1
|
Carr S, Bryazka D, McLaughlin SA, Zheng P, Bahadursingh S, Aravkin AY, Hay SI, Lawlor HR, Mullany EC, Murray CJL, Nicholson SI, Rehm J, Roth GA, Sorensen RJD, Lewington S, Gakidou E. A burden of proof study on alcohol consumption and ischemic heart disease. Nat Commun 2024; 15:4082. [PMID: 38744810 PMCID: PMC11094064 DOI: 10.1038/s41467-024-47632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
Cohort and case-control data have suggested an association between low to moderate alcohol consumption and decreased risk of ischemic heart disease (IHD), yet results from Mendelian randomization (MR) studies designed to reduce bias have shown either no or a harmful association. Here we conducted an updated systematic review and re-evaluated existing cohort, case-control, and MR data using the burden of proof meta-analytical framework. Cohort and case-control data show low to moderate alcohol consumption is associated with decreased IHD risk - specifically, intake is inversely related to IHD and myocardial infarction morbidity in both sexes and IHD mortality in males - while pooled MR data show no association, confirming that self-reported versus genetically predicted alcohol use data yield conflicting findings about the alcohol-IHD relationship. Our results highlight the need to advance MR methodologies and emulate randomized trials using large observational databases to obtain more definitive answers to this critical public health question.
Collapse
Affiliation(s)
- Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Dana Bryazka
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sarasvati Bahadursingh
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Aleksandr Y Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Hilary R Lawlor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sneha I Nicholson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada
- World Health Organization / Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sarah Lewington
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
2
|
Park CS, Choi J, Choi J, Lee KY, Ahn HJ, Kwon S, Lee SR, Choi EK, Kwak SH, Oh S. Alcohol is neither a risk factor nor a protective factor for sudden cardiac death and/or fatal ventricular arrhythmia: A population-based study with genetic traits and alcohol consumption in the UK Biobank. Heart Rhythm 2024:S1547-5271(24)02531-1. [PMID: 38697272 DOI: 10.1016/j.hrthm.2024.04.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND The association between alcohol consumption and the risk of sudden cardiac death and/or fatal ventricular arrhythmia remains controversial. OBJECTIVE We analyzed the association between alcohol consumption, genetic traits for alcohol metabolism, and the risk of sudden cardiac death and/or fatal ventricular arrhythmia. METHODS We identified 397,164 individuals enrolled between 2006 and 2010 from the UK Biobank database and followed them until 2021. Alcohol consumption was categorized as current nondrinkers (nondrinkers and ex-drinkers), mild drinkers, moderate drinkers, or heavy drinkers. Genetic traits of alcohol metabolism were stratified according to the polygenic risk score tertiles. The primary and secondary outcomes were a composite of sudden cardiac death and fatal ventricular arrhythmia as well as their individual components. RESULTS During follow-up (median 12.5 years), 3543 cases (0.89%) of clinical outcomes occurred. Although mild, moderate, and heavy drinkers showed deceased risks of outcomes compared with current nondrinkers, there was no prognostic difference among nondrinkers, mild drinkers, moderate drinkers, and heavy drinkers. Ex-drinkers showed an increased risk in univariate analysis, but the significance was attenuated after adjusting covariates (hazard ratio 1.19; 95% confidence interval 0.94-1.50). As a continuous variable, alcohol consumption was not associated with clinical outcomes (hazard ratio 1.01; 95% confidence interval 0.99-1.02). Consistent with these findings, there was no association between genetic traits for alcohol metabolism and the risk of clinical outcomes. CONCLUSION Alcohol consumption was neither a protective factor nor a risk factor for sudden cardiac death or fatal ventricular arrhythmia. Genetic traits of alcohol metabolism were not associated with the clinical prognosis.
Collapse
Affiliation(s)
- Chan Soon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaewon Choi
- Division of Data Science Research, Innovative Biomedical Technology Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - JungMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Yeon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| |
Collapse
|
3
|
Lenarczyk R, Zeppenfeld K, Tfelt-Hansen J, Heinzel FR, Deneke T, Ene E, Meyer C, Wilde A, Arbelo E, Jędrzejczyk-Patej E, Sabbag A, Stühlinger M, di Biase L, Vaseghi M, Ziv O, Bautista-Vargas WF, Kumar S, Namboodiri N, Henz BD, Montero-Cabezas J, Dagres N. Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC-endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society. Europace 2024; 26:euae049. [PMID: 38584423 PMCID: PMC10999775 DOI: 10.1093/europace/euae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/09/2024] Open
Abstract
Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA.
