may also alter osteoblast function in these patients.

In women, there are conflicting data, particularly regarding ethanol use and spinal osteoporosis. In the European Vertebral Osteoporosis Study, alcohol consumption appeared to reduce the risk of vertebral fractures in women who consumed alcohol more than five days a week. Others have found reduced bone formation rates in women with established alcoholic liver disease. The conflicting results may be attributed to varying doses of alcohol intake in the two studies. However, the risk factors of late menarche, early menopause, a low dairy product consumption, low physical activity and family history of hip fracture do appear to be stronger predictors of vertebral fracture in women .

The mechanism by which ethanol promotes bone loss in both men and women is not fully understood. Some work has proposed that ethanol promotes osteoporosis through the alteration of production and resorption pathways of bone remodelling. Osteoblasts derive from the mesenchymal lineage marrow stroma and osteoclasts from the haemopoietic lineage. Ethanol inhibits proliferation of human osteoblasts. In one study, ethanol increased bone resorption in rat trabecular bone , suggesting that the osteoclastic phase is also affected by ethanol.

The development of osteoclasts from their progenitors is dependent on stromal–osteoblastic cells, which are a major source of cytokines that are critical in osteoclastogenesis. In vitro studies using human osteoblasts show that cytokine mediators include interleukin (IL)-1 (IL-1), tumour necrosis factor (TNF-), IL-6 and IL-11 . In humans, sex steroids regulate IL-6 production by stromal-osteoblastic cells, including the response of bone marrow cells to this cytokine and IL-11. The production of IL-6 by cultured bone marrow stromal and osteoblastic cell lines is inhibited by oestrogens . Others have not found a regulatory effect of 17ß-oestradiol in osteoblast cell preparations stimulated with IL-1b and TNF- . The inhibitory effect of oestrogen on IL-6 production is mediated by inhibition of IL-6 gene transcription through an oestrogen receptor-mediated effect on the transcriptional activity of an identified promoter sequence.

Inhibition of sex steroids, such as is seen in the low serum free testosterone concentration in male drinkers , may affect osteoclast activity . Androgens have already been shown to have an effect on IL-6 transcription, which is similar to oestrogen receptor-mediated effects, by acting through androgen-specific receptors . Furthermore, in a study using IL-6 knockout mice, Dai et al. found that mice that produced IL-6 and were fed ethanol for 4 months had reduced bone mineral density and cancellous bone formation compared with IL-6 knockouts, which had no change in these parameters with ethanol. Ethanol may therefore achieve its effect by inducing bone loss through IL-6 mediation. They proposed that this process may occur by IL-6 inducing increased receptor activation of NFB ligand messenger RNA expression in IL-6 mice, promoting granulocyte–macrophage colony-forming units and osteoclastogenesis.

Studies in mice with oophorectomies show that osteoclast formation increases in response to IL-6 or the combination of the soluble IL-6 receptor and IL-11 in bone marrow cultures. These findings suggest that osteoclast precursors have an enhanced response to IL-6 and IL-11 in oestrogen-deficient states, which correlates with clinical scenarios. Furthermore, in mice that have undergone orchidectomy, there is increased replication of granulocyte–macrophage colony-forming units with increased formation of osteoclasts . These effects are prevented by testosterone or IL-6-neutralizing antibody . It follows that the bone loss occurring through loss of gonadal function in both sexes may be mediated in both sexes through mechanisms involving IL-6.

The results from the studies described above show that there is clearly a complex interaction between ethanol use, sex hormones, cytokines and the osteoblastic and osteoclastic processes that contribute to osteoporosis in susceptible individuals. ( parterns : www.rheumatology.oxfordjournals.org )

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Alcohol drinking patterns have different CHD outcomes in men and women

Alcohol drinking patterns have different CHD outcomes in men and women by BMJ

( bmj news )The inverse association between drinking alcohol and risk of coronary heart disease (CHD) seems to be independent of drinking frequency in women but not in men. Tolstrup and colleagues (p 1244) looked at alcohol drinking patterns in a cohort of more than 50 000 middle aged women and men free of cardiovascular disease at baseline. After a median follow-up of six years, women who drank alcohol on at least one day a week had a reduced risk of CHD compared with those who drank less often, but above this frequency intake mattered more than frequency. Among men, frequency mattered more than intake, with the lowest risk in those who drank daily. ( www.bmj.com)

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Alcohol misuse

Alcohol misuse

( nhs news ) Drinking a moderate amount of alcohol will not do you any physical or psychological harm. However, for some people, social drinking can lead to heavier drinking, which can cause serious health problems.

It is estimated that one in 13 people in the UK are dependent on alcohol (an alcoholic), with several million drinking excessively, to the extent that they are putting their health at risk.

Alcoholism causes many social and health-related problems

Heavy drinking is linked to suicide, murder, fatal accidents and many fatal diseases. It can increase your chances of developing cirrhosis of the liver, and it is associated with many different types of cancer, including cancer of the breast, mouth, larynx (voice box) and liver.

As well as being directly related to many serious diseases, drinking large amounts of alcohol can also lead to poor sexual performance, and it can harm an unborn baby.

If you have an alcohol-related problem, there are many ways in which you can get help to reduce your drinking. There are also many services that can help you give up alcohol altogether. ( resource : www.nhs.uk )

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Alcohol-related Liver Disease

Alcohol-related Liver Disease Numbers Double In Ten Years, UK by Christian Nordqvist

Alcohol-related liver disease hospital admissions in the UK have doubled in ten years, while total deaths related to alcoholic liver disease rose by 37%, according to NHS figures. In 2004/5 35,400 people were admitted to hospital with an alcohol-related liver disease.

