151
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Alcoholic Cardiomyopathy: Is it Time for Genetic Testing? J Am Coll Cardiol 2019; 71:2303-2305. [PMID: 29773158 DOI: 10.1016/j.jacc.2018.03.463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 03/23/2018] [Indexed: 11/23/2022]
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152
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Dietary intake in patients with peripheral arterial disease and concomitant periodontal disease. Br J Nutr 2019; 122:78-85. [PMID: 31006393 DOI: 10.1017/s0007114519000850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Nutrition plays a crucial role in the pathophysiology and management of peripheral arterial disease (PAD) and periodontal disease (PD). As PD can have profound effects on an individual's functional ability to eat and can affect nutrient intake, we aimed to evaluate the role of PD severity on dietary intake (DI) and quality in PAD patients and compare it with current dietary recommendations for CVD. PD stages of 421 consecutive PAD patients were determined according to a standardised basic periodontal examination (Periodontal Screening and Recording Index) ('healthy', 'gingivitis', 'moderate periodontitis' and 'severe periodontitis'). Dietary intake (24-h recall), dietary quality (food frequency index (FFI)) and anthropometrical data were assessed. Nutritional intake was stratified according to the severity of PD. No significant differences in DI of macronutrients, nutrients relevant for CVD and FFI were seen between the PD stages. Only median alcohol intake was significantly different between gingivitis and severe periodontitis (P = 0·001), and positively correlated with PD severity (P = 0·001; r 0·159). PD severity and the patient's number of teeth showed no correlation with investigated nutritional parameters and FFI. Few subjects met the recommended daily intakes for fibre (5 %), SFA (10 %), Na (40 %) and sugar (26 %). Macronutrient intake differed from reference values. In our sample of patients with PAD and concomitant PD, we found no differences in DI of macronutrients, nutrients relevant for CVD and diet quality depending on PD severity. The patients' nutrition was, however, poor, deviating seriously from dietary guidelines and recommendations.
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153
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Walls ML, Hautala D, Gonzalez M, Greenfield B, Aronson BD, Onello E. Perceptions and Prevalence of Alcohol and Cigarette Use Among American Indian Adults With Type 2 Diabetes. Clin Diabetes 2019; 37:260-268. [PMID: 31371857 PMCID: PMC6640875 DOI: 10.2337/cd18-0078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IN BRIEF This study examined community perceptions and prevalence of alcohol use and cigarette smoking among American Indian adults with type 2 diabetes. Results revealed normative rates and perceptions of smoking and negative views and low rates of alcohol use. Participants reported high levels of household indoor smoking and comorbid high-risk drinking and smoking. The high smoking rate among the adult American Indians in this study is especially problematic given the increased risk of cardiovascular problems related to both smoking and type 2 diabetes. The results underscore the importance of considering substance use behaviors and beliefs as a component of overall health and well-being for people with diabetes.
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Affiliation(s)
- Melissa L. Walls
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Dane Hautala
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Miigis Gonzalez
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Brenna Greenfield
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Benjamin D. Aronson
- Department of Pharmacy Practice, Ohio Northern University Raabe College of Pharmacy, Ada, OH
| | - Emily Onello
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
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154
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The Consumption of Alcoholic Beverages and the Prevalence of Cardiovascular Diseases in Men and Women: A Cross-Sectional Study. Nutrients 2019; 11:nu11061318. [PMID: 31212846 PMCID: PMC6628509 DOI: 10.3390/nu11061318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/08/2019] [Accepted: 06/11/2019] [Indexed: 12/11/2022] Open
Abstract
Associations between alcohol consumption and the prevalence of cardiovascular diseases have been the subject of several studies for a long time; however, the presence and nature of any associations still remain unclear. The aim of the study was to analyze the associations between the consumption of alcoholic beverages and the prevalence of cardiovascular diseases in men and women. The data of 12,285 individuals aged 37-66 were used in the analysis. Multiple logistic regression models were utilized to estimate odds ratios and confidence intervals. The multivariable models included several potential confounders including age, education, marital status, body mass index (BMI), physical activity, smoking, coffee consumption, and statin use. The analyses were performed separately for men and women. In the model adjusted for confounders, the consumption from 0.1 to 10.0 g of alcohol/day was related to a lower risk of coronary disease and stroke (p < 0.05), and the consumption from 0.1 to 15.0 g/day was related to a lower risk of hypertension in women (p < 0.05). In men, in the adjusted model, there were no associations between alcohol consumption and the occurrence of hypertension or stroke. The risk of circulatory failure was significantly lower in the group in which participants drank more than 20.0 g of alcohol/day (p < 0.05) compared to nondrinkers. The risk of coronary disease was lower in drinkers at every level of alcohol consumption (p < 0.05) compared to nondrinkers. Alcohol consumption was related to a lower prevalence of cardiovascular diseases (CVD), both in men and women.
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155
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Berli MC, Wanivenhaus F, Kabelitz M, Götschi T, Böni T, Rancic Z, Waibel FWA. Predictors for reoperation after lower limb amputation in patients with peripheral arterial disease. VASA 2019; 48:419-424. [PMID: 31063045 DOI: 10.1024/0301-1526/a000796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Major amputations in patients with peripheral arterial disease (PAD) carry a high risk for complications, including revision of the amputation, sometimes to a higher level. Determining a safe level for amputation with good wound healing potential depends largely on vascular measurements. This study evaluated potential predictive factors for revision of major lower extremity amputations in patients with PAD. Patients and methods: A retrospective chart review of all major lower extremity amputations at our institution was conducted. Amputations due to trauma or tumor and below-ankle amputations were excluded. Patient demographics, level/type of amputation, level/time of revision, comorbidities and risk factors were extracted. Results: 180 patients with PAD, mean age 66.48 (range: 31-93) years, 125 (69.4%) male were included. Most (154/180, 86.6%) underwent below-knee amputation. 71 (39.4%) patients had coronary arterial disease, 104 (57.8%) had diabetes. More than half of patients, (93/138; 51.7%) had undergone previous balloon angioplasty. 44 (30%) patients required revision surgery: 42/180 (23.3%) were revised at the same level, and in 12/180 (6.7%) a more proximal amputation was necessary. PAD stage was not associated with the level of reamputation (p = 0.4369). Significantly more patients who had previous balloon angioplasty required revision surgery (66.7% versus 45.2%, p = 0.009). 67 (37.2%) patients underwent preoperative TcPO2 measurement: 40/67 (59.7%) had TcPO2 ≥ 40 mmHg; 4/67 (6%) had TcPO2 < 10 mmHG. Three patients with TcPO2 ≥ 40 mmHg, one with 30 mmHg ≤ TcPO2 ≤ 40 mmHg and one with 10 mmHg ≤ TcPO2 ≤ 20 mmHg required re-amputation to a more proximal level. Conclusions: TcPO2 measurements are useful for determining level of lower limb amputation and predicting wound healing problems when an amputation level with TcPO2 < 40 mmHg is chosen. In transtibial amputations, TcPO2 ≥ 40 mmHg does not safely predict wound healing.
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Affiliation(s)
- Martin C Berli
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Florian Wanivenhaus
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Method Kabelitz
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopaedic Surgery, University of Zurich, Institute for Biomechanics, ETH Zurich, Balgrist Campus, Zurich, Switzerland
| | - Thomas Böni
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Zoran Rancic
- Division of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Felix W A Waibel
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
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156
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Oikonomou E, Lazaros G, Tsalamandris S, Vogiatzi G, Christoforatou E, Papakonstantinou M, Goliopoulou A, Tousouli M, Chasikidis C, Tousoulis D. Alcohol Consumption and Aortic Root Dilatation: Insights from the Corinthia Study. Angiology 2019; 70:969-977. [DOI: 10.1177/0003319719848172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Aortic diameter and progression to thoracic aortic aneurysm are influenced by several factors. In this study, we investigated the association of alcohol consumption with aortic root and ascending aorta dilatation. In the context of the Corinthia study, we examined 1751 patients with echocardiography. Several demographic and clinical characteristics were recorded. Alcohol consumption was assessed based on a questionnaire of frequency, type, and quantity. Accordingly, patients were categorized as everyday alcohol consumers (EDACs) and as social drinkers (SoD). Everyday alcohol consumers were further categorized to group 1: 0 to 1 drink/d; group 2: 1 to 2 drinks/d; and group 3: ≥3 drinks/d. From the study population, 40% were categorized as EDAC and had an increased aortic root diameter (AoRD) and an elevated AoRD index compared with SoD. Interestingly, there was a stepwise increase in aortic root and ascending aorta diameter according to daily alcohol consumption. Specifically, patients consuming ≥3 drinks of alcohol/d had increased indexed aortic by 1.4 mm/m2 compared with SoD even after adjustment for possible confounders. Daily alcohol consumption is associated with increased aortic root diameter. These findings may have important clinical implications, especially in patients with borderline or dilated aortic root, and merit further investigation.
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Affiliation(s)
- Evangelos Oikonomou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - George Lazaros
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sotirios Tsalamandris
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgia Vogiatzi
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Evangelia Christoforatou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Margenti Papakonstantinou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Athina Goliopoulou
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Tousouli
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christos Chasikidis
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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157
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Millwood IY, Walters RG, Mei XW, Guo Y, Yang L, Bian Z, Bennett DA, Chen Y, Dong C, Hu R, Zhou G, Yu B, Jia W, Parish S, Clarke R, Davey Smith G, Collins R, Holmes MV, Li L, Peto R, Chen Z. Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China. Lancet 2019; 393:1831-1842. [PMID: 30955975 PMCID: PMC6497989 DOI: 10.1016/s0140-6736(18)31772-0] [Citation(s) in RCA: 279] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/21/2018] [Accepted: 07/24/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Moderate alcohol intake has been associated with reduced cardiovascular risk in many studies, in comparison with abstinence or with heavier drinking. Studies in east Asia can help determine whether these associations are causal, since two common genetic variants greatly affect alcohol drinking patterns. We used these two variants to assess the relationships between cardiovascular risk and genotype-predicted mean alcohol intake in men, contrasting the findings in men with those in women (few of whom drink). METHODS The prospective China Kadoorie Biobank enrolled 512 715 adults between June 25, 2004, and July 15, 2008, from ten areas of China, recording alcohol use and other characteristics. It followed them for about 10 years (until Jan 1, 2017), monitoring cardiovascular disease (including ischaemic stroke, intracerebral haemorrhage, and myocardial infarction) by linkage with morbidity and mortality registries and electronic hospital records. 161 498 participants were genotyped for two variants that alter alcohol metabolism, ALDH2-rs671 and ADH1B-rs1229984. Adjusted Cox regression was used to obtain the relative risks associating disease incidence with self-reported drinking patterns (conventional epidemiology) or with genotype-predicted mean male alcohol intake (genetic epidemiology-ie, Mendelian randomisation), with stratification by study area to control for variation between areas in disease rates and in genotype-predicted intake. FINDINGS 33% (69 897/210 205) of men reported drinking alcohol in most weeks, mainly as spirits, compared with only 2% (6245/302 510) of women. Among men, conventional epidemiology showed that self-reported alcohol intake had U-shaped associations with the incidence of ischaemic stroke (n=14 930), intracerebral haemorrhage (n=3496), and acute myocardial infarction (n=2958); men who reported drinking about 100 g of alcohol per week (one to two drinks per day) had lower risks of all three diseases than non-drinkers or heavier drinkers. In contrast, although genotype-predicted mean male alcohol intake varied widely (from 4 to 256 g per week-ie, near zero to about four drinks per day), it did not have any U-shaped associations with risk. For stroke, genotype-predicted mean alcohol intake had a continuously positive log-linear association with risk, which was stronger for intracerebral haemorrhage (relative risk [RR] per 280 g per week 1·58, 95% CI 1·36-1·84, p<0·0001) than for ischaemic stroke (1·27, 1·13-1·43, p=0·0001). For myocardial infarction, however, genotype-predicted mean alcohol intake was not significantly associated with risk (RR per 280 g per week 0·96, 95% CI 0·78-1·18, p=0·69). Usual alcohol intake in current drinkers and genotype-predicted alcohol intake in all men had similarly strong positive associations with systolic blood pressure (each p<0·0001). Among women, few drank and the studied genotypes did not predict high mean alcohol intake and were not positively associated with blood pressure, stroke, or myocardial infarction. INTERPRETATION Genetic epidemiology shows that the apparently protective effects of moderate alcohol intake against stroke are largely non-causal. Alcohol consumption uniformly increases blood pressure and stroke risk, and appears in this one study to have little net effect on the risk of myocardial infarction. FUNDING Chinese Ministry of Science and Technology, Kadoorie Charitable Foundation, National Natural Science Foundation of China, British Heart Foundation, Cancer Research UK, GlaxoSmithKline, Medical Research Council, and Wellcome Trust.