Collapse
Affiliation(s)
- Radosław Lenarczyk
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology and Electrotherapy, Silesian Center for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frank R Heinzel
- Cardiology, Angiology, Intensive Care, Städtisches Klinikum Dresden Campus Friedrichstadt, Dresden, Germany
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
- Clinic for Electrophysiology, Klinikum Nuernberg, University Hospital of the Paracelsus Medical University, Nuernberg, Germany
| | - Elena Ene
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Christian Meyer
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Düsseldorf, Germany
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Markus Stühlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luigi di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrythmia Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Ohad Ziv
- Case Western Reserve University, Cleveland, OH, USA
- The MetroHealth System Campus, Cleveland, OH, USA
| | | | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Benhur Davi Henz
- Instituto Brasilia de Arritmias-Hospital do Coração do Brasil-Rede Dor São Luiz, Brasilia, Brazil
| | - Jose Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
4
|
Lee AS, Sung YL, Pan SH, Sung KT, Su CH, Ding SL, Lu YJ, Hsieh CL, Chen YF, Liu CC, Chen WY, Chen XR, Chung FP, Wang SW, Chen CH, Mochly-Rosen D, Hung CL, Yeh HI, Lin SF. A Common East Asian aldehyde dehydrogenase 2*2 variant promotes ventricular arrhythmia with chronic light-to-moderate alcohol use in mice. Commun Biol 2023; 6:610. [PMID: 37280327 PMCID: PMC10244406 DOI: 10.1038/s42003-023-04985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/26/2023] [Indexed: 06/08/2023] Open
Abstract
Chronic heavy alcohol use is associated with lethal arrhythmias. Whether common East Asian-specific aldehyde dehydrogenase deficiency (ALDH2*2) contributes to arrhythmogenesis caused by low level alcohol use remains unclear. Here we show 59 habitual alcohol users carrying ALDH2 rs671 have longer QT interval (corrected) and higher ventricular tachyarrhythmia events compared with 137 ALDH2 wild-type (Wt) habitual alcohol users and 57 alcohol non-users. Notably, we observe QT prolongation and a higher risk of premature ventricular contractions among human ALDH2 variants showing habitual light-to-moderate alcohol consumption. We recapitulate a human electrophysiological QT prolongation phenotype using a mouse ALDH2*2 knock-in (KI) model treated with 4% ethanol, which shows markedly reduced total amount of connexin43 albeit increased lateralization accompanied by markedly downregulated sarcolemmal Nav1.5, Kv1.4 and Kv4.2 expressions compared to EtOH-treated Wt mice. Whole-cell patch-clamps reveal a more pronounced action potential prolongation in EtOH-treated ALDH2*2 KI mice. By programmed electrical stimulation, rotors are only provokable in EtOH-treated ALDH2*2 KI mice along with higher number and duration of ventricular arrhythmia episodes. The present research helps formulate safe alcohol drinking guideline for ALDH2 deficient population and develop novel protective agents for these subjects.
Collapse
Affiliation(s)
- An-Sheng Lee
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Division of Cardiovascular Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Ling Sung
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Graduate Institute of Biomedical Optomechatronics, Taipei Medical University, Taipei, Taiwan
| | - Szu-Hua Pan
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei, Taiwan
- Genome and Systems Biology Degree Program, National Taiwan University and Academia Sinica, Taipei, Taiwan
- Doctoral Degree Program of Translational Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuo-Tzu Sung
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Huang Su
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shiao-Li Ding
- Department of Medical Research, MacKay Memorial Hospital, New Taipei, Taiwan
| | - Ying-Jui Lu
- Department of Medical Research, MacKay Memorial Hospital, New Taipei, Taiwan
| | - Chin-Ling Hsieh
- Department of Medical Research, MacKay Memorial Hospital, New Taipei, Taiwan
| | - Yun-Fang Chen
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Chuan-Chuan Liu
- Department of Physiology Examination, MacKay Memorial Hospital, New Taipei, Taiwan
| | - Wei-Yu Chen
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Xuan-Ren Chen
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan
| | - Shih-Wei Wang
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei, Taiwan
| | - Che-Hong Chen
- Department of Chemical and Systems Biology, Stanford University, School of Medicine, Stanford, CA, USA
| | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology, Stanford University, School of Medicine, Stanford, CA, USA
| | - Chung-Lieh Hung
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan.
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei, Taiwan.
| | - Hung-I Yeh
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan.
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
| | - Shien-Fong Lin
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| |
Collapse
|
5
|
Kilcoyne J, Assaassa A. Alcohol and Cardiac Arrythmias: A Review of the Current Data. Rev Cardiovasc Med 2023; 24:105. [PMID: 39076274 PMCID: PMC11273001 DOI: 10.31083/j.rcm2404105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 07/31/2024] Open
Abstract
Background Alcohol is a pervasive substance in the US and the world in general. Cardiac arrythmias, specifically atrial fibrillation, are also a critical health issue. The interplay between alcohol and arrythmia is explored here. Methods Original research, editorials and other literature reviews were searched and assessed for candidacy for inclusion and ability to contribute to this article. Conclusions Alcohol consumption has a significant interplay with cardiac arrhythmia.
Collapse
Affiliation(s)
- James Kilcoyne
- Saint Mary Physician Group, Comprehensive Cardiology Section, Langhorne,
PA 19067, USA
| | - Abdalrahman Assaassa
- Saint Mary Medical Center, Internal Medicine Residency, Langhorne,
PA 19067, USA
| |
Collapse
|
6
|
Wong CX, Tu SJ, Marcus GM. Alcohol and Arrhythmias. JACC Clin Electrophysiol 2023; 9:266-279. [PMID: 36858701 DOI: 10.1016/j.jacep.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/12/2022] [Indexed: 03/03/2023]
Abstract
The association between alcohol consumption and abnormalities of heart rate and rhythm has long been recognized. Significant attention has focused on the risk of atrial fibrillation (AF) and sudden cardiac death (SCD) with excessive alcohol intake. Recent studies have advanced our understanding of these relationships and provided additional insights into potentially arrhythmogenic mechanisms. However, considerable uncertainty remains, such as the level of consumption at which harm begins and whether alcohol plays a role in other arrhythmias. This review characterizes the spectrum of conduction abnormalities and heart rhythm disorders in relation to alcohol consumption. In addition, it discusses the latest epidemiologic and experimental evidence, the potential importance of beverage type and constituent ingredients, and conflicting information on drink definitions, thresholds, and recommendations.
Collapse
Affiliation(s)
- Christopher X Wong
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA; Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Samuel J Tu
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Gregory M Marcus
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
| |
Collapse
|
7
|
Chudzińska M, Wołowiec Ł, Banach J, Rogowicz D, Grześk G. Alcohol and Cardiovascular Diseases—Do the Consumption Pattern and Dose Make the Difference? J Cardiovasc Dev Dis 2022; 9:jcdd9100317. [PMID: 36286269 PMCID: PMC9603956 DOI: 10.3390/jcdd9100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/06/2022] [Accepted: 09/17/2022] [Indexed: 11/22/2022] Open
Abstract
Excessive consumption of alcohol is not only a social problem, but it also significantly increases the morbidity and mortality rates of many societies. A correlation has been demonstrated between alcohol consumption and increased mortality from cancer, accidents and injuries, liver cirrhosis and other causes. Alcohol abuse increases the incidence of hemorrhagic stroke and the risk of ischemic stroke, induces serious arrhythmias, adversely affects blood pressure and damages the heart muscle. The dose and way of drinking alcohol play a crucial role in assessing whether this drink allows people to maintain health or whether it is a great health and social threat. The beneficial effects of low and moderate doses of alcohol on the occurrence of cardiovascular diseases have been shown in many population studies and meta-analyses in which the effect of U-shaped or J-shaped curves relating alcohol intake to cardiovascular mortality was observed, especially in ischemic heart disease. However, due to the fact that alcohol consumption is associated with many health hazards, it is not recommended to consume it as a preventive action of cardiovascular diseases. Moreover, recent studies suggest that association of low-to-moderate alcohol consumption with the reduction in cardiovascular risk is a result of lifestyle changes and that any reduction in alcohol consumption is in fact beneficial in terms of general health.
Collapse
Affiliation(s)
- Małgorzata Chudzińska
- Department of Nutrition and Dietetics, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Dębowa 3 Street, 85-626 Bydgoszcz, Poland
| | - Łukasz Wołowiec
- Department of Cardiology and Clinical Pharmacology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland
- Correspondence:
| | - Joanna Banach
- Department of Cardiology and Clinical Pharmacology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland
| | - Daniel Rogowicz
- Department of Cardiology and Clinical Pharmacology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland
| |
Collapse
|
8
|
Klein MD, Keen SK, Sanka P, Senter E, Lin FC, Jones H, Vandermolen JL, Simpson RJ. Social Disparities among Sudden Death victims with HIV. AIDS Behav 2022; 26:3974-3980. [PMID: 35672553 DOI: 10.1007/s10461-022-03723-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/18/2022] [Indexed: 11/01/2022]
Abstract
Although cardiovascular death is a growing source of mortality for people living with human immunodeficiency virus (HIV), the risk factors and circumstances surrounding sudden death in this population are poorly understood. We compared 399 adult sudden death victims reported by Emergency Medical Services in North Carolina to 1,114 controls. Sudden death was more common among HIV-positive than HIV-negative individuals (OR: 2.59, 95% CI: 1.15-5.83). In a multivariable model of sudden death victims including Black race, BMI, and history of divorce, incarceration, substance abuse, and respiratory disease, HIV-positive individuals were more likely to be Black (adjusted OR [aOR]: 6.04, 95% CI: 1.08-33.7) or divorced (aOR: 4.71, 95% CI: 1.04-21.3), adjusted for all other variables in the