In 2004/5 21,700 people were admitted to hospital for alcoholic poisoning, versus 13,600 in 1994/5.

In a survey published in The Information Centre, NHS, in 2005 25% of 11-15 year old children had had an alcoholic beverage during the previous seven days of being surveyed. The average teenager in the UK is consuming alarming quantities of alcohol.

33% of men and 25% of women, aged 16-24 had been on a binge drink once during the previous seven days of being surveyed.

Binge drinking is much more part of young people's lifestyles than older adults. Most 45-64 year-olds will drink little, but often.

When compared to European Union countries, UK alcohol consumption if not high - it ranks more or less in the middle. However, while consumption in the European Union has either levelled off or is coming down, in the UK it is rising fast. The average UK adult consumes 10.39 litres of alcohol per year while people from Luxembourg consume 17,54 litres.

The Department of Health, through a spokesman, said "We know that alcohol misuse has a devastating effect on millions of lives each year. And that is why we are working with the drinks industry, police and health professionals to increase awareness of the dangers of excessive drinking and make the sensible drinking message easier to understand. We will also be launching a joint campaign with the Home Office later this year to promote sensible drinking amongst young people." (http://www.medicalnewstoday.com) Read More......

To Your Health

To Your Health: New Web Site Helps Predict Alcohol Problems By MELINDA BECK

The conventional wisdom used to be that alcoholics had to hit bottom before they got better. But it can be a long, slow way down. A new government Web site called "Rethinking Drinking" aims to help people recognize problem patterns earlier and catch themselves before they fall.

"Most people don't know what 'drink responsibly' means -- they think it means not getting tanked," says Mark Willenbring, director of treatment and recovery research at the National Institute of Alcohol Abuse and Alcoholism. "But there are levels of drinking that raise your risk for alcohol problems just like high cholesterol raises your risk for heart disease."

Behind the NIAAA's effort is a new understanding that there is a spectrum of alcohol-use disorders, which some experts hope will replace the current criteria for "abuse" and "dependence." The old definitions were based on observing addicts in treatment. Several large studies of drinking in the general population show that some patterns clearly pave the way for future problems.

The NIAAA say you are at "low-risk" for serious problems if you consume no more than four standard-size alcoholic drinks a day for a man or no more than three for a woman. That may sound like a lot, but you can't drink like that every day. The weekly "low-risk" limit is no more than 14 drinks for a man or seven for a woman. Drinking more daily, or weekly or both carries higher risk of abuse or dependence.

At www.rethinkingdrinking.niaaa.nih.gov, you can plug in your average consumption and see how you compare with the general population and problem drinkers. Since this is anonymous, you can try different amounts and see what they mean.

Some 37% of Americans always stay within the daily and weekly limits, according to the site. Only two in 100 of them progress to serious alcohol problems.

But 19% of Americans exceed either the daily or weekly levels; one in 12 of those people has already progressed to alcohol abuse or alcoholism. About 9% of Americans exceeds both the weekly and daily limits; half of them have alcohol problems.

Very few Americans exceed the weekly limits without exceeding the daily limitations, according to Dr. Willenbring. That contrasts with drinking patterns in Europe, where people are more likely to have wine with lunch and dinner on a daily basis.

About 35% of Americans don't drink at all. "That can be a real eye-opener for people who drink heavily and surround themselves with other people who drink a lot," says Ann Bradley, an NIAAA spokeswoman.

Even "low-risk" drinking can be risky for people with bipolar disorder, liver disease, abnormal heart rhythm and chronic pain, the Web site notes. It also links to a list of dozens of medications that can react adversely with alcohol, including drugs for high blood pressure, high cholesterol, pain and depression.

The limits are lower for women than men not just because of their size. According to the NIAAA, women's bodies tend to have less water so the alcohol tends to become more concentrated and more damaging to organs like the liver.

The Web site also notes that being able to "hold" a lot of liquor is actually a warning sign of dependence. And driving and judgment can be impaired even if you don't feel a buzz.

Knowing the size and strength of a "standard" drink is critical, so the site has a size chart and a content calculator. Some cocktails contain as much alcohol as three standard drinks. A wine bottle usually holds five 5-oz. glasses.

"Rethinking Drinking" leaves it up to you whether and when to change your habits, though it notes that alcohol is a factor in many fatal accidents and increases the risk of heart and liver disease, depression, sleep disorders, diabetes and many cancers. One section discusses the merits of cutting down versus quitting completely. Another lists pros and cons to consider—including "I'd need another way to wind down."

In focus groups when the site was tested, "some people got very quiet and engaged when they got to this part. It turned into an intervention," says Maureen Gardner, who co-authored the program.

The site also lists strategies for changing drinking habits, from "space and pace" (no more than one per hour) to "avoiding triggers" (recognizing external situations and internal emotions that tempt you to drink). An "urge tracker" lets you record times when you wanted a drink and why, what you did and what you might have done differently. A section on "refusal skills" helps you plan ahead to say no in social situations.

Dr. Willenbring hopes the site, and a downloadable print version, provides a tool for doctors, clergy and others who counsel people concerned about their drinking habits.

Awareness already seems to be rising, says Eileen Travis, director of a New York City Bar Association program that assists lawyers with substance abuse. "We get calls all the time from people who say they think they have a problem and want to stop before it gets bad—many more than in the past, when the only people we dealt with were in trouble in some way," she says.

Studies show that just five minutes of discussion with a primary-care doctor can reduce heavy drinking by 25%. Exploring online all by yourself might be just as useful. http://online.wsj.com

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