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Affiliation(s)
- Iona Y Millwood
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robin G Walters
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xue W Mei
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Caixia Dong
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Ruying Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Gang Zhou
- Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Bo Yu
- Nangang Center for Disease Control and Prevention, Harbin, China
| | - Weifang Jia
- Liuyang Center for Disease Control and Prevention, Changsha, China
| | - Sarah Parish
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael V Holmes
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Peking University, Beijing, China.
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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158
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Cardiovascular effects of alcohol: A double-edged sword / how to remain at the nadir point of the J-Curve? Alcohol 2019; 76:117-129. [PMID: 30735906 DOI: 10.1016/j.alcohol.2018.08.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/19/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND In addition to its established harmful effects on the liver and other organs, heavy alcohol use confers deleterious effects on the cardiovascular (CV) system, as well. However, data have emerged that light/moderate alcohol consumption (1 drink/day for women and 1-2 drinks/day for men) may be protective against CV disease. OBJECTIVE/METHODS English articles regarding the CV effects of alcohol/ethanol were reviewed by search in Medline, Scopus, and Google Scholar. RESULTS A J-shaped curve has been proposed to illustrate a differential effect of alcohol on the CV system with the lowest point on the curve (light/moderate drinking) corresponding to optimal exposure to alcohol, which may confer cardioprotection, the rather neutral effect of non-drinking, and the highest risk of heavy and/or binge drinking reflecting the consequence of harmful exposure. However, staying at the nadir of this J-shaped curve appears difficult. Furthermore, concern and distrust have also been raised about the quality of evidence for such "cardioprotection", emphasizing the need for further randomized controlled trials. Another concern relates to the risk of moderate drinking leading to problem drinking, since alcohol is the most common addictive substance. CONCLUSION Optimal exposure to alcohol (light/moderate use) means that one needs to stay at the nadir of the J-shaped curve for alcohol use to avail oneself of possible cardioprotection, and this may not be an easy thing to accomplish and/or adhere to, especially if one "likes" alcohol drinking. However, the evidence of "cardioprotection" conferred by alcohol has also been refuted, due to lack of randomized controlled trials.
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159
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Zhang X, Sun L, Wang L, Wang M, Lu G, Wang Y, Li Q, Li C, Zhou J, Ma H, Sun H. The effects of histone deacetylase inhibitors on the attentional set-shifting task performance of alcohol-dependent rats. Brain Res Bull 2019; 149:208-215. [PMID: 31029598 DOI: 10.1016/j.brainresbull.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/13/2019] [Accepted: 04/23/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Alcohol dependence causes extensive damage to the central nervous system, resulting in impaired brain structure and behavioral changes. Moreover, histone deacetylase (HDAC) inhibitors restrain the activity of HDAC and cause increased histone acetylation, which may be related to alcohol dependence. METHODS Ethanol dependence was modelled in animals by persistent alcohol exposure and tested in the conditioned place preference (CPP) paradigm. To induce CPP, the alcohol-treated rats were given orally gradient concentration (3%, 6%, and 9% v/v) alcohol administration for 20 consecutive days. The sodium butyrate (NaB)-treated rats were injected daily. Cognitive flexibility was evaluated using an attentional set-shifting task (ASST) in which the rats performed a series of seven consecutive discriminations after the final CPP paradigm. RESULTS Ethanol administration induced alcohol dependence behaviors, with more time spent in the ethanol-paired compartment. Compared with the CPP scores of the control group, the scores of the ethanol- and NaB-treated groups were significantly higher. In the ASST, alcohol-treated rats had significantly increased number of trials to reach criteria (TTC) in most phases, higher error rate, and lower cognitive levels compared to the control group. Moreover, the present findings demonstrated that NaB combined with ethanol caused cognitive deficits as the result of an increased number of TTC during the ASST. CONCLUSIONS The attentional/cognitive flexibility of the prefrontal cortex of alcohol-dependent rats was damaged and the NaB administration procedure itself did not produce cognitive deficits, but instead exacerbated cognitive impairment in alcohol-dependent rats.
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Affiliation(s)
- Xianqiang Zhang
- Department of Psychology, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong, 261053, China
| | - Lin Sun
- Department of Psychology, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong, 261053, China
| | - Li Wang
- Department of Reproductive Medicine Center, Affiliated Hospital of Weifang Medical University, China
| | - Mengting Wang
- Department of Clinical Medicine, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong, 261053, China
| | - Guohua Lu
- Department of Psychology, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong, 261053, China
| | - Yanyu Wang
- Department of Psychology, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong, 261053, China
| | - Qi Li
- Department of Psychiatry and Centre for Reproduction Growth and Development, University of Hong Kong, China
| | - Changjiang Li
- Department of Psychology, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong, 261053, China
| | - Jin Zhou
- College of Pharmacy, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong, 261053, China
| | - Huimin Ma
- Beijing National Laboratory for Molecular Sciences, Key Laboratory of Analytical Chemistry for Living Biosystems, Institute of Chemsitry, Chinese Academy of Sciences, China
| | - Hongwei Sun
- Department of Psychology, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong, 261053, China.
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160
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Costanzo S, Mukamal KJ, Di Castelnuovo A, Bonaccio M, Olivieri M, Persichillo M, De Curtis A, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Alcohol consumption and hospitalization burden in an adult Italian population: prospective results from the Moli-sani study. Addiction 2019; 114:636-650. [PMID: 30548347 DOI: 10.1111/add.14490] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/23/2018] [Accepted: 10/26/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Epidemiological evidence on the impact of different alcohol drinking patterns on health-care systems or hospitalizations is sparse. We investigated how the different average volumes of alcohol consumed relate to all-cause and cause-specific hospitalizations. DESIGN Prospective cohort study (baseline 2005-10) linked to a registry of hospital discharge records to identify hospitalizations at follow-up (December 2013). SETTING Molise region, Italy. PARTICIPANTS A total of 20 682 individuals (48% men, age ≥ 35 years) who participated in the Moli-sani Study and were free from cardiovascular disease or cancer at baseline. MEASUREMENTS The alcohol volume consumed in the year before enrolment was classified as: life-time abstainers, former drinkers, occasional drinkers and current drinkers who drank 1-12 (referent), 12.1-24, 24.1-48 and > 48 g/day of alcohol. Cause-specific hospitalizations were assigned by Italian Diagnosis Related Groups classification or by ICD-9 code of main admission diagnoses. Incidence rate ratios (IRR) of hospitalization were estimated by Poisson regression, taking into account the total number of admissions that occurred during the follow-up per person. FINDINGS During a median follow-up of 6.3 years, 12 996 multiple hospital admissions occurred. In multivariable analyses, life-time abstainers and former drinkers had higher rates of all-cause [IRR = 1.11, 95% confidence interval (CI) = 1.05-1.17 and IRR = 1.19, 95% CI = 1.02-1.31, respectively] and vascular (IRR = 1.14, 95% CI = 1.02-1.27 and IRR = 1.48, 95% CI = 1.24-1.76, respectively) hospitalizations compared with light alcohol consumers. Alcohol consumption > 48 g/day was associated with a higher rate of hospitalization for both alcohol-related diseases (IRR = 1.74, 95% CI = 1.32-2.29) and cancer (IRR = 1.36, 95% CI = 1.12-1.65). The magnitude of the association between heavier alcohol intake and hospitalization tended to be greater in smokers than non-smokers. No associations were observed with hospitalization for trauma or neurodegenerative diseases. CONCLUSIONS Moderate alcohol consumption appears to have a modest but complex impact on global hospitalization burden. Heavier drinkers have a higher rate of hospitalization for all causes, including alcohol-related diseases and cancer, a risk that appears to be further magnified by concurrent smoking.
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Affiliation(s)
- Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Kenneth J Mukamal
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | | | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | | | | | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy.,Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
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161
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Chichetto NE, Plankey MW, Abraham AG, Sheps DS, Ennis N, Chen X, Weber KM, Shoptaw S, Kaplan RC, Post WS, Cook RL. The Impact of Past and Current Alcohol Consumption Patterns on Progression of Carotid Intima-Media Thickness Among Women and Men Living with HIV Infection. Alcohol Clin Exp Res 2019; 43:695-703. [PMID: 30735256 PMCID: PMC6443465 DOI: 10.1111/acer.13974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relationship between alcohol consumption and atherosclerosis has not been sufficiently examined among people living with HIV (PLWH). METHODS We analyzed data from PLWH in the Women's Interagency HIV Study (WIHS; n = 1,164) and the Multicenter AIDS Cohort Study (MACS; n = 387) with no history of cardiovascular disease (CVD). Repeated measures of intima-media thickness of the right common carotid artery (CCA-IMT) were assessed using B-mode ultrasound from 2004 to 2013. Current alcohol consumption was collected at time of CCA-IMT measurement and was categorized according to gender-specific weekly limits. Group-based trajectory models categorized participants into past 10-year consumption patterns (1994 to 2004). Multivariate generalized estimating equations were conducted to assess the association of past and current alcohol use patterns on change in CCA-IMT by cohort, controlling for age, race, cigarette and illicit drug use, probable depression, HIV RNA viral load, antiretroviral therapy exposure, and hepatitis C coinfection. RESULTS Among the WIHS, past heavy alcohol consumption was associated with increased CCA-IMT level over time (β = 8.08, CI 0.35, 15.8, p = 0.04), compared to abstinence. Among the MACS, compared to abstinence, all past consumption patterns were associated with increased CCA-IMT over time (past low: β = 15.3, 95% CI 6.46, 24.2, p < 0.001; past moderate: β = 14.3, CI 1.36, 27.2, p = 0.03; past heavy: β = 21.8, CI 4.63, 38.9, p = 0.01). Current heavy consumption was associated with decreased CCA-IMT among the WIHS (β = -11.4, 95% CI -20.2, -2.63, p = 0.01) and MACS (β = -15.4, 95% CI -30.7, -0.13, p = 0.04). No statistically significant time by consumption pattern effects were found. CONCLUSIONS In both cohorts, 10-year heavy consumption was associated with statistically significant increases in carotid artery thickness, compared to abstinence. Long-term patterns of drinking at any level above abstinence were particularly significant for increases in IMT among men, with heavy consumption presenting with the greatest increase. Our results suggest a potentially different window of risk among past and current heavy drinkers. Further studies are needed to determine whether alcohol consumption level is associated with intermediate measures of atherosclerosis. Alcohol screening and interventions to reduce heavy consumption may benefit PLWH who are at risk of CVD.
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Affiliation(s)
- Natalie E Chichetto
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael W Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia
| | - Alison G Abraham
- Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David S Sheps
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, Florida
| | - Nicole Ennis
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Xinguang Chen
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, Florida
| | - Kathleen M Weber
- Cook County Health & Hospitals System/Hektoen Institute of Medicine, Chicago, Illinois
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, California
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Wendy S Post
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, Florida
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Szolnoki G, Stein-Hammer C, Brazsil D. Beurteilung von moderatem Weinkonsum und Alkoholmissbrauch aus Sicht deutscher und ungarischer Konsumenten. BIO WEB OF CONFERENCES 2019. [DOI: 10.1051/bioconf/20191204014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Die Differenzierung zwischen moderatem Konsum alkoholischer Getränke und Alkoholmissbrauch wird in der Medizin, Soziologie und Politik zunehmend kontrovers diskutiert. Trotz sich zum Teil widersprechender Studienergebnisse, steht aktuell die Forderung im Raum nach generell niedrigeren Richtwerten für Alkohol, als in vielen Ländern festgelegt. Allerdings reicht die Spannbreite der weltweiten Guidelines von 10 bis 40 Gramm Alkohol/Tag. Für Deutschland werden je nach Absender 12 bzw. 14 Gramm täglich für Frauen und das Doppelte für Männer als moderat definiert, in Ungarn 17 Gramm (Frauen) und 34 Gramm (Männer). Dies wirft die Frage auf, wie Konsumenten den Zusammenhang zwischen Gesundheit, Weinkonsum und Alkoholmissbrauch einschätzen. Um auch kulturelle Unterschiede analysieren zu können, wurde 2017/18 eine repräsentative Befragung sowohl in Deutschland als auch in Ungarn mit 2000 bzw. 1500 Befragten durchgeführt. Die Befragungen beinhalteten Themen wie die Beurteilung und Definition des Alkoholmissbrauchs und moderaten Weinkonsums. Die Ergebnisse zeigen, dass in Ungarn der “moderate Weinkonsum” anders definiert wird als in Deutschland. Während die Deutschen die moderate Weinmenge durchschnittlich mit 0.31 l Wein/Tag definieren, liegt der gleiche Wert in Ungarn bei 0.36 l. Auch im Fall des Alkoholmissbrauchs ergaben sich Unterschiede: Deutschland gibt dafür 0.76 l Wein/Tag und Ungarn 1 l Wein/Tag an. Jedoch lassen sich auch Ähnlichkeiten, vor allem in der generellen Einschätzung von Alkoholmissbrauch erkennen. Unabhängig vom kulturellen Hintergrund waren die Befragten einig, dass übermäßiger Weinkonsum der Gesundheit schadet und dass sich nur leichter bis moderater Weinkonsum mit gesundem Lebensstil vereinbaren lässt.
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Härmälä S, O’Brien A, Parisinos CA, Direk K, Shallcross L, Hayward A. Development and validation of a prediction model to estimate the risk of liver cirrhosis in primary care patients with abnormal liver blood test results: protocol for an electronic health record study in Clinical Practice Research Datalink. Diagn Progn Res 2019; 3:10. [PMID: 31143841 PMCID: PMC6532213 DOI: 10.1186/s41512-019-0056-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/29/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Driven by alcohol consumption and obesity, the prevalence of non-viral liver disease in the UK is increasing. Due to its silent and slow nature, the progression of liver disease is currently unpredictable and challenging to monitor. The latest National Institute for Health Care Excellence cirrhosis guidelines call for a validated risk tool that would allow general practitioners to identify patients that are at high risk of developing cirrhosis. METHODS Using linked electronic health records from the Clinical Practice Research Datalink (a database of > 10 million patients in England), we aim to develop and validate a prediction model to estimate 2-, 5- and 10-year risk of cirrhosis. The model will provide individualised cirrhosis risk predictions for adult primary care patients, free from underlying liver disease or viral hepatitis infection, whose liver blood test results come back abnormal. We will externally validate the model in patients from 30 further Clinical Practice Research Datalink general practices in England. DISCUSSION The prediction model will provide estimates of cirrhosis risk in primary care patients with abnormal liver blood test results to guide referral to secondary care, to identify patients who are in serious need of preventative health interventions and to help reassure patients at low risk of cirrhosis in the long term.
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Affiliation(s)
- Suvi Härmälä
- 0000000121901201grid.83440.3bInstitute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Alastair O’Brien
- 0000000121901201grid.83440.3bDivision of Medicine, University College London, Rayne Building, 5 University Street, London, WC1E 6JJ UK
| | - Constantinos A. Parisinos
- 0000000121901201grid.83440.3bInstitute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Kenan Direk
- 0000000121901201grid.83440.3bInstitute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Laura Shallcross
- 0000000121901201grid.83440.3bInstitute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Andrew Hayward
- 0000000121901201grid.83440.3bInstitute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
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164
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Yeh JJ, Lin CL, Kao CH. Relationship between pneumonia and cardiovascular diseases: A retrospective cohort study of the general population. Eur J Intern Med 2019; 59:39-45. [PMID: 30098854 DOI: 10.1016/j.ejim.2018.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 12/18/2022]
Abstract
AIMS To evaluate the relationship between cardiovascular diseases (CVDs) and pneumonia in the general population. METHODS This retrospective observational study included two cohorts, namely CVD (n = 28,363) and non-CVD (n = 28,363) cohorts, which were matched by propensity score and examined for cases of pneumonia. Data were obtained from 2000 to 2011. In both cohorts, pneumonia risk was measured using multivariable Cox proportional hazard models. RESULTS With the non-CVD cohort as reference, the corresponding adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] of pneumonia were 2.03 [1.77-2.31] for coronary artery disease, 4.11 [3.15-5.36] for heart failure, 3.21 [2.70-3.81] for cerebrovascular disease, 1.46 [1.07-1.98] for peripheral vascular disease, and 2.27 [2.01-2.56] for the CVD cohort. The cohort with comorbidities had a higher risk (all p < .05) of pneumonia compared with that without comorbidities, except for patients with the comorbidities of hypertension, hyperlipidemia, obesity, and liver disease. The aHR (95% CI) of pneumonia for antibiotic use was 1.26 (1.09-1.47). The aHRs of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) were 3.25 (95% CI = 1.04-10.1) and 2.95 (95% CI = 2.25-3.88), respectively. The aHRs (95% CI) were 1.78 (1.05-3.03) for intensive care unit (ICU) risk and 0.98 (0.96-0.99) for length of admission. CONCLUSION Pneumonia risk was associated with CVDs, especially heart failure, regardless of age, gender, comorbidities, and antibiotic use, particularly in elderly male patients. In addition, Patients with CVDs had a higher risk of CAP and HAP. The CVD cohort had a higher frequency of ICU admissions, but shorter admission lengths.
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Affiliation(s)
- Jun-Jun Yeh
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan; Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Meiho University, Pingtung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Grdaduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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165
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Aburto JM, van Raalte A. Lifespan Dispersion in Times of Life Expectancy Fluctuation: The Case of Central and Eastern Europe. Demography 2018; 55:2071-2096. [PMID: 30519844 PMCID: PMC6290692 DOI: 10.1007/s13524-018-0729-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Central and Eastern Europe (CEE) have experienced considerable instability in mortality since the 1960s. Long periods of stagnating life expectancy were followed by rapid increases in life expectancy and, in some cases, even more rapid declines, before more recent periods of improvement. These trends have been well documented, but to date, no study has comprehensively explored trends in lifespan variation. We improved such analyses by incorporating life disparity as a health indicator alongside life expectancy, examining trends since the 1960s for 12 countries from the region. Generally, life disparity was high and fluctuated strongly over the period. For nearly 30 of these years, life expectancy and life disparity varied independently of each other, largely because mortality trends ran in opposite directions over different ages. Furthermore, we quantified the impact of large classes of diseases on life disparity trends since 1994 using a newly harmonized cause-of-death time series for eight countries in the region. Mortality patterns in CEE countries were heterogeneous and ran counter to the common patterns observed in most developed countries. They contribute to the discussion about life expectancy disparity by showing that expansion/compression levels do not necessarily mean lower/higher life expectancy or mortality deterioration/improvements.
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Affiliation(s)
- José Manuel Aburto
- Interdisciplinary Center on Population Dynamics, University of Southern Denmark, Odense, Denmark
- Max Planck Institute for Demographic Research, Rostock, Germany
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166
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Taneja G, Sud A, Pendse N, Panigrahi B, Kumar A, Sharma AK. Nano-medicine and Vascular Endothelial Dysfunction: Options and Delivery Strategies. Cardiovasc Toxicol 2018; 19:1-12. [DOI: 10.1007/s12012-018-9491-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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167
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Rautiainen E, Ryynänen OP, Laatikainen T. Care outcomes and alcohol-related treatment utilisation profiles of patients with alcohol-use disorder: A prospective cohort study using electronic health records. NORDIC STUDIES ON ALCOHOL AND DRUGS 2018; 35:329-343. [PMID: 32934536 PMCID: PMC7434146 DOI: 10.1177/1455072518783972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background: We examined the probabilities of longitudinal care outcomes of working-aged
patients with alcohol-use disorder (AUD) and their alcohol-related treatment
utilisation patterns across the healthcare services, by using linked
electronic health records. Methods: A random sample (n = 396) of patients with alcohol-related
visits to healthcare services in 2011–2012 was collected retrospectively
from the electronic health record data in the North Karelia region of
Finland and followed prospectively in time until the end of 2016. Data on
care outcomes and alcohol-related healthcare use were gathered from the
electronic health records. Three outcome groups were identified: (1) dead,
(2) present AUD, and (3) remission. Group differences in alcohol-related
health service use were compared. Results: At the end of the follow-up period, an increased mortality rate of 22.9% was
observed, and 18.4% had achieved stable remission, while for the majority
(56%), the AUD remained. Most of those in remission had contact with either
specialised AUD services or mental health services. Conversely, the majority
of those who had died had no contact with specialised AUD services during
the follow-up period. Conclusions: The electronic-health-record-based register analysis captured mainly
individuals with advanced forms of AUD. An excess mortality rate and other
negative health consequences were observed. Training providers to identify
and treat earlier the less severe forms of AUD could have major benefit to
patients and also reduce health system costs.
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168
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Moderate Beer Intake and Cardiovascular Health in Overweight Individuals. Nutrients 2018; 10:nu10091237. [PMID: 30189619 PMCID: PMC6164820 DOI: 10.3390/nu10091237] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 12/24/2022] Open
Abstract
Consistent epidemiological evidence indicates that low-to-moderate alcohol consumption is inversely associated with cardiovascular event presentation, while high levels of alcohol intake are associated to increased cardiovascular risk. Little is known on the effects of moderate beer intake in the metabolic syndrome. The aim of this study is to investigate the effects of moderate and regular daily intake of beer with meals in overweight (body mass index (BMI) of 28–29.9 kg/m2) or obese class 1 (BMI of 30–35 kg/m2) individuals without other cardiovascular risk factors (dyslipidemia, type 2-diabetes, hypertension) focusing on the effects related to changes in weight, in lipoproteins and vascular endothelial function. We have performed an open, prospective two-arms longitudinal crossover study to investigate the effects associated with regular consumption (four week) of alcohol-free-beer (0 g alcohol/day) or traditional-beer (30 g alcohol/day in men and 15 g alcohol/day in women) on anthropometrical and biochemical parameters, liver and kidney function biomarkers, and vascular endothelial function. After four-week intervention with traditional and/or alcohol-free beer, BMI did not show any significant change and values for liver and kidney functions were within the normal levels. Moderate traditional beer intake did not affect lipid levels—however it significantly increased the antioxidant capacity of high density lipoprotein (HDL). In addition, apoB-depleted serum (after the four-week intervention period) showed a higher potential to promote cholesterol efflux from macrophages. Beer consumption did not induce vascular endothelial dysfunction or stiffness. In summary, our results based on a 12-week prospective study provide evidence that moderate intake of beer (traditional and alcohol-free) does not exert vascular detrimental effects nor increases body weight in obese healthy individuals. In contrast, moderate intake of beer increases the anti-oxidative properties of HDL and facilitates cholesterol efflux, which may prevent lipid deposition in the vessel wall.
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169
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O'Neill D, Britton A, Hannah MK, Goldberg M, Kuh D, Khaw KT, Bell S. Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data. BMC Med 2018; 16:124. [PMID: 30131059 PMCID: PMC6103865 DOI: 10.1186/s12916-018-1123-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/10/2018] [Indexed: 11/10/2022] Open
Abstract
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 .
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Affiliation(s)
- Dara O'Neill
- CLOSER, Department of Social Science, Institute of Education, University College London, London, UK.
| | - Annie Britton
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Mary K Hannah
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marcel Goldberg
- Inserm UMS 011, Villejuif, France and Paris Descartes University, Villejuif, France
| | - Diana Kuh
- Research Department of Epidemiology and Public Health, University College London, London, UK
- UK MRC Unit for Lifelong Health & Ageing at UCL, London, UK
| | - Kay Tee Khaw
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Steven Bell
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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170
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Luben R, Hayat S, Mulligan A, Lentjes M, Wareham N, Pharoah P, Khaw KT. Alcohol consumption and future hospital usage: The EPIC-Norfolk prospective population study. PLoS One 2018; 13:e0200747. [PMID: 30020973 PMCID: PMC6051641 DOI: 10.1371/journal.pone.0200747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/01/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Heavy drinkers of alcohol are reported to use hospitals more than non-drinkers, but it is unclear whether light-to-moderate drinkers use hospitals more than non-drinkers. OBJECTIVE We examined the relationship between alcohol consumption in 10,883 men and 12,857 women aged 40-79 years in the general population and subsequent admissions to hospital and time spent in hospital. METHODS Participants from the EPIC-Norfolk prospective population-based study were followed for ten years (1999-2009) using record linkage. RESULTS Compared to current non-drinkers, men who reported any alcohol drinking had a lower risk of spending more than twenty days in hospital multivariable adjusted OR 0.80 (95%CI 0.68-0.94) after adjusting for age, smoking status, education, social class, body mass index and prevalent diseases. Women who were current drinkers were less likely to have any hospital admissions multivariable adjusted OR 0.84 (95%CI 0.74-0.95), seven or more admissions OR 0.77 (95% CI 0.66-0.88) or more than twenty hospital days OR 0.70 (95%CI 0.62-0.80). However, compared to lifelong abstainers, men who were former drinkers had higher risk of any hospital admissions multivariable adjusted OR 2.22 (95%CI 1.51-3.28) and women former drinkers had higher risk of seven or more admissions OR 1.30 (95%CI 1.01-1.67). CONCLUSION Current alcohol consumption was associated with lower risk of future hospital usage compared with non-drinkers in this middle aged and older population. In men, this association may in part be due to whether former drinkers are included in the non-drinker reference group but in women, the association was consistent irrespective of the choice of reference group. In addition, there were few participants in this cohort with very high current alcohol intake. The measurement of past drinking, the separation of non-drinkers into former drinkers and lifelong abstainers and the choice of reference group are all influential in interpreting the risk of alcohol consumption on future hospitalisation.
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Affiliation(s)
- Robert Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Shabina Hayat
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Angela Mulligan
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Marleen Lentjes
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge United Kingdom
| | - Paul Pharoah
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
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171
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C-reactive protein as a predictor of posttraumatic stress induced by acute myocardial infarction. Gen Hosp Psychiatry 2018; 53:125-130. [PMID: 29880326 DOI: 10.1016/j.genhosppsych.2018.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/19/2018] [Accepted: 03/28/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) may cause clinically relevant posttraumatic stress disorder symptoms (PTSS). An inflammatory state might be one mechanism linking PTSS with poor prognosis after ACS. We tested the hypothesis that a change in C-reactive protein (CRP) between hospital admission and 3-month follow-up is an independent predictor of ACS-triggered PTSS. METHODS We assessed 183 patients (median age 59 years; 84% men) with verified myocardial infarction (MI) within 48 h of an acute coronary intervention and three months post-MI for self-rated PTSS. 14 (7.7%) patients fulfilled definition criteria for PTSS caseness. CRP values were categorized according to the predicted risk of cardiovascular disease (CVD) at hospital admission (acute inflammatory response): 0 to <5 mg/L, 5 to <10 mg/L, 10 to <20 mg/L, and ≥ 20 mg/L; and at 3-month follow-up (low-grade inflammation): 0 to <1 mg/L, 1 to <3 mg/L, and ≥ 3 mg/L. Additionally, in a subsample of 84 patients with CRP levels below 20 mg/L at admission, CRP values were log-transformed. RESULTS After adjustment for covariates, less of a reduction or an increase of log CRP values between admission and 3-month follow-up predicted PTSS caseness (OR 6.25, 95% CI 1.25, 31.38), and continuous PTSS (unstandardized B = 0.21, 95% CI 0.07, 4.19; p = 0.043). Less reduction in CRP risk categories predicted both PTSS caseness (OR 4.14, 95% CI 1.89, 9.06) and continuous PTSS (B = 1.80, 95% CI 1.09, 2.51; p < 0.001). CONCLUSIONS Persistently heightened inflammation seems to be predictive for the development of PTSS three months after ACS, so interventions to lower inflammation might be warranted.
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172
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Galbete C, Kröger J, Jannasch F, Iqbal K, Schwingshackl L, Schwedhelm C, Weikert C, Boeing H, Schulze MB. Nordic diet, Mediterranean diet, and the risk of chronic diseases: the EPIC-Potsdam study. BMC Med 2018; 16:99. [PMID: 29945632 PMCID: PMC6020433 DOI: 10.1186/s12916-018-1082-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Mediterranean Diet (MedDiet) has been acknowledged as a healthy diet. However, its relation with risk of major chronic diseases in non-Mediterranean countries is inconclusive. The Nordic diet is proposed as an alternative across Northern Europe, although its associations with the risk of chronic diseases remain controversial. We aimed to investigate the association between the Nordic diet and the MedDiet with the risk of chronic disease (type 2 diabetes (T2D), myocardial infarction (MI), stroke, and cancer) in the EPIC-Potsdam cohort. METHODS The EPIC-Potsdam cohort recruited 27,548 participants between 1994 and 1998. After exclusion of prevalent cases, we evaluated baseline adherence to a score reflecting the Nordic diet and two MedDiet scores (tMDS, reflecting the traditional MedDiet score, and the MedPyr score, reflecting the MedDiet Pyramid). Cox regression models were applied to examine the association between the diet scores and the incidence of major chronic diseases. RESULTS During a follow-up of 10.6 years, 1376 cases of T2D, 312 of MI, 321 of stroke, and 1618 of cancer were identified. The Nordic diet showed a statistically non-significant inverse association with incidence of MI in the overall population and of stroke in men. Adherence to the MedDiet was associated with lower incidence of T2D (HR per 1 SD 0.93, 95% CI 0.88-0.98 for the tMDS score and 0.92, 0.87-0.97 for the MedPyr score). In women, the MedPyr score was also inversely associated with MI. No association was observed for any of the scores with cancer. CONCLUSIONS In the EPIC-Potsdam cohort, the Nordic diet showed a possible beneficial effect on MI in the overall population and for stroke in men, while both scores reflecting the MedDiet conferred lower risk of T2D in the overall population and of MI in women.
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Affiliation(s)
- Cecilia Galbete
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany.,NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
| | - Janine Kröger
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Franziska Jannasch
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Khalid Iqbal
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.,NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
| | - Lukas Schwingshackl
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.,NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
| | - Carolina Schwedhelm
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.,NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
| | - Cornelia Weikert
- Department of Food Safety, Federal Institute for Risk Assessment, Berlin, Germany.,NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.,NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany. .,University of Potsdam, Institute of Nutritional Sciences, Nuthetal, Germany. .,German Center for Diabetes Research (DZD), München-Neuherberg, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany. .,NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany.
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173
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Bell S. Alcohol Consumption, Hypertension, and Cardiovascular Health Across the Life Course: There Is No Such Thing as a One-Size-Fits-All Approach. J Am Heart Assoc 2018; 7:JAHA.118.009698. [PMID: 29950487 PMCID: PMC6064877 DOI: 10.1161/jaha.118.009698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Steven Bell
- National Institute for Health Research Blood and Transplant Unit in Donor Health and Genomics at the University of Cambridge University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom .,UK Medical Research Council/British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge Strangeways Research Laboratory, Cambridge, United Kingdom.,Division of Cardiovascular Medicine, British Heart Foundation Centre of Excellence, Addenbrooke's Hospital, Cambridge, United Kingdom
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174
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Ruan Y, Guo Y, Zheng Y, Huang Z, Sun S, Kowal P, Shi Y, Wu F. Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: results from SAGE Wave 1. BMC Public Health 2018; 18:778. [PMID: 29925336 PMCID: PMC6011508 DOI: 10.1186/s12889-018-5653-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/01/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is one of the leading causes of death worldwide. Our study aimed to investigate the prevalence of two conditions, angina and stroke, and relevant risk factors among older adults in six low- and middle- income countries(LMICs). METHODS The data was from World Health Organization (WHO) Study on global AGEing and adult Health (SAGE) Wave 1 in China, Ghana, India, Mexico, Russian Federation and South Africa. Presence of CVD was based on self-report of angina and stroke. Multivariate logistic regression was performed to examine the relationship between CVD and selected variables, including age, sex, urban/rural setting, household wealth, and risk factors such as smoking, alcohol drinking, fruit/vegetable intake, physical activity and BMI. RESULTS The age standardized prevalence of angina ranged from 9.5 % (South Africa) to 47.5 % (Russian Federation), and for stoke from 2.0% (India) to 6.1 % (Russia). Hypertension was associated with angina in China, India and Russian Federation after adjustment for age, sex, urban/rural setting, education and marital status (OR ranging from 1.3 [1.1-1.6] in India to 3.8 [2.9-5.0] in Russian Federation), furthermore it was a risk factor of stroke in five countries except Mexico. Low or moderate physical activity were also associated with angina in China, and were also strongly associated with stroke in all countries except Ghana and India. Obesity had a stronger association with angina in Russian Federation and China(ORs were 1.5[1.1-2.0] and 1.2 [1.0-1.5] respectively), and increased the risk of stroke in China. Smoking was associated with angina in India and South Africa(ORs were 1.6[1.0-2.4] and 2.1 [1.2-3.6] respectively ), and was also a risk factor of stroke in South Africa. We observed a stronger association between frequent heavy drinking and stroke in India. Household income was associated with reduced odds of angina in China, India and Russian Federation, however higher household income was a risk factor of angina in South Africa. CONCLUSION While the specific mix of risk factors contribute to disease prevalence in different ways in these six countries - they should all be targeted in multi-sectoral efforts to reduce the high burden of CVD in today's society.
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Affiliation(s)
- Ye Ruan
- Shanghai Municipal Center for Disease Control and Prevention (Shanghai CDC), Shanghai, China
| | - Yanfei Guo
- Shanghai Municipal Center for Disease Control and Prevention (Shanghai CDC), Shanghai, China
| | - Yang Zheng
- Shanghai Municipal Center for Disease Control and Prevention (Shanghai CDC), Shanghai, China
| | - Zhezhou Huang
- Shanghai Municipal Center for Disease Control and Prevention (Shanghai CDC), Shanghai, China
| | - Shuangyuan Sun
- Shanghai Municipal Center for Disease Control and Prevention (Shanghai CDC), Shanghai, China
| | - Paul Kowal
- World Health Organization, Geneva, Switzerland
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Yan Shi
- Shanghai Municipal Center for Disease Control and Prevention (Shanghai CDC), Shanghai, China
| | - Fan Wu
- Shanghai Municipal Center for Disease Control and Prevention (Shanghai CDC), Shanghai, China
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175
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Kunzmann AT, Coleman HG, Huang WY, Berndt SI. The association of lifetime alcohol use with mortality and cancer risk in older adults: A cohort study. PLoS Med 2018; 15:e1002585. [PMID: 29920516 PMCID: PMC6007830 DOI: 10.1371/journal.pmed.1002585] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/11/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While current research is largely consistent as to the harms of heavy drinking in terms of both cancer incidence and mortality, there are disparate messages regarding the safety of light-moderate alcohol consumption, which may confuse public health messages. We aimed to evaluate the association between average lifetime alcohol intakes and risk of both cancer incidence and mortality. METHODS AND FINDINGS We report a population-based cohort study using data from 99,654 adults (68.7% female), aged 55-74 years, participating in the U.S. Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Cox proportional hazards models assessed the risk of overall and cause-specific mortality, cancer incidence (excluding nonmelanoma skin cancer), and combined risk of cancer and death across categories of self-reported average lifetime alcohol intakes, with adjustment for potential confounders. During 836,740 person-years of follow-up (median 8.9 years), 9,599 deaths and 12,763 primary cancers occurred. Positive linear associations were observed between lifetime alcohol consumption and cancer-related mortality and total cancer incidence. J-shaped associations were observed between average lifetime alcohol consumption and overall mortality, cardiovascular-related mortality, and combined risk of death or cancer. In comparison to lifetime light alcohol drinkers (1-3 drinks per week), lifetime never or infrequent drinkers (<1 drink/week), as well as heavy (2-<3 drinks/day) and very heavy drinkers (3+ drinks/day) had increased overall mortality and combined risk of cancer or death. Corresponding hazard ratios (HRs) and 95% confidence intervals (CIs) for combined risk of cancer or death, respectively, were 1.09 (1.01-1.13) for never drinkers, 1.08 (1.03-1.13) for infrequent drinkers, 1.10 (1.02-1.18) for heavy drinkers, and 1.21 (1.13-1.30) for very heavy drinkers. This analysis is limited to older adults, and residual confounding by socioeconomic factors is possible. CONCLUSIONS The study supports a J-shaped association between alcohol and mortality in older adults, which remains after adjustment for cancer risk. The results indicate that intakes below 1 drink per day were associated with the lowest risk of death. TRIAL REGISTRATION NCT00339495 (ClinicalTrials.gov).
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Affiliation(s)
- Andrew T. Kunzmann
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- * E-mail:
| | - Helen G. Coleman
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
| | - Sonja I. Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, United States of America
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176
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Abstract
Lifestyle is far more important than most physicians suppose. Dietary changes in China that have resulted from increased prosperity are probably responsible for a marked rise in coronary risk in the past several decades, accelerating in recent years. Intake of meat and eggs has increased, while intake of fruits, vegetables and whole grains has decreased. Between 2003 and 2013, coronary mortality in China increased 213%, while stroke mortality increased by 26.6%. Besides a high content of cholesterol, meat (particularly red meat) contains carnitine, while egg yolks contain phosphatidylcholine. Both are converted by the intestinal microbiome to trimethylamine, in turn oxidised in the liver to trimethylamine n-oxide (TMAO). TMAO causes atherosclerosis in animal models, and in patients referred for coronary angiography high levels after a test dose of two hard-boiled eggs predicted increased cardiovascular risk. The strongest evidence for dietary prevention of stroke and myocardial infarction is with the Mediterranean diet from Crete, a nearly vegetarian diet that is high in beneficial oils, whole grains, fruits, vegetables and legumes. Persons at risk of stroke should avoid egg yolk, limit intake of red meat and consume a diet similar to the Mediterranean diet. A crucial issue for stroke prevention in China is reduction of sodium intake. Dietary changes, although difficult to implement, represent an important opportunity to prevent stroke and have the potential to reverse the trend of increased cardiovascular risk in China.
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Affiliation(s)
- J David Spence
- Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario, Canada
- Neurology and Clinical Pharmacology, University of Western Ontario, London, Ontario, Canada
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177
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Sumi M, Hisamatsu T, Fujiyoshi A, Kadota A, Miyagawa N, Kondo K, Kadowaki S, Suzuki S, Torii S, Zaid M, Sato A, Arima H, Terada T, Miura K, Ueshima H. Association of Alcohol Consumption With Fat Deposition in a Community-Based Sample of Japanese Men: The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA). J Epidemiol 2018; 29:205-212. [PMID: 29848904 PMCID: PMC6522392 DOI: 10.2188/jea.je20170191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Excessive alcohol intake has been shown to be associated with cardiovascular disease via metabolic pathways. However, the relationship between alcohol intake and obesity has not been fully elucidated. We aimed to examine the association of alcohol consumption with fat deposition and anthropometric measures. Methods From 2006–2008, we conducted a cross-sectional study in a population-based sample of Japanese men aged 40 through 79 years. Areas of abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were calculated using computed tomography imaging. Based on a questionnaire, we classified participants into five groups according to weekly alcohol consumption, excluding former drinkers: non-drinkers (0 g/week), 0.1–160.9, 161–321.9, 322–482.9, and ≥483 g/week. Multivariable linear regression was used to estimate adjusted means of obesity indices for each group. Results We analyzed 998 men (mean age and body mass index [BMI], 63.8 years and 23.6 kg/m2, respectively). Higher weekly alcohol consumption was strongly and significantly associated with higher abdominal VAT area, percentage of VAT, and VAT-to-SAT ratio (all P for trend <0.001), and also with waist circumferences and waist-to-hip ratio (P for trend = 0.042 and 0.007, respectively). These associations remained significant after further adjustment for BMI, whereas alcohol consumption had no significant association with abdominal SAT area. Conclusions Higher alcohol consumption was associated with higher VAT area, VAT%, and VAT-to-SAT ratio, independent of confounders, including BMI, in general Japanese men. These results suggest that alcohol consumption may have a potential adverse effect on visceral fat deposition.
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Affiliation(s)
- Masaki Sumi
- Department of Public Health, Shiga University of Medical Science.,Department of Pharmacy, Shiga University of Medical Science Hospital
| | - Takashi Hisamatsu
- Department of Public Health, Shiga University of Medical Science.,Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science
| | - Aya Kadota
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science
| | - Sayaka Kadowaki
- Department of Public Health, Shiga University of Medical Science
| | - Sentaro Suzuki
- Department of Public Health, Shiga University of Medical Science
| | - Sayuki Torii
- Department of Public Health, Shiga University of Medical Science
| | - Maryam Zaid
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Atsushi Sato
- Department of Public Health, Shiga University of Medical Science
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University
| | - Tomohiro Terada
- Department of Pharmacy, Shiga University of Medical Science Hospital
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
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178
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Ricci C, Wood A, Muller D, Gunter MJ, Agudo A, Boeing H, van der Schouw YT, Warnakula S, Saieva C, Spijkerman A, Sluijs I, Tjønneland A, Kyrø C, Weiderpass E, Kühn T, Kaaks R, Sánchez MJ, Panico S, Agnoli C, Palli D, Tumino R, Engström G, Melander O, Bonnet F, Boer JMA, Key TJ, Travis RC, Overvad K, Verschuren WMM, Quirós JR, Trichopoulou A, Papatesta EM, Peppa E, Iribas CM, Gavrila D, Forslund AS, Jansson JH, Matullo G, Arriola L, Freisling H, Lassale C, Tzoulaki I, Sharp SJ, Forouhi NG, Langenberg C, Saracci R, Sweeting M, Brennan P, Butterworth AS, Riboli E, Wareham NJ, Danesh J, Ferrari P. Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study. BMJ 2018; 361:k934. [PMID: 29844013 PMCID: PMC5972779 DOI: 10.1136/bmj.k934] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the association between alcohol consumption (at baseline and over lifetime) and non-fatal and fatal coronary heart disease (CHD) and stroke. DESIGN Multicentre case-cohort study. SETTING A study of cardiovascular disease (CVD) determinants within the European Prospective Investigation into Cancer and nutrition cohort (EPIC-CVD) from eight European countries. PARTICIPANTS 32 549 participants without baseline CVD, comprised of incident CVD cases and a subcohort for comparison. MAIN OUTCOME MEASURES Non-fatal and fatal CHD and stroke (including ischaemic and haemorrhagic stroke). RESULTS There were 9307 non-fatal CHD events, 1699 fatal CHD, 5855 non-fatal stroke, and 733 fatal stroke. Baseline alcohol intake was inversely associated with non-fatal CHD, with a hazard ratio of 0.94 (95% confidence interval 0.92 to 0.96) per 12 g/day higher intake. There was a J shaped association between baseline alcohol intake and risk of fatal CHD. The hazard ratios were 0.83 (0.70 to 0.98), 0.65 (0.53 to 0.81), and 0.82 (0.65 to 1.03) for categories 5.0-14.9 g/day, 15.0-29.9 g/day, and 30.0-59.9 g/day of total alcohol intake, respectively, compared with 0.1-4.9 g/day. In contrast, hazard ratios for non-fatal and fatal stroke risk were 1.04 (1.02 to 1.07), and 1.05 (0.98 to 1.13) per 12 g/day increase in baseline alcohol intake, respectively, including broadly similar findings for ischaemic and haemorrhagic stroke. Associations with cardiovascular outcomes were broadly similar with average lifetime alcohol consumption as for baseline alcohol intake, and across the eight countries studied. There was no strong evidence for interactions of alcohol consumption with smoking status on the risk of CVD events. CONCLUSIONS Alcohol intake was inversely associated with non-fatal CHD risk but positively associated with the risk of different stroke subtypes. This highlights the opposing associations of alcohol intake with different CVD types and strengthens the evidence for policies to reduce alcohol consumption.
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Affiliation(s)
- Cristian Ricci
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Angela Wood
- Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - David Muller
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marc J Gunter
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Antonio Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona, Spain
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Samantha Warnakula
- Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy
| | - Annemieke Spijkerman
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Ivonne Sluijs
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Cecilie Kyrø
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Maria-Jose Sánchez
- Andaluzian School of Public Health, University of Granada, Granada, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute, Florence, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Civic M P Arezzo Hospital, Ragusa, Italy
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | - Jolanda M A Boer
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | | | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Centre for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, University of Athens Medical School, Athens, Greece
| | - Eleni-Maria Papatesta
- WHO Collaborating Centre for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, University of Athens Medical School, Athens, Greece
| | | | - Conchi Moreno Iribas
- Navarre Public Health Institute, Institute for Health Research (IdiSNA), Pamplona, Spain
- Research Network in Health Services in Chronic Diseases (REDISSEC), Pamplona, Spain
| | - Diana Gavrila
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Ann-Sofie Forslund
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Department of Medicine, Umeå University, Umeå, Sweden
| | - Giuseppe Matullo
- Department Medical Sciences, University of Torino, Italian Institute for Genomic Medicine -IIGM/HuGeF, Torino, Italy
| | - Larraitz Arriola
- Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Gipuzkoa, Spain
| | - Heinz Freisling
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Camille Lassale
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ioanna Tzoulaki
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Stephen J Sharp
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nita G Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Claudia Langenberg
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Rodolfo Saracci
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Michael Sweeting
- Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul Brennan
- Genetic Epidemiology Group, Genetics Section, International Agency for Research on Cancer, Lyon, France
| | - Adam S Butterworth
- Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Elio Riboli
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Nick J Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - John Danesh
- Medical Research Council, British Heart Foundation, Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Pietro Ferrari
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health Organization, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France
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179
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Alcohol Consumption and Risk of Coronary Artery Disease (from the Million Veteran Program). Am J Cardiol 2018; 121:1162-1168. [PMID: 29580627 DOI: 10.1016/j.amjcard.2018.01.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 12/18/2022]
Abstract
Moderate alcohol consumption has been associated with a lower risk of coronary artery disease (CAD) in the general population but has not been well studied in US veterans. We obtained self-reported alcohol consumption from Million Veteran Program participants. Using electronic health records, CAD events were defined as 1 inpatient or 2 outpatient diagnosis codes for CAD, or 1 code for a coronary procedure. We excluded participants with prevalent CAD (n = 69,995) or incomplete alcohol information (n = 8,449). We used a Cox proportional hazards model to estimate hazard ratios and 95% confidence intervals for CAD, adjusting for age, gender, body mass index, race, smoking, education, and exercise. Among 156,728 participants, the mean age was 65.3 years (standard deviation = 12.1) and 91% were men. There were 6,153 CAD events during a mean follow-up of 2.9 years. Adjusted hazard ratios (95% confidence intervals) for CAD were 1.00 (reference), 1.02 (0.92 to 1.13), 0.83 (0.74 to 0.93), 0.77 (0.67 to 0.87), 0.71 (0.62 to 0.81), 0.62 (0.51 to 0.76), 0.58 (0.46 to 0.74), and 0.95 (0.85 to 1.06) for categories of never drinker; former drinker; current drinkers of ≤0.5 drink/day, >0.5 to 1 drink/day, >1 to 2 drinks/day, >2 to 3 drinks/day, and >3 to 4 drinks/day; and heavy drinkers (>4 drinks/day) or alcohol use disorder, respectively. For a fixed amount of ethanol, intake at ≥3 days/week was associated with lower CAD risk compared with ≤1 day/week. Beverage preference (beer, wine, or liquor) did not influence the alcohol-CAD relation. Our data show a lower risk of CAD with light-to-moderate alcohol consumption among US veterans, and drinking frequency may provide a further reduction in risk.
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Johnston-Cox H, Mather PJ. Cardiovascular Disease and Alcohol Consumption. Am J Med Sci 2018; 355:409-410. [PMID: 29753368 DOI: 10.1016/j.amjms.2018.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/30/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Hillary Johnston-Cox
- Department of Medicine, Division of Cardiology University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Paul J Mather
- Department of Medicine, Division of Cardiology University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, Paige E, Paul DS, Sweeting M, Burgess S, Bell S, Astle W, Stevens D, Koulman A, Selmer RM, Verschuren WMM, Sato S, Njølstad I, Woodward M, Salomaa V, Nordestgaard BG, Yeap BB, Fletcher A, Melander O, Kuller LH, Balkau B, Marmot M, Koenig W, Casiglia E, Cooper C, Arndt V, Franco OH, Wennberg P, Gallacher J, de la Cámara AG, Völzke H, Dahm CC, Dale CE, Bergmann MM, Crespo CJ, van der Schouw YT, Kaaks R, Simons LA, Lagiou P, Schoufour JD, Boer JMA, Key TJ, Rodriguez B, Moreno-Iribas C, Davidson KW, Taylor JO, Sacerdote C, Wallace RB, Quiros JR, Tumino R, Blazer DG, Linneberg A, Daimon M, Panico S, Howard B, Skeie G, Strandberg T, Weiderpass E, Nietert PJ, Psaty BM, Kromhout D, Salamanca-Fernandez E, Kiechl S, Krumholz HM, Grioni S, Palli D, Huerta JM, Price J, Sundström J, Arriola L, Arima H, Travis RC, Panagiotakos DB, Karakatsani A, Trichopoulou A, Kühn T, Grobbee DE, Barrett-Connor E, van Schoor N, Boeing H, Overvad K, Kauhanen J, Wareham N, Langenberg C, Forouhi N, Wennberg M, Després JP, Cushman M, Cooper JA, Rodriguez CJ, Sakurai M, Shaw JE, Knuiman M, Voortman T, Meisinger C, Tjønneland A, Brenner H, Palmieri L, Dallongeville J, Brunner EJ, Assmann G, Trevisan M, Gillum RF, Ford I, Sattar N, Lazo M, Thompson SG, Ferrari P, Leon DA, Smith GD, Peto R, Jackson R, Banks E, Di Angelantonio E, Danesh J. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet 2018; 391:1513-1523. [PMID: 29676281 PMCID: PMC5899998 DOI: 10.1016/s0140-6736(18)30134-x] [Citation(s) in RCA: 715] [Impact Index Per Article: 119.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/03/2017] [Accepted: 12/05/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease. METHODS We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th-95th percentile 1·04-13·5]) from 71 011 participants from 37 studies. FINDINGS In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10-1·17), coronary disease excluding myocardial infarction (1·06, 1·00-1·11), heart failure (1·09, 1·03-1·15), fatal hypertensive disease (1·24, 1·15-1·33); and fatal aortic aneurysm (1·15, 1·03-1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91-0·97). In comparison to those who reported drinking >0-≤100 g per week, those who reported drinking >100-≤200 g per week, >200-≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively. INTERPRETATION In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines. FUNDING UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.
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Affiliation(s)
- Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Adam S Butterworth
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Peter Willeit
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Medical University Innsbruck, Innsbruck, Austria
| | - Samantha Warnakula
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Bolton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ellie Paige
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Dirk S Paul
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Michael Sweeting
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Burgess
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Steven Bell
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - William Astle
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - David Stevens
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Albert Koulman
- NIHR BRC Nutritional Biomarker Laboratory, University of Cambridge, Cambridge, UK
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Shinichi Sato
- Chiba Prefectural Institute of Public Health, Chiba, Japan
| | - Inger Njølstad
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Mark Woodward
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Veikko Salomaa
- THL-National Institute for Health and Welfare, Helsinki, Finland
| | - Børge G Nordestgaard
- Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bu B Yeap
- School of Medicine, University of Western Australia, Perth, WA, Australia; Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | | | - Olle Melander
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Lewis H Kuller
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Wolfgang Koenig
- 92 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany, DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; University of Ulm Medical Center, Ulm, Germany
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Volker Arndt
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Oscar H Franco
- Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - John Gallacher
- Department of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | | | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Caroline E Dale
- Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, UK
| | | | - Carlos J Crespo
- School of Community Health, Portland State University, Portland, OR, USA
| | - Yvonne T van der Schouw
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rudolf Kaaks
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Leon A Simons
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Pagona Lagiou
- Hellenic Health Foundation, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece; Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Jolanda M A Boer
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Timothy J Key
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Beatriz Rodriguez
- Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA
| | - Conchi Moreno-Iribas
- Instituto de Salud Pública de Navarra, IdiSNA - Navarra Institute for Health Research, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
| | | | | | | | - Robert B Wallace
- College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - J Ramon Quiros
- Consejería de Sanidad del Principado de Asturias, Oviedo, Asturias, Spain
| | | | - Dan G Blazer
- Duke Divinity School, Duke University, Durham, NC, USA
| | - Allan Linneberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Makoto Daimon
- Global Center of Excellence Program Study Group, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Salvatore Panico
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | | | - Guri Skeie
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Timo Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Elisabete Weiderpass
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Paul J Nietert
- Medical University of South Carolina, Charleston, SC, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Daan Kromhout
- Department of Agrotechnology and Food Sciences, University of Wageningen, Wageningen, Netherlands; Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Elena Salamanca-Fernandez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Domenico Palli
- Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - José M Huerta
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Jackie Price
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Larraitz Arriola
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Instituto BIO-Donostia, Basque Government, San Sebastian, Spain
| | - Hisatomi Arima
- The University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Preventive Medicine and Public Health, Kyushu University, Fukuoka, Japan
| | - Ruth C Travis
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Diederick E Grobbee
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Natasja van Schoor
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
| | - Heiner Boeing
- German Institute of Human Nutrition, Potsdam-Rehbrüke, Germany
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark; Aalborg University Hospital, Aalborg, Denmark
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Nick Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Claudia Langenberg
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nita Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Mary Cushman
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Jackie A Cooper
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Carlos J Rodriguez
- Wake Forest University School of Medicine, Winston-Salem, NC, USA; Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Masaru Sakurai
- Department of Social and Environmental Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Matthew Knuiman
- Busselton Population Medical Research Institute, Busselton, WA, Australia; School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Trudy Voortman
- Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Christa Meisinger
- Helmholtz Zentrum München German Research Center for Environmental Health, Germany
| | | | - Hermann Brenner
- German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, University of Heidelberg, Heidelberg, Germany
| | | | | | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Gerd Assmann
- Assmann-Stiftung für Prävention, Münster, Germany
| | | | | | - Ian Ford
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mariana Lazo
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Simon G Thompson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Pietro Ferrari
- International Agency for Research on Cancer, Lyon, France
| | - David A Leon
- London School of Hygiene & Tropical Medicine, London, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Richard Peto
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Rod Jackson
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | | | - John Danesh
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Strandberg AY, Trygg T, Pitkälä KH, Strandberg TE. Alcohol consumption in midlife and old age and risk of frailty: Alcohol paradox in a 30-year follow-up study. Age Ageing 2018; 47:248-254. [PMID: 29088316 DOI: 10.1093/ageing/afx165] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Indexed: 01/12/2023] Open
Abstract
Background alcohol consumption has many harmful health effects, but also benefits of moderate consumption on frailty have been reported. We examined this relationship longitudinally from midlife to old age. Methods data of reported alcohol consumption in midlife (year 1974) and in old age (years 2000 and 2003) were available of a socioeconomically homogenous sample of 2360 men (born 1919-34, the Helsinki Businessmen Study). Alcohol consumption was divided into zero (N = 131 at baseline), light (1-98 g/week, N = 920), moderate (99-196, N = 593), and high consumption (>196, n = 716). Incidence of phenotypic frailty and prefrailty was assessed in 2000 and 2003. Alcohol consumption (reference 1-98 g/week, adjusted for age, body mass index and smoking) was related to frailty both longitudinally (from 1974 to 2000, and from 2000 to 2003) and cross-sectionally in 2000 and 2003. Results during a 30-year follow-up, high consumption clearly decreased whereas lighter consumption remained stable. High consumption in midlife predicted both frailty (odds ratio = 1.61, 95% confidence interval = 1.01-2.56) and prefrailty (1.42; 1.06-1.92) in 2000, association with zero and moderate consumption was insignificant. Cross-sectionally in 2000, both zero (2.08; 1.17-3.68) and high consumption (1.83; 1.07-3.13) were associated with frailty, while in 2003 only zero consumption showed this association (2.47; 1.25-4.88). Conclusion the relationship between alcohol and frailty is a paradox during the life course. High, not zero, consumption in midlife predicts old age frailty, while zero consumption in old age is associated with frailty, probably reflecting reverse causality.
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Affiliation(s)
- Arto Y Strandberg
- University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Teemu Trygg
- University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice and
Helsinki University Central Hospital, University of Helsinki, Unit of Primary Health Care, Helsinki, Finland
| | - Timo E Strandberg
- University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- University of Oulu, Center for Life Course Health Research, Oulu, Finland
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183
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Wild SH, Walker JJ, Morling JR, McAllister DA, Colhoun HM, Farran B, McGurnaghan S, McCrimmon R, Read SH, Sattar N, Byrne CD, Wild SH, Walker JJ, Morling JR, McAllister DA, Colhoun H, Farran B, McGurnaghan S, McCrimmon R, Read SH, Sattar N, Byrne CD, Lindsay R, Leese G, McKnight J, Petrie J, Chalmers J, Fischbacher C, Cunningham S, Wu O, Philip S. Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission. Diabetes Care 2018; 41:341-347. [PMID: 29167212 DOI: 10.2337/dc17-1590] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/20/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people aged 40-89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and ICD-10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors. RESULTS A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95% CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non-HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality. CONCLUSIONS Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM.
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Affiliation(s)
- Sarah H. Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Jeremy J. Walker
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Joanne R. Morling
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, U.K
| | - David A. McAllister
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Helen M. Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K
| | - Bassam Farran
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K
| | - Stuart McGurnaghan
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K
| | - Rory McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, U.K
| | - Stephanie H. Read
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Christopher D. Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, U.K
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, U.K
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Colafella KMM, Denton KM. Sex-specific differences in hypertension and associated cardiovascular disease. Nat Rev Nephrol 2018; 14:185-201. [PMID: 29380817 DOI: 10.1038/nrneph.2017.189] [Citation(s) in RCA: 251] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although intrinsic mechanisms that regulate arterial blood pressure (BP) are similar in men and women, marked variations exist at the molecular, cellular and tissue levels. These physiological disparities between the sexes likely contribute to differences in disease onset, susceptibility, prevalence and treatment responses. Key systems that are important in the development of hypertension and cardiovascular disease (CVD), including the sympathetic nervous system, the renin-angiotensin-aldosterone system and the immune system, are differentially activated in males and females. Biological age also contributes to sexual dimorphism, as premenopausal women experience a higher degree of cardioprotection than men of similar age. Furthermore, sex hormones such as oestrogen and testosterone as well as sex chromosome complement likely contribute to sex differences in BP and CVD. At the cellular level, differences in cell senescence pathways may contribute to increased longevity in women and may also limit organ damage caused by hypertension. In addition, many lifestyle and environmental factors - such as smoking, alcohol consumption and diet - may influence BP and CVD in a sex-specific manner. Evidence suggests that cardioprotection in women is lost under conditions of obesity and type 2 diabetes mellitus. Treatment strategies for hypertension and CVD that are tailored according to sex could lead to improved outcomes for affected patients.
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Affiliation(s)
- Katrina M Mirabito Colafella
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Monash University Wellington Road, Clayton, Victoria 3800, Australia.,Department of Physiology, Monash University, 26 Innovation Walk, Clayton, Victoria 3800, Australia.,Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, Netherlands
| | - Kate M Denton
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Monash University Wellington Road, Clayton, Victoria 3800, Australia.,Department of Physiology, Monash University, 26 Innovation Walk, Clayton, Victoria 3800, Australia
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Nordestgaard BG, Cosentino F, Landmesser U, Laufs U. The year in cardiology 2017: prevention. Eur Heart J 2018; 39:345-353. [DOI: 10.1093/eurheartj/ehx766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/19/2017] [Indexed: 12/18/2022] Open
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186
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Ndrepepa G, Colleran R, Kastrati A. Gamma-glutamyl transferase and the risk of atherosclerosis and coronary heart disease. Clin Chim Acta 2018; 476:130-138. [DOI: 10.1016/j.cca.2017.11.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 02/08/2023]
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187
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Knott CS, Bell S, Britton A. The stability of baseline-defined categories of alcohol consumption during the adult life-course: a 28-year prospective cohort study. Addiction 2018; 113:34-43. [PMID: 28734088 PMCID: PMC5725237 DOI: 10.1111/add.13949] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/10/2017] [Accepted: 07/14/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Studies that report the relationship between alcohol consumption and disease risk have predominantly operationalized drinking according to a single baseline measure. The resulting assumption of longitudinal stability may be simplistic and complicate interpretation of risk estimates. This study aims to describe changes to the volume of consumption during the adult life-course according to baseline categories of drinking. DESIGN A prospective observational study. SETTING United Kingdom. PARTICIPANTS A cohort of British civil servants totalling 6838 men and 3372 women aged 34-55 years at baseline, followed for a mean 19.1 (standard deviation = 9.5) years. MEASUREMENTS The volume of weekly alcohol consumption was estimated from data concerning the frequency and number of drinks consumed. Baseline categories were defined: non-current drinkers, infrequent drinkers, 0.1-50.0 g/week, 50.1-100.0 g/week, 100.1-150.0 g/week, 150.1-250.0 g/week and >250.0 g/week. For women, the highest category was defined as > 100.0 g/week. Baseline frequency was derived as 'daily or almost daily' and 'not daily or almost daily'. Trajectories were estimated within baseline categories using growth curve models. FINDINGS Trajectories differed between men and women, but were relatively stable within light-to-moderate categories of baseline consumption. Drinking was least stable within the highest categories of baseline consumption (men: > 250.0 g/week; women: > 100.0 g/week), declining by 47.0 [95% confidence interval (CI) = 40.7, 53.2] and 16.8 g/week (95% CI = 12.6, 21.0), respectively, per 10-year increase in age. These declines were not a consequence of sudden transitions to complete abstention. Rates of decline appear greatest in older age, with trajectories converging toward moderate volumes. CONCLUSION Among UK civil servants, consumption within baseline drinking categories is generally stable during the life-course, except among heavier baseline drinkers, for whom intakes decline with increasing age. This shift does not appear to be driven by transitions to non-drinking. Cohorts of older people may be at particular risk of misclassifying former heavy drinkers as moderate consumers of alcohol.
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Affiliation(s)
- Craig S. Knott
- Research Department of Epidemiology and Public HealthUniversity College LondonLondonUK,MRC Epidemiology Unit and Centre for Diet and Activity Research (CEDAR)University of Cambridge School of Clinical MedicineCambridgeUK
| | - Steven Bell
- Research Department of Epidemiology and Public HealthUniversity College LondonLondonUK,Department of Public Health and Primary Care, Strangeways Research LaboratoryUniversity of CambridgeCambridgeUK
| | - Annie Britton
- Research Department of Epidemiology and Public HealthUniversity College LondonLondonUK
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188
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Parisi R, Webb RT, Carr MJ, Moriarty KJ, Kleyn CE, Griffiths CEM, Ashcroft DM. Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study. JAMA Dermatol 2017; 153:1256-1262. [PMID: 28914955 DOI: 10.1001/jamadermatol.2017.3225] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance People diagnosed with psoriasis have an increased risk of premature mortality, but the underlying reasons for this mortality gap are unclear. Objective To investigate whether patients with psoriasis have an elevated risk of alcohol-related mortality. Design, Setting, and Participants An incident cohort of patients with psoriasis aged 18 years and older was delineated for 1998 through 2014 using the Clinical Practice Research Datalink (CPRD) and linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality records. Patients with psoriasis were matched with up to 20 comparison patients without psoriasis on age, sex, and general practice. Main Outcomes and Measures Alcohol-related deaths were ascertained via the Office for National Statistics mortality records. A stratified Cox proportional hazard model was used to estimate the cause-specific hazard ratio for alcohol-related death, with adjustment for socioeconomic status. Results The cohort included 55 537 with psoriasis and 854 314 patients without psoriasis. Median (interquartile) age at index date was 47 (27) years; 408 230 of total patients (44.9%) were men. During a median (IQR) of 4.4 (6.2) years of follow-up, the alcohol-related mortality rate was 4.8 per 10 000 person-years (95% CI, 4.1-5.6; n = 152) for the psoriasis cohort, vs 2.5 per 10 000 (95% CI, 2.4- 2.7; n = 1118) for the comparison cohort. The hazard ratio for alcohol-related death in patients with psoriasis was 1.58 (95% CI, 1.31-1.91), and the predominant causes of alcohol-related deaths were alcoholic liver disease (65.1%), fibrosis and cirrhosis of the liver (23.7%), and mental and behavioral disorders due to alcohol (7.9%). Conclusions and Relevance People with psoriasis have approximately a 60% greater risk of dying due to alcohol-related causes compared with peers of the same age and sex in the general population. This appears to be a key contributor to the premature mortality gap. These findings call for routine screening, identification and treatment, using the Alcohol Use Disorders Identification Test (AUDIT-C) in both primary and secondary care to detect alcohol consumption and misuse among people diagnosed with psoriasis.
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Affiliation(s)
- Rosa Parisi
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | - Roger T Webb
- Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | - Matthew J Carr
- Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | | | - C Elise Kleyn
- Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, England.,NIHR Manchester Biomedical Research Centre, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, England.,NIHR Manchester Biomedical Research Centre, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, England.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, England
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189
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Bielas H, Meister-Langraf RE, Schmid JP, Barth J, Znoj H, Schnyder U, Princip M, von Känel R. Acute stress disorder and C-reactive protein in patients with acute myocardial infarction. Eur J Prev Cardiol 2017; 25:298-305. [DOI: 10.1177/2047487317748506] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Myocardial infarction-triggered acute stress disorder (ASD) and subclinical inflammation associate with the development of posttraumatic stress disorder, and worsen the prognosis of myocardial infarction patients. We examined the relationship between ASD severity and C-reactive protein levels in patients with acute myocardial infarction. Methods We assessed 190 patients (median age 59 years; 83% men) with a verified myocardial infarction within 48 h of an acute coronary intervention. Circulating levels of C-reactive protein were categorized according to their prognostic risk for cardiovascular disease: 0 to <5, 5 to <10, 10 to <20, and ≥ 20 mg/l. Patients completed the ASD-Scale (ASDS) for myocardial infarction-triggered symptoms and questionnaires for demographic factors, health behaviours, cardiac-related variables and psychosocial characteristics. Results The ASDS sum score was positively associated with C-reactive protein categories in the bivariate analysis ( r = 0.20, p < 0.01). Significant relationships with C-reactive protein also emerged for dissociation ( r = 0.25, p < 0.001) and avoidance ( r = 0.19, p < 0.01), but not for arousal and re-experiencing. Similarly, C-reactive protein levels ≥ 20 mg/l versus < 20 mg/l were predicted by the ASDS sum score, and the dissociation, avoidance and arousal subscores (all p-values < 0.05) in the fully adjusted binary regression analyses. C-reactive protein levels ≥ 20 mg/l were also independently predicted by male gender, body mass index, lower education, and lower left ventricular ejection fraction and higher white blood cell count. Conclusions Higher levels of myocardial infarction-triggered ASD symptoms associate with a greater inflammatory response in patients with acute myocardial infarction independently of important covariates. The findings suggest a link between myocardial infarction-triggered ASD symptoms and a heightened acute phase response with a potential impact on cardiovascular disease prognosis.
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Affiliation(s)
- Hannes Bielas
- Department of Biomedical Ethics, University Hospital Zurich, University of Zurich, Switzerland
- Department of Child and Adolescent Psychosomatic Medicine and Psychotherapy, Clinic Fontane, Mittenwalde, Germany
| | - Rebecca E Meister-Langraf
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Clinical Research, University of Bern, Switzerland
- Clienia Schlössli AG, Zurich, Switzerland
| | | | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Switzerland
| | - Hansjörg Znoj
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
| | - Mary Princip
- Department of Child and Adolescent Psychosomatic Medicine and Psychotherapy, Clinic Fontane, Mittenwalde, Germany
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Division of Cardiovascular Prevention, Rehabilitation and Sports Medicine, Department of Cardiology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Roland von Känel
- Department of Child and Adolescent Psychosomatic Medicine and Psychotherapy, Clinic Fontane, Mittenwalde, Germany
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Psychosomatic Medicine, Clinic Barmelweid, Switzerland
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190
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Di Castelnuovo A, Costanzo S, Bonaccio M, Rago L, De Curtis A, Persichillo M, Bracone F, Olivieri M, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Moderate Alcohol Consumption Is Associated With Lower Risk for Heart Failure But Not Atrial Fibrillation. JACC-HEART FAILURE 2017; 5:837-844. [PMID: 29032141 DOI: 10.1016/j.jchf.2017.08.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/01/2017] [Accepted: 08/03/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of this study was to assess the hypothesis that alcohol consumption is associated with onset of atrial fibrillation (AF) and/or heart failure (HF). BACKGROUND The connection between ethanol intake and AF or HF remains controversial. METHODS The study population was 22,824 AF- or HF-free subjects (48% men, age ≥35 years) randomly recruited from the general population included in the Moli-sani study, for whom complete data on HF, AF, and alcohol consumption were available. The cohort was followed up to December 31, 2015, for a median of 8.2 years (183,912 person-years). Incident cases were identified through linkage to the Molise regional archive of hospital discharges. Hazard ratios were calculated using Cox proportional hazard models and cubic spline regression. RESULTS A total of 943 incident cases of HF and 554 of AF were identified. In comparison with never drinkers, both former and occasional drinkers showed comparable risk for developing HF. Drinking alcohol in the range of 1 to 4 drinks/day was associated with a lower risk for HF, with a 22% maximum risk reduction at 20 g/day, independent of common confounders. In contrast, no association of alcohol consumption with onset of AF was observed. Very similar results were obtained after restriction of the analyses to regular or only wine drinkers or according to sex, age, social status, or adherence to the Mediterranean diet. CONCLUSIONS Consumption of alcohol in moderation was associated with a lower incidence of HF but not with development of AF.
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Affiliation(s)
- Augusto Di Castelnuovo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy.
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | | | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Mariarosaria Persichillo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | | | | | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Maria Benedetta Donati
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy
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191
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Chen C, Li Q, Nie X, Han B, Chen Y, Xia F, Zhai H, Wang N, Lu Y. Association of lead exposure with cardiovascular risk factors and diseases in Chinese adults. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:22275-22283. [PMID: 28799038 DOI: 10.1007/s11356-017-9884-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
We aimed to determine whether lead exposure was associated with cardiovascular diseases (CVD) and risk factors in Chinese adults. Five thousand three hundred and forty-eight subjects were enrolled from 16 sites in China. Blood lead level (BLL) was measured by atomic absorption spectrometry. Cardiovascular diseases included coronary heart disease, stroke, and myocardial infarction. Cardiovascular risk factors included body mass index (BMI), fasting plasma glucose (FPG), lipid profile, and blood pressure. We found that 5.9% of the study population had prevalent CVD. Medians (interquartile range) of BLLs were 44.00 μg/L (29.00-62.48) for men and 37.70 μg/L (25.00-54.60) for women. The prevalence of CVD gradually and markedly increased with increasing BLL quartiles in women (P for trend < 0.01), but not in men. After adjustment for age, current smoking, and drinking, BLLs were independently associated with cardiovascular risk factors including BMI, FPG, and blood pressure in women (all P < 0.05), but not in men. Binary logistic regression showed that increased quartiles of BLL were significantly and positively associated with increased odds ratio of prevalent CVD (P for trend < 0.01) in women. This association was independent of age, smoking, drinking, education, diabetes, obesity, hypertension, and lipid profile. In conclusion, BLL in the range currently considered acceptable is independently associated with CVD, which is the leading cause of death in China. Further practical and cost-effective efforts to reduce lead exposure may be warranted.
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Affiliation(s)
- Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Qin Li
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xiaomin Nie
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Bing Han
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Hualing Zhai
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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192
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Larsson SC, Wolk A, Bäck M. Alcohol consumption, cigarette smoking and incidence of aortic valve stenosis. J Intern Med 2017; 282:332-339. [PMID: 28494128 DOI: 10.1111/joim.12630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alcohol consumption and cigarette smoking are modifiable lifestyle factors with important impact on public health. It is unclear whether these factors influence the risk of aortic valve stenosis (AVS). OBJECTIVE To investigate the associations of alcohol consumption and smoking, including smoking intensity and time since cessation, with AVS incidence in two prospective cohorts. METHODS This analysis was based on data from the Swedish Mammography Cohort and the Cohort of Swedish Men, comprising 69 365 adults without cardiovascular disease at baseline. Participants were followed for AVS incidence and death by linkage to the Swedish National Patient and Causes of Death Registers. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated by Cox proportional hazards regression. RESULTS Over a mean follow-up of 15.3 years, 1249 cases of AVS (494 in women and 755 in men) were recorded. Compared with never drinkers of alcohol (lifelong abstainers), the risk of AVS was significantly lower in current light drinkers (1-6 drinks per week [1 drink = 12 g alcohol]; multivariable HR 0.82; 95% CI: 0.68-0.99). The risk of AVS increased with increasing smoking intensity. Compared with never smokers, the HR was 1.46 (95% CI: 1.16-1.85) in current smokers of ≥30 pack-years. Former smokers who had quit smoking 10 or more years previously had similar risk for AVS as never smokers. CONCLUSIONS This study suggests that current light alcohol consumption is associated with a lower risk of AVS, and indicates that the association between smoking and AVS risk is reversible.
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Affiliation(s)
- S C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Bäck
- Department of Medicine, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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193
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Banerjee A. Challenges for learning health systems in the NHS. Case study: electronic health records in cardiology. Future Healthc J 2017; 4:193-197. [PMID: 31098470 PMCID: PMC6502575 DOI: 10.7861/futurehosp.4-3-193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Electronic health records (EHRs) are at the centre of advances in health informatics, but also many other innovations in healthcare. However, there are still obstacles to implementation and realisation of the full potential of EHRs as there are with learning health systems (LHS). Cardiovascular disease, in the UK and globally, carries greater morbidity and mortality than any other disease. Therefore, planning and delivery of health services represent major costs to individuals and populations. Both the scale of disease burden and the growing role of technology in cardiology practice make analysis of experiences with EHRs in cardiology a useful lens through which to view achievements and gaps to date. In this article regarding LHS, EHRs in cardiology are used as a case study of LHS in the NHS.
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Affiliation(s)
- Amitava Banerjee
- Farr Institute of Health Informatics Research, University College London, London, UK
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194
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Reply: Neutrophil Count Is Associated With Risks of Cardiovascular Diseases. J Am Coll Cardiol 2017; 70:912. [PMID: 28797367 DOI: 10.1016/j.jacc.2017.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 05/17/2017] [Indexed: 11/20/2022]
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195
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196
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Gene-Dairy Food Interactions and Health Outcomes: A Review of Nutrigenetic Studies. Nutrients 2017; 9:nu9070710. [PMID: 28684688 PMCID: PMC5537825 DOI: 10.3390/nu9070710] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/10/2017] [Accepted: 07/03/2017] [Indexed: 12/23/2022] Open
Abstract
Each person differs from the next by an average of over 3 million genetic variations in their DNA. This genetic diversity is responsible for many of the interindividual differences in food preferences, nutritional needs, and dietary responses between humans. The field of nutrigenetics aims to utilize this type of genetic information in order to personalize diets for optimal health. One of the most well-studied genetic variants affecting human dietary patterns and health is the lactase persistence mutation, which enables an individual to digest milk sugar into adulthood. Lactase persistence is one of the most influential Mendelian factors affecting human dietary patterns to occur since the beginning of the Neolithic Revolution. However, the lactase persistence mutation is only one of many mutations that can influence the relationship between dairy intake and disease risk. The purpose of this review is to summarize the available nutrigenetic literature investigating the relationships between genetics, dairy intake, and health outcomes. Nonetheless, the understanding of an individual’s nutrigenetic responses is just one component of personalized nutrition. In addition to nutrigenetic responses, future studies should also take into account nutrigenomic responses (epigenomic, transcriptomic, proteomic, metabolomic), and phenotypic/characteristic traits (age, gender, activity level, disease status, etc.), as these factors all interact with diet to influence health.
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197
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Stewart D, Han L, Doran T, McCambridge J. Alcohol consumption and all-cause mortality: an analysis of general practice database records for patients with long-term conditions. J Epidemiol Community Health 2017; 71:729-735. [DOI: 10.1136/jech-2017-209241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 11/03/2022]
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198
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George J, Mathur R, Shah AD, Pujades-Rodriguez M, Denaxas S, Smeeth L, Timmis A, Hemingway H. Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients. PLoS One 2017; 12:e0178945. [PMID: 28598987 PMCID: PMC5466321 DOI: 10.1371/journal.pone.0178945] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/22/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While the association of ethnic group with individual cardiovascular diseases has been studied, little is known about ethnic differences in the initial lifetime presentation of clinical cardiovascular disease in contemporary populations. METHODS AND RESULTS We studied 1,068,318 people, aged ≥30 years and free from diagnosed CVD at baseline (90.9% White, 3.6% South Asian and 2.9% Black), using English linked electronic health records covering primary care, hospital admissions, acute coronary syndrome registry and mortality registry (CALIBER platform). During 5.7 years median follow-up between 1997-2010, 95,224 people experienced an incident cardiovascular diagnosis. 69.9% (67.2%-72.4%) of initial presentation in South Asian <60 yrs were coronary heart disease presentations compared to 47.8% (47.3%-48.3%) in White and 40.1% (36.3%-43.9%) in Black patients. Compared to White patients, Black patients had significantly lower age-sex adjusted hazard ratios (HRs) for initial lifetime presentation of all the coronary disease diagnoses (stable angina HR 0.80 (95% CI 0.68-0.93); unstable angina- 0.75 (0.59-0.97); myocardial infarction 0.49 (0.40-0.62)) while South Asian patients had significantly higher HRs (stable angina- 1.67 (1.52-1.84); unstable angina 1.82 (1.56-2.13); myocardial infarction- 1.67 (1.49-1.87). We found no ethnic differences in initial presentation with heart failure (Black 0.97 (0.79-1.20); S Asian 1.04(0.87-1.26)). Compared to White patients, Black patients were more likely to present with ischaemic stroke (1.24 (0.97-1.58)) and intracerebral haemorrhage (1.44 (0.97-2.12)). Presentation with peripheral arterial disease was less likely for Black (0.63 (0.50-0.80)) and South Asian patients (0.70 (0.57-0.86)) compared with White patients. DISCUSSION While we found the anticipated substantial predominance of coronary heart disease presentations in South Asian and predominance of stroke presentations in Black patients, we found no ethnic differences in presentation with heart failure. We consider the public health and research implications of our findings. TRIAL REGISTRATION NCT02176174, www.clinicaltrials.gov.
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Affiliation(s)
- Julie George
- The Farr Institute of Health Informatics Research and the National Institute for Health Research, Biomedical Research Centre, University College London, London, United Kingdom
| | - Rohini Mathur
- Electronic Health Records Group, Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anoop Dinesh Shah
- The Farr Institute of Health Informatics Research and the National Institute for Health Research, Biomedical Research Centre, University College London, London, United Kingdom
| | - Mar Pujades-Rodriguez
- The Farr Institute of Health Informatics Research and the National Institute for Health Research, Biomedical Research Centre, University College London, London, United Kingdom
- Leeds Institute of Biomedical and Clinical Science, University of Leeds, Leeds, United Kingdom
| | - Spiros Denaxas
- The Farr Institute of Health Informatics Research and the National Institute for Health Research, Biomedical Research Centre, University College London, London, United Kingdom
| | - Liam Smeeth
- Electronic Health Records Group, Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Adam Timmis
- NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, London, United Kingdom
| | - Harry Hemingway
- The Farr Institute of Health Informatics Research and the National Institute for Health Research, Biomedical Research Centre, University College London, London, United Kingdom
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199
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Abstract
Big data puts the link between moderate drinking and lower risk under the microscope
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Affiliation(s)
- Kenneth Mukamal
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Mariana Lazo
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Public Health and School of Medicine, Baltimore, MD 21202, USA
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200
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Denaxas S, Direk K, Gonzalez-Izquierdo A, Pikoula M, Cakiroglu A, Moore J, Hemingway H, Smeeth L. Methods for enhancing the reproducibility of biomedical research findings using electronic health records. BioData Min 2017; 10:31. [PMID: 28912836 PMCID: PMC5594436 DOI: 10.1186/s13040-017-0151-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/28/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The ability of external investigators to reproduce published scientific findings is critical for the evaluation and validation of biomedical research by the wider community. However, a substantial proportion of health research using electronic health records (EHR), data collected and generated during clinical care, is potentially not reproducible mainly due to the fact that the implementation details of most data preprocessing, cleaning, phenotyping and analysis approaches are not systematically made available or shared. With the complexity, volume and variety of electronic health record data sources made available for research steadily increasing, it is critical to ensure that scientific findings from EHR data are reproducible and replicable by researchers. Reporting guidelines, such as RECORD and STROBE, have set a solid foundation by recommending a series of items for researchers to include in their research outputs. Researchers however often lack the technical tools and methodological approaches to actuate such recommendations in an efficient and sustainable manner. RESULTS In this paper, we review and propose a series of methods and tools utilized in adjunct scientific disciplines that can be used to enhance the reproducibility of research using electronic health records and enable researchers to report analytical approaches in a transparent manner. Specifically, we discuss the adoption of scientific software engineering principles and best-practices such as test-driven development, source code revision control systems, literate programming and the standardization and re-use of common data management and analytical approaches. CONCLUSION The adoption of such approaches will enable scientists to systematically document and share EHR analytical workflows and increase the reproducibility of biomedical research using such complex data sources.
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Affiliation(s)
- Spiros Denaxas
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK.,Farr Institute of Health Informatics Research, 222 Euston Road, London, UK
| | - Kenan Direk
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK.,Farr Institute of Health Informatics Research, 222 Euston Road, London, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK.,Farr Institute of Health Informatics Research, 222 Euston Road, London, UK
| | - Maria Pikoula
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK.,Farr Institute of Health Informatics Research, 222 Euston Road, London, UK
| | - Aylin Cakiroglu
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT UK
| | - Jason Moore
- Institute of Biomedical Informatics, University of Pennsylvania, Richards Medical Research Laboratories, 3700 Hamilton Walk, Philadelphia, 19104 USA
| | - Harry Hemingway
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK.,Farr Institute of Health Informatics Research, 222 Euston Road, London, UK
| | - Liam Smeeth
- EHR Research Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Streeet, London, WC1E 7HT UK
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