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Behavioral factors predict all-cause mortality in female coronary patients and healthy controls over 26 years - a prospective secondary analysis of the Stockholm Female Coronary Risk Study. PLoS One 2022; 17:e0277028. [PMID: 36477657 PMCID: PMC9728905 DOI: 10.1371/journal.pone.0277028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/19/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The prognosis of coronary artery disease (CAD) is related to its severity and cardiovascular risk factors in both sexes. In women, social isolation, marital stress, sedentary lifestyle and depression predicted CAD progression and outcome within 3 to 5 years. We hypothesised that these behavioral factors would still be associated with all-cause mortality in female patients after 26 years. METHODS We examined 292 patients with CAD and 300 healthy controls (mean age of 56 ± 7 y) within the Fem-Cor-Risk-Study at baseline. Their cardiac, behavioral, and psychosocial risk profiles, exercise, smoking, and dietary habits were assessed using standardized procedures. Physiological characteristics included a full lipid profile, the coagulation cascade and autonomic dysfunction (heart rate variability, HRV). A new exploratory analysis using machine-learning algorithms compared the effects of social and behavioral mechanisms with standard risk factors. Results: All-cause mortality records were completed in 286 (97.9%) patients and 299 (99.7%) healthy women. During a median follow-up of 26 years, 158 (55.2%) patients and 101 (33.9%) matched healthy controls died. The annualized mortality rate was 2.1% and 1.3%, respectively. After controlling for all available confounders, behavioral predictors of survival in patients were social integration (HR 0.99, 95% CI 0.99-1.0) and physical activity (HR 0.54, 95% CI 0.37-0.79). Smoking acted as a predictor of all-cause mortality (HR 1.56, 95% CI 1.03-2.36). Among healthy women, moderate physical activity (HR 0.42, 95% CI 0.24-0.74) and complete HRV recordings (≥50%) were found to be significant predictors of survival. CONCLUSIONS CAD patients with adequate social integration, who do not smoke and are physically active, have a favorable long-term prognosis. The exact survival times confirm that behavioral risk factors are associated with all-cause mortality in female CAD patients and healthy controls.
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Swarath S, Maharaj N, Lalchansingh D, Seecheran R, Seecheran V, Leyva Quert AY, Seecheran NA. Alcohol Binge Drinking-Induced ST-Segment-Elevation Acute Coronary Syndrome. J Investig Med High Impact Case Rep 2022; 10:23247096221133192. [PMID: 36286618 PMCID: PMC9618743 DOI: 10.1177/23247096221133192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 26-year-old man, without any apparent cardiovascular risk factors, who experienced an ST-segment-elevation acute coronary syndrome after binge drinking high-proof alcohol, which was successfully managed with primary percutaneous coronary intervention and comprehensive, guideline-directed medical therapy.
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Affiliation(s)
- Steven Swarath
- North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Nicole Maharaj
- North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Dayna Lalchansingh
- North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | | | - Valmiki Seecheran
- North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | | | - Naveen Anand Seecheran
- The University of the West Indies, Saint Augustine, Trinidad and Tobago,Naveen Anand Seecheran, MBBS, MD, MSc, FACP, FRCP(E), FACC, FESC, FSCAI, Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Saint Augustine, Trinidad and Tobago. Emails: ;
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Noh DW, Kim S. Associations between coronary artery stenosis detected by coronary computed tomography angiography and the characteristics of health checkup examinees in the Republic of Korea. Radiography (Lond) 2019; 26:22-26. [PMID: 31902450 DOI: 10.1016/j.radi.2019.06.001] [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: 03/21/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study was conducted on healthy adults without a diagnosis related to cardiovascular disease to investigate the associations between asymptomatic coronary artery stenosis and the characteristics of health checkup examinees. METHODS This study was performed on 601 people (320 males and 281 females), who underwent coronary computed tomography angiography (CCTA), among health checkup examinees from January 2, 2015 to December 31, 2016. Those with any prior history of cardiovascular diseases, underwent coronary artery bypass grafting or coronary artery stenting in the past, those with atrial fibrillation, those suspected of contrast agent side effects, and those whose creatinine levels deviated from the normal range were excluded. RESULTS The mean age was 58.7 ± 8.0 years. Coronary artery stenosis was detected in 173 people (28.8%), and the mean coronary artery stenosis rate was 25.8 ± 12.8%. Regression analysis showed that coronary artery stenosis was influenced significantly by age, gender, glycated hemoglobin (HbA1c), past smoking duration, current smoking duration, and number of glasses of alcohol consumed (p < 0.05). In terms of the relationship between the presence of coronary artery stenosis and lifestyle habits, amount of alcohol consumed per day (p = 0.03), and patients with a longer period of past (p < 0.001) and current smoking duration (p = 0.01) had a significant effect on coronary artery stenosis. CONCLUSION These results suggest that men aged 60 years or older, who have consumed large amounts of alcohol and cigarettes for a long time, require continuous management through tests such as a health checkup, because of the high probability of coronary artery stenosis, even in those without specific symptoms.
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Affiliation(s)
- D-W Noh
- Department of Radiology, Korea Association of Health Promotion Medicheck, 500 Dokbae-ro, Michuhol-gu, 22172, Incheon, Republic of Korea; Department of Radiological Science, Gachon University Medical Campus, Incheon, Republic of Korea.
| | - S Kim
- Department of Radiological Science, Gachon University Medical Campus, Incheon, Republic of Korea.
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Abstract
PURPOSE OF REVIEW This review aims to discuss the effect of alcohol consumption on various cardiovascular (CV) diseases and CV mortality. RECENT FINDINGS Alcohol intake has consistently shown a J- or U-shaped relationship with several cardiovascular diseases. Light to moderate alcohol intake has been associated with lower risk of coronary artery disease, heart failure (HF), as well as CV mortality. On the other hand, heavy consumption has been associated with deleterious CV outcomes including increased mortality. However, the evidence is based from observational and population-based studies where risk of confounding cannot be excluded even after meticulous methodological approaches. This is compounded by conflicting data such as higher risk of certain CV diseases like HF in former drinkers compared to abstainers. Further, Mendelian randomization studies using genetic polymorphisms in enzymes have recently questioned the beneficial association of low-moderate drinking with CV system. There has been substantial and consistent evidence that light to moderate alcohol consumption have beneficial effect on overall cardiovascular profile and mortality. However, there are considerable limitations in the reported literature to determine a strong causality of a protective effect of moderate alcohol consumption by itself. Further robust studies or possibly a well-structured randomized controlled could bring an end to this debate.
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Affiliation(s)
- Sunny Goel
- Division of Cardiovascular Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Abhishek Sharma
- Division of Cardiovascular Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Institute of Cardiovascular Research and Technology, Brooklyn, NY, USA.
| | - Aakash Garg
- Rutgers Robert Wood Johnson Medical School, 69 Duke Street, New Brunswick, NJ, USA
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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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Lazo M, Chen Y, McEvoy JW, Ndumele C, Konety S, Ballantyne CM, Sharrett AR, Selvin E. Alcohol Consumption and Cardiac Biomarkers: The Atherosclerosis Risk in Communities (ARIC) Study. Clin Chem 2016; 62:1202-10. [PMID: 27440513 DOI: 10.1373/clinchem.2016.255778] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/16/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND The role of alcohol in the development of subclinical cardiovascular disease is unclear. We examined the association between alcohol consumption and markers of subclinical cardiac damage and wall stress. METHODS We studied the cross-sectional and prospective associations of alcohol consumption with high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) measured at 2 time points, 6 years apart (baseline, 1990-1992; follow-up, 1996-1998), in over 11000 participants of the Atherosclerosis Risk in Communities (ARIC) Study with no history of cardiovascular disease. Alcohol consumption was categorized as follows: never, former, current: ≤1, 2-7, 8-14, and ≥15 drinks/week. RESULTS Compared to never drinkers, persons who consumed 2-7 drinks per week were less likely to have increased hs-cTnT (≥14 ng/L) at baseline (odds ratio = 0.67, 95% CI, 0.46-0.96), and had a lower risk of incident increases in hs-cTnT at follow-up (relative risk = 0.70, 95% CI, 0.49-1.00). Conversely, there was a positive association between alcohol intake and NT-proBNP concentrations at baseline. Consumption of ≥15 drinks/week was positively associated with incident increases in NT-proBNP (≥300 pg/mL) at the 6-year follow-up visit (relative risk = 2.38, 95% CI, 1.43-3.96). CONCLUSIONS In this community-based study of middle-aged adults without a history of cardiovascular disease, moderate drinking was associated with lower concentrations of hs-cTnT, a marker of chronic subclinical myocardial damage, and positively associated with NT-proBNP, a biomarker of cardiac wall stress. Our results suggest that the cardiac effects of alcohol are complex. Cardiac biomarkers may help improve our understanding of the full cardiovascular effects of alcohol consumption.
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Affiliation(s)
- Mariana Lazo
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD;
| | - Yuan Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - John W McEvoy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD
| | - Chiadi Ndumele
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Medicine, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD
| | - Suma Konety
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN
| | - Christie M Ballantyne
- Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, TX
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Elizabeth Selvin
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Abstract
A number of studies from different countries and several large-scale meta-analyses have reported reduced coronary heart disease rates among those regularly consuming mild to moderate amounts of alcohol compared with those abstaining from alcohol. In contrast, various studies have also reported that heavy alcohol consumption promotes the progression of atherosclerosis and that binge drinking might trigger embolic stroke and acute myocardial infarction. We discuss the association between alcohol consumption and acute myocardial infarction on the basis of evidence from literature published recently. Alcohol consumption has both favourable and unfavourable effects on metabolism, lipid profile, blood coagulation and fibrinolysis, blood pressure and vascular tone depending on the amount of alcohol consumed and the way that it is drunk (i.e. drinking habits). We conclude that it is extremely important to warn people of the risks associated with binge drinking and to encourage them to remain within the recommended safe limits for alcohol consumption.
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Affiliation(s)
- I Biyik
- Department of Cardiology, Uşak State Hospital, Uşak, Turkey.
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Gémes K, Janszky I, Ahnve S, László KD, Laugsand LE, Vatten LJ, Mukamal KJ. Light-to-moderate drinking and incident heart failure--the Norwegian HUNT study. Int J Cardiol 2015; 203:553-60. [PMID: 26569362 DOI: 10.1016/j.ijcard.2015.10.179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/19/2015] [Accepted: 10/24/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND We analyzed the association between light-to-moderate alcohol intake and the risk of heart failure (HF). METHODS AND RESULTS We studied 60,665 individuals free of HF who provided information on alcohol consumption in a population-based cohort study conducted in 1995-97 in Norway. Sociodemographic factors, cardiovascular risk factors and common chronic disorders were assessed by questionnaires and/or by a clinical examination. The cohort was followed for a first HF event for an average of 11.2 ± 3.0 years. Mean alcohol consumption was 2.95 ± 4.5 g/day; 1588 HF cases occurred during follow-up. The quantity of alcohol consumption was inversely associated with incident HF in this low-drinking population. The risk was lowest for consumption over three but less than six drinks/week; the multivariate hazard ratio when comparing this category to non-drinkers was 0.67 (95% CI: 0.50-0.92). Among problem drinkers based on CAGE questionnaires, total consumption showed no favorable association with HF, even when overall consumption was otherwise moderate. Excluding former drinkers and controlling for common chronic diseases had minimal effect on these associations. Frequent alcohol consumption, i.e. more than five times/month, was associated with the lowest HF risk; the adjusted hazard ratio comparing this group to alcohol intake less than once/month was 0.83 (95% CI: 0.68-1.03). We found no evidence for a differential effect according to beverage type, nor that the competing risks of death from other causes modified the association. CONCLUSIONS Frequent light-to-moderate alcohol consumption without problem drinking was associated with a lower HF risk in this population characterized by a low average alcohol intake.
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Affiliation(s)
- Katalin Gémes
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Imre Janszky
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Center for Health Care Research, St Olav Hospital, Norway.
| | - Staffan Ahnve
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Krisztina D László
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lars E Laugsand
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Cascio WE. Life Style. Atherosclerosis 2015. [DOI: 10.1002/9781118828533.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Markus MRP, Lieb W, Stritzke J, Siewert U, Troitzsch P, Koch M, Dörr M, Felix SB, Völzke H, Schunkert H, Baumeister SE. Light to Moderate Alcohol Consumption Is Associated With Lower Risk of Aortic Valve Sclerosis: The Study of Health in Pomerania (SHIP). Arterioscler Thromb Vasc Biol 2015; 35:1265-70. [PMID: 25767276 DOI: 10.1161/atvbaha.114.304831] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In developed countries, sclerotic and calcific degeneration of the aortic valve is a common disorder showing pathophysiologic similarities with atherothrombotic coronary disease. Light to moderate alcohol consumption has been associated with a lower risk for atherothrombotic coronary disease and mortality. Whether alcohol consumption affects the development of aortic valve sclerosis (AVS) is not well known. In the present study, we aim to analyze the cross-sectional association between average daily alcohol consumption and AVS in the general population. APPROACH AND RESULTS We analyzed cross-sectional data from 2022 men and women, aged 45 to 81 years, from the population-based Study of Health in Pomerania. We used a computer-assisted interview that included beverage-specific questions about quantity and frequency of alcohol over the last 30 days to calculate the average quantity of alcohol consumption (in grams of ethanol per day). AVS was ascertained by echocardiography. The prevalence of AVS was 32.3%. Average daily alcohol intake displayed a J-type relation with AVS (fully adjusted P value: 0.005). Compared with individuals with an average consumption of 10 g of alcohol per day, multivariable-adjusted odds ratios were 1.60 (95% confidence interval, 1.19-2.14) among current abstainers and 1.56 (95% confidence interval, 1.01-2.41) among individuals with an average consumption of 60 g per day. CONCLUSIONS Our findings indicate that light to moderate alcohol consumption was associated with a lower odd of having AVS. Prospective data need to address whether alcohol consumption and related changes over time in several biological markers affect the progression of AVS.
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Affiliation(s)
- Marcello Ricardo Paulista Markus
- From the Department of Internal Medicine B (M.R.P.M., M.D., S.B.F.), Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., P.T., H.V., S.E.B.), and Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine (U.S.), University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany (M.R.P.M., M.D., S.B.F., H.V.); Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany (W.L., M.K.); Department of Cardiology, Asklepios North Sea Clinic, Westerland/Sylt, Germany (J.S.); Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (H.S.); and Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (S.E.B.).
| | - Wolfgang Lieb
- From the Department of Internal Medicine B (M.R.P.M., M.D., S.B.F.), Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., P.T., H.V., S.E.B.), and Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine (U.S.), University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany (M.R.P.M., M.D., S.B.F., H.V.); Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany (W.L., M.K.); Department of Cardiology, Asklepios North Sea Clinic, Westerland/Sylt, Germany (J.S.); Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (H.S.); and Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (S.E.B.)
| | - Jan Stritzke
- From the Department of Internal Medicine B (M.R.P.M., M.D., S.B.F.), Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., P.T., H.V., S.E.B.), and Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine (U.S.), University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany (M.R.P.M., M.D., S.B.F., H.V.); Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany (W.L., M.K.); Department of Cardiology, Asklepios North Sea Clinic, Westerland/Sylt, Germany (J.S.); Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (H.S.); and Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (S.E.B.)
| | - Ulrike Siewert
- From the Department of Internal Medicine B (M.R.P.M., M.D., S.B.F.), Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., P.T., H.V., S.E.B.), and Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine (U.S.), University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany (M.R.P.M., M.D., S.B.F., H.V.); Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany (W.L., M.K.); Department of Cardiology, Asklepios North Sea Clinic, Westerland/Sylt, Germany (J.S.); Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (H.S.); and Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (S.E.B.)
| | - Paulina Troitzsch
- From the Department of Internal Medicine B (M.R.P.M., M.D., S.B.F.), Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., P.T., H.V., S.E.B.), and Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine (U.S.), University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany (M.R.P.M., M.D., S.B.F., H.V.); Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany (W.L., M.K.); Department of Cardiology, Asklepios North Sea Clinic, Westerland/Sylt, Germany (J.S.); Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (H.S.); and Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (S.E.B.)
| | - Manja Koch
- From the Department of Internal Medicine B (M.R.P.M., M.D., S.B.F.), Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., P.T., H.V., S.E.B.), and Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine (U.S.), University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany (M.R.P.M., M.D., S.B.F., H.V.); Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany (W.L., M.K.); Department of Cardiology, Asklepios North Sea Clinic, Westerland/Sylt, Germany (J.S.); Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (H.S.); and Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (S.E.B.)
| | - Marcus Dörr
- From the Department of Internal Medicine B (M.R.P.M., M.D., S.B.F.), Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., P.T., H.V., S.E.B.), and Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine (U.S.), University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany (M.R.P.M., M.D., S.B.F., H.V.); Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany (W.L., M.K.); Department of Cardiology, Asklepios North Sea Clinic, Westerland/Sylt, Germany (J.S.); Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (H.S.); and Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (S.E.B.)
| | - Stephan Burkhard Felix
- From the Department of Internal Medicine B (M.R.P.M., M.D., S.B.F.), Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., P.T., H.V., S.E.B.), and Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine (U.S.), University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany (M.R.P.M., M.D., S.B.F., H.V.); Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany (W.L., M.K.); Department of Cardiology, Asklepios North Sea Clinic, Westerland/Sylt, Germany (J.S.); Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (H.S.); and Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (S.E.B.)
| | - Henry Völzke
- From the Department of Internal Medicine B (M.R.P.M., M.D., S.B.F.), Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., P.T., H.V., S.E.B.), and Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine (U.S.), University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany (M.R.P.M., M.D., S.B.F., H.V.); Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany (W.L., M.K.); Department of Cardiology, Asklepios North Sea Clinic, Westerland/Sylt, Germany (J.S.); Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (H.S.); and Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (S.E.B.)
| | - Heribert Schunkert
- From the Department of Internal Medicine B (M.R.P.M., M.D., S.B.F.), Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., P.T., H.V., S.E.B.), and Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine (U.S.), University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany (M.R.P.M., M.D., S.B.F., H.V.); Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany (W.L., M.K.); Department of Cardiology, Asklepios North Sea Clinic, Westerland/Sylt, Germany (J.S.); Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (H.S.); and Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (S.E.B.)
| | - Sebastian Edgar Baumeister
- From the Department of Internal Medicine B (M.R.P.M., M.D., S.B.F.), Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., P.T., H.V., S.E.B.), and Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine (U.S.), University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany (M.R.P.M., M.D., S.B.F., H.V.); Institute of Epidemiology, Christian-Albrechts-University Kiel, Kiel, Germany (W.L., M.K.); Department of Cardiology, Asklepios North Sea Clinic, Westerland/Sylt, Germany (J.S.); Department of Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (H.S.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (H.S.); and Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany (S.E.B.)
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11
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Pai JK, Mukamal KJ, Rimm EB. Long-term alcohol consumption in relation to all-cause and cardiovascular mortality among survivors of myocardial infarction: the Health Professionals Follow-up Study. Eur Heart J 2012; 33:1598-605. [PMID: 22453658 PMCID: PMC3388015 DOI: 10.1093/eurheartj/ehs047] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 01/14/2012] [Accepted: 02/14/2012] [Indexed: 11/12/2022] Open
Abstract
AIMS The aim of this study was to examine the association between long-term alcohol consumption, alcohol consumption before and after myocardial infarction (MI), and all-cause and cardiovascular mortality among survivors of MI. METHODS AND RESULTS The Health Professionals Follow-up Study (HPFS) is a prospective cohort study of 51 529 US male health professionals. From 1986 to 2006, 1818 men were confirmed with incident non-fatal MI. Among MI survivors, 468 deaths were documented during up to 20 years of follow-up. Long-term average alcohol consumption was calculated beginning from the time period immediately before the first MI and updated every 4 years afterward. Cox proportional hazards were used to estimate the multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI). Compared with non-drinkers, the multivariable-adjusted HRs for all-cause mortality were 0.78 (95% CI: 0.62-0.97) for 0.1-9.9 g/day, 0.66 (95% CI: 0.51-0.86) for 10.0-29.9 g/day, and 0.87 (95% CI: 0.61-1.25) for ≥30 g/day (P(quadratic)= 0.006). For cardiovascular mortality, the corresponding HRs were 0.74 (95% CI: 0.54-1.02), 0.58 (95% CI: 0.39-0.84), and 0.98 (95% CI: 0.60-1.60), P(quadratic)= 0.003. These findings were consistent when restricted to pre- and post-MI alcohol assessments. In subgroup analyses, moderate alcohol consumption was inversely associated with mortality among men with non-anterior infarcts, and among men with mildly diminished left ventricular function. CONCLUSION Long-term moderate alcohol consumption is inversely associated with all-cause and cardiovascular mortality among men who survived a first MI. This U-shaped association may be strongest among individuals with less impaired cardiac function after MI and should be examined further.
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Affiliation(s)
- Jennifer K Pai
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
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12
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Movva R, Figueredo VM. Alcohol and the heart: to abstain or not to abstain? Int J Cardiol 2012; 164:267-76. [PMID: 22336255 DOI: 10.1016/j.ijcard.2012.01.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 01/07/2012] [Accepted: 01/19/2012] [Indexed: 12/12/2022]
Abstract
Alcohol has been consumed by most societies over the last 7000 years. Abraham Lincoln said "It has long been recognized that the problems with alcohol relate not to the use of a bad thing, but to the abuse of a good thing." Light to moderate alcohol consumption reduces the incidence of coronary heart disease (CHD), ischemic stroke, peripheral arterial disease, CHD mortality, and all-cause mortality, especially in the western populations. However, heavy alcohol consumption is detrimental causing cardiomyopathy, cardiac arrhythmias, hepatic cirrhosis, pancreatitis, and hemorrhagic stroke. In this article, we review the effects of alcohol on CHD, individual cardiovascular risk factors, cardiomyopathy, and cardiac arrhythmias, including the most recent evidence of the effects of alcohol on CHD.
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Affiliation(s)
- Rajesh Movva
- Albert Einstein Medical Center, Philadelphia, PA 19141, United States
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13
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Jiang CQ, Xu L, Lam TH, Thomas GN, Zhang WS, Cheng KK, Schooling CM. Alcohol consumption and aortic arch calcification in an older Chinese sample: the Guangzhou Biobank Cohort Study. Int J Cardiol 2011; 164:349-54. [PMID: 21813196 DOI: 10.1016/j.ijcard.2011.07.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 06/07/2011] [Accepted: 07/10/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To examine the association between alcohol consumption and aortic arch calcification (AAC) in an older Chinese sample. METHODS In 27,844 older people aged 50-85, socioeconomic position and lifestyle factors were assessed by a questionnaire. The presence and severity of AAC were diagnosed from chest X-ray by two experienced radiologists. RESULTS In men, the risk for AAC increased significantly in frequent or excessive drinkers [adjusted odds ratio (OR)=1.36 (95% confidence interval (CI) 1.16-1.59) and 1.49 (1.21-1.83) for those who drank >5 times/week and those who drank excessively, respectively] (P for trend from 0.002 to 0.001). When AAC was analyzed as an outcome variable with 3 categories of severity, significant dose-response relations between the severity of AAC and alcohol consumption were observed, with those who drank frequently (>5/week) or excessively having more serious AAC (P for trend=0.03 and 0.02, respectively). No significant association was found in women as few drank excessively. CONCLUSION The presence and severity of AAC were associated with quantity or frequency of alcohol consumption in a dose-response pattern, suggesting that alcohol drinking, even when moderate, has no benefit for AAC. Excessive drinking increased the risk of AAC by 50% compared to never drinkers.
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14
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Fagring AJ, Kjellgren KI, Rosengren A, Lissner L, Manhem K, Welin C. Depression, anxiety, stress, social interaction and health-related quality of life in men and women with unexplained chest pain. BMC Public Health 2008; 8:165. [PMID: 18489751 PMCID: PMC2416450 DOI: 10.1186/1471-2458-8-165] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 05/19/2008] [Indexed: 11/17/2022] Open
Abstract
Background Unexplained chest pain (UCP) is a common reason for emergency hospital admission and generates considerable health-care costs for society. Even though prior research indicates that psychological problems and impaired quality of life are common among UCP patients, there is lack of knowledge comparing UCP patients with a reference group from the general population. The aim of this study was to analyse differences between men and women with UCP and a reference group in terms of psychosocial factors as depression, anxiety, stress, social interaction and health-related quality of life (HRQOL). Methods A self-administered questionnaire about psychosocial factors was completed by 127 men and 104 women with acute UCP admitted consecutively to the Emergency Department (ED) or as in-patients on a medical ward. A reference group from the general population, 490 men and 579 women, participants in the INTERGENE study and free of clinical heart disease, were selected. Results The UCP patients were more likely to be immigrants, have a sedentary lifestyle, report stress at work and have symptoms of depression and trait-anxiety compared with the reference group. After adjustment for differences in age, smoking, hypertension and diabetes, these factors were still significantly more common among patients with UCP. In a stepwise multivariate model with mutual adjustment for psychosocial factors, being an immigrant was associated with a more than twofold risk in both sexes. Stress at work was associated with an almost fourfold increase in risk among men, whereas there was no independent impact for women. In contrast, depression only emerged as an independent risk factor in women. Trait-anxiety and a low level of social interaction were not independently associated with risk in either men or women. Patients with UCP were two to five times more likely to have low scores for HRQOL. Conclusion Both men and women with UCP had higher depression scores than referents, but an independent association was only found in women. Among men, perceived stress at work emerged as the only psychosocial variable significantly associated with UCP.
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Affiliation(s)
- Annika Janson Fagring
- The Sahlgrenska Academy at Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden.
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15
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Abstract
Numerous studies have used a J-shaped or U-shaped curve to describe the relationship between alcohol use and total mortality. The nadir of the curves based on recent meta-analysis suggested optimal benefit at approximately half a drink per day. Fewer than 4 drinks per day in men and fewer than 2 per day in women appeared to confer benefit. Reductions in cardiovascular death and nonfatal myocardial infarction were also associated with light to moderate alcohol intake. Although some studies suggested that wine had an advantage over other types of alcoholic beverages, other studies suggested that the type of drink was not important. Heavy drinking was associated with an increase in mortality, hypertension, alcoholic cardiomyopathy, cancer, and cerebrovascular events, including cerebrovascular hemorrhage. Paradoxically, light-to-moderate alcohol use actually reduced the development of heart failure and did not appear to exacerbate it in most patients who had underlying heart failure. Numerous mechanisms have been proposed to explain the benefit that light-to-moderate alcohol intake has on the heart, including an increase of high-density lipoprotein cholesterol, reduction in plasma viscosity and fibrinogen concentration, increase in fibrinolysis, decrease in platelet aggregation, improvement in endothelial function, reduction of inflammation, and promotion of antioxidant effects. Controversy exists on whether alcohol has a direct cardioprotective effect on ischemic myocardium. Studies from our laboratory do not support the concept that alcohol has a direct cardioprotective effect on ischemic/reperfused myocardium. Perhaps the time has come for a prospectively randomized trial to determine whether 1 drink per day (or perhaps 1 drink every other day) reduces mortality and major cardiovascular events.
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Affiliation(s)
- Robert A Kloner
- Heart Institute, Good Samaritan Hospital, 1225 Wilshire Blvd, Los Angeles, CA 90017, USA.
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16
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Mellen PB, Bittner V, Herrington DM. Post-challenge glucose predicts coronary atherosclerotic progression in non-diabetic, post-menopausal women. Diabet Med 2007; 24:1156-9. [PMID: 17672859 DOI: 10.1111/j.1464-5491.2007.02222.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS We sought to determine whether fasting or post-challenge glucose were associated with progression of coronary atherosclerosis in non-diabetic women. METHODS We performed a post-hoc analysis of 132 non-diabetic women who underwent 75-g oral glucose tolerance testing. The primary outcome of interest was progression of atherosclerosis determined by baseline and follow-up coronary angiography, a mean of 3.1 +/- 0.9 years apart. We analysed the association of change in minimal vessel diameter (DeltaMD) by quartile of fasting and post-challenge glucose using mixed models that included adjustment for age, systolic blood pressure, total : high-density lipoprotein cholesterol ratio, current smoking, lipid-lowering and anti-hypertensive medication use and other covariates. RESULTS At baseline, participants had a mean age of 65.7 +/- 6.7 years and a mean body mass index of 27.9 +/- 8.5 kg/m(2). Although there were no significant differences in atherosclerotic progression by fasting glucose category (P for trend across quartiles = 0.99), there was a significant inverse association between post-challenge glucose and DeltaMD (in mm) (Q1 : 0.01 +/- 0.03; Q2 : 0.08 +/- 0.03; Q3 : 0.13 +/- 0.03; Q4 : 0.11 +/- 0.03; P for trend = 0.02). CONCLUSIONS In post-menopausal women without diabetes, post-challenge glucose predicts angiographic disease progression. These findings suggest that even modest post-challenge hyperglycaemia influences the pathogenesis of atherosclerotic progression.
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Affiliation(s)
- P B Mellen
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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17
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Femia R, Natali A, L'Abbate A, Ferrannini E. Coronary atherosclerosis and alcohol consumption: angiographic and mortality data. Arterioscler Thromb Vasc Biol 2006; 26:1607-12. [PMID: 16627806 DOI: 10.1161/01.atv.0000222929.99098.1f] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Moderate alcohol consumption is associated with reduced cardiovascular disease (CVD) risk. Whether this protection is based on a lesser degree of coronary atherosclerosis has not been established. METHODS AND RESULTS We studied 1676 men and 465 women consecutively undergoing coronary angiography. A score (ATS) was calculated by summing the percent lumen narrowing of all main vessels; alcohol consumption was quantitated by questionnaire. In univariate analysis, ATS was significantly (P< or = 0.001) associated with male sex, age, familial CVD, smoking, diabetes, hypertension, and serum cholesterol levels; alcohol consumption was associated with less frequent diabetes (P<0.001) and lower ATS (P = 0.02). By multivariate analysis, alcohol intake was associated with lower ATS (P<0.01) independently of the other risk factors; the estimated effect size was comparable to that associated with a 1-mmol decrement in serum cholesterol. Over a median follow-up of 93 months, 37 women and 194 men died from a cardiac cause. By Cox analysis, positive predictors for cardiac mortality were male sex (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.1 to 2.6]), age (HR, 2.1; 95% CI, 1.8 to 2.5 per decade) and diabetes (HR, 1.7; 95% CI, 1.2 to 2.4), whereas alcohol consumption was the only negative predictor (HR, 0.84; 95% CI, 0.71 to 1.00). CONCLUSIONS In a selected high-risk population, moderate alcohol consumption was independently associated with less coronary atherosclerosis and lower risk for cardiac mortality.
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Affiliation(s)
- Romana Femia
- Department of Internal Medicine and CNR Institute of Clinical Physiology, University of Pisa School of Medicine, Pisa, Italy
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18
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Mukamal KJ, Girotra S, Mittleman MA. Alcohol consumption, atherosclerotic progression, and prognosis among patients with coronary artery bypass grafts. Am Heart J 2006; 151:368-72. [PMID: 16442902 DOI: 10.1016/j.ahj.2005.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Accepted: 05/09/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although moderate drinking has been associated with lower mortality among patients after myocardial infarction, its relationship with prognosis and graft obstruction among patients with coronary artery bypass grafts is unknown. METHODS We studied 1351 patients enrolled in the Post-CABG trial, who had undergone coronary bypass surgery 1 to 11 years before entry. Participants were randomly assigned to lovastatin in low or high doses and to low-dose warfarin or placebo in a factorial design. Participants underwent coronary angiography at baseline and after a mean follow-up of 4.3 years and were followed up for a composite end point of death, myocardial infarction, stroke, bypass surgery, or angioplasty. We categorized reported weekly alcohol intake as abstention (<1 drink), light (1-6 drinks), moderate (7-13 drinks), and heavier (> or =14 drinks). RESULTS During follow-up, 238 participants sustained a clinical event. Moderate drinking was associated with a trend toward both fewer clinical events (hazard ratio 0.7, 95% CI 0.4-1.1) and less angiographic progression (odds ratio 0.7, 95% CI 0.5-1.1), although neither of these effects were statistically significant. High-density lipoprotein cholesterol appeared to account for one third of the trend toward lower risk among moderate drinkers. CONCLUSION We did not demonstrate statistically significant differences in prognosis according to alcohol intake in this study, although there were inverse trends between moderate drinking and both morbidity and graft progression of a magnitude similar to studies in other populations. Larger studies of alcohol intake among patients with coronary artery bypass grafts are needed.
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Affiliation(s)
- Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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19
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Mellen PB, Cefalu WT, Herrington DM. Diabetes, the Metabolic Syndrome, and Angiographic Progression of Coronary Arterial Disease in Postmenopausal Women. Arterioscler Thromb Vasc Biol 2006; 26:189-93. [PMID: 16239594 DOI: 10.1161/01.atv.0000191656.71812.7c] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Although the metabolic syndrome (MS) is associated with increased cardiovascular risk, its relationship with atherosclerotic progression is less well defined. We sought to determine whether the MS predicts angiographic progression of coronary heart disease in a cohort of postmenopausal women. METHODS AND RESULTS A total of 309 postmenopausal women entered the Estrogen Replacement and Atherosclerosis trial, of whom 248 underwent baseline angiography and completed follow-up angiography after an average of 3.2 years. Women were identified as having type 2 diabetes mellitus (T2DM) or the MS (National Cholesterol Education Panel diagnostic criteria). In adjusted models, participants with T2DM and the MS had greater angiographic progression [change in minimal diameter (DeltaMD): -0.15] than women without T2DM or the MS (DeltaMD: -0.08; P<0.05) or with MS alone (DeltaMD: -0.07; P<0.005); there was no difference in progression by MS status in women without T2DM (P=0.54)]. In adjusted logistic regression models, T2DM predicted coronary heart disease events [odds ratio, 2.79 (95% CI, 1.29 to 6.02)], and the MS demonstrated a similar trend [odds ratio, 1.98 (95% CI, 0.90 to 4.33)]. CONCLUSIONS Among postmenopausal women with coronary heart disease, the presence of diabetes predicted disease progression, but the MS did not.
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Affiliation(s)
- Philip B Mellen
- Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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21
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Cullen JP, Sayeed S, Jin Y, Theodorakis NG, Sitzmann JV, Cahill PA, Redmond EM. Ethanol inhibits monocyte chemotactic protein-1 expression in interleukin-1{beta}-activated human endothelial cells. Am J Physiol Heart Circ Physiol 2005; 289:H1669-75. [PMID: 15908470 PMCID: PMC1249528 DOI: 10.1152/ajpheart.00106.2005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The aim of this study was to determine the effect of ethanol (EtOH) on endothelial monocyte chemotactic protein-1 (MCP-1) expression. IL-1beta increased the production of MCP-1 by human umbilical vein endothelial cells from undetectable levels to approximately 900 pg/ml at 24 h. EtOH dose-dependently inhibited IL-1beta-stimulated MCP-1 secretion as determined by ELISA: 25 +/- 1%, 35 +/- 7%, and 65 +/- 5% inhibition for 1, 10, and 100 mM EtOH, respectively, concomitant with inhibition of monocyte adhesion to activated endothelial cells. Similarly, EtOH dose-dependently inhibited IL-1beta-stimulated MCP-1 mRNA expression. Experiments with actinomycin D demonstrated that EtOH decreased the stability of MCP-1 mRNA. In addition, EtOH significantly reduced NF-kappaB and AP-1 binding activity induced by IL-1beta and inhibited MCP-1 gene transcription. Binding of (125)I-labeled MCP-1 to its receptor (CCR2) on THP-1 human monocytic cells was not affected by EtOH treatment. Modulation of the expression of MCP-1 represents a mechanism whereby EtOH could inhibit atherogenesis by blocking the crucial early step of monocyte adhesion and subsequent recruitment to the subendothelial space. These actions of EtOH may underlie, in part, its cardiovascular protective effects in vivo.
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Affiliation(s)
- John P. Cullen
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642 and
| | - Shariq Sayeed
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642 and
| | - Ying Jin
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642 and
| | | | - James V. Sitzmann
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642 and
| | - Paul A. Cahill
- Vascular Health Research Centre, Dublin City University, Dublin, Ireland
| | - Eileen M. Redmond
- Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642 and
- Corresponding author: Dr. Eileen M. Redmond, University of Rochester Medical Center, Department of Surgery, Box SURG, 601 Elmwood Avenue, Rochester, NY, 14642-8410, Tel: (585) 275-2870, Fax: (585) 756-7819, E-mail:
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Abstract
BACKGROUND AND OBJECTIVE Cardiovascular disease has been identified as the leading cause of morbidity and mortality in developed countries. Given the increase in life expectancy and the development of cardiovascular preventive measures, it has become increasingly important to detect and prevent cardiovascular diseases in the elderly. We reviewed the scientific literature concerning cardiovascular prevention to assess the importance of cardiovascular preventive measures in old (> or =65 years of age) individuals. METHODS We undertook a systematic search for references relating to prevention of cardiovascular disease in the elderly, mainly ischaemic stroke, coronary artery disease and heart failure, on the MEDLINE database 1962-2005. For cardiovascular prevention by drugs or surgery, emphasis was placed on randomised controlled trials, review articles and meta-analyses. For cardiovascular prevention by lifestyle modification, major cohort studies were also considered. RESULTS Stroke, coronary heart disease and heart failure were found to be the main targets for cardiovascular prevention in published studies. Antihypertensive treatment has proven its efficacy in primary prevention of fatal or nonfatal stroke in hypertensive and high-risk patients >60 years of age, particularly through treatment of systolic hypertension. Systolic blood pressure reduction is equally important in the secondary prevention of stroke. Similarly, in nonvalvular atrial fibrillation, an adjusted dose of warfarin with a target International Normalized Ratio (INR) of between 2 to 3 prevents ischaemic stroke in elderly patients with an acceptable haemorrhagic risk but is still under prescribed. Antiplatelet agents are indicated in elderly patients with nonembolic strokes. Few large-scale studies have investigated the effect of HMG-CoA reductase inhibitors (statins) on stroke prevention in old individuals. To date, the largest trials suggest a beneficial effect for stroke prevention with use of statins in high-risk elderly subjects < or =82 years of age. Carotid endarterectomy is indicated in carotid artery stenosis >70% and outcomes are even better in elderly than in younger patients. However, medical treatment is still the first-line treatment in asymptomatic elderly patients with <70% stenosis. In ischaemic heart disease, different trials in elderly individuals have shown that use of statins, antithrombotic agents, beta-adrenoceptor antagonists and ACE inhibitors plays an important role either in primary or in secondary cardiovascular prevention. Hormone replacement therapy has been used to treat climacteric symptoms and postmenopausal osteoporosis and was thought to confer a cardiovascular protection. However, controlled trials in elderly individuals changed this false belief when it was found that there was no benefit and even a harmful cardiovascular effect during the first year of treatment. Smoking cessation, regular physical activity and healthy diet are, as in younger individuals, appropriate and effective measures for preventing cardiovascular events in the elderly. Finally, antihypertensive treatment and influenza vaccination are useful for heart failure prevention in elderly individuals. CONCLUSIONS Cardiovascular prevention should be more widely implemented in the elderly, including individuals aged > or =75 years, and this might contribute to improved healthy status and quality of life in this growing population.
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Affiliation(s)
- Wafik Farah Andrawes
- Service de Gériatrie, Hôpital Charles Foix et Université Paris 6, Ivry-sur-Seine, France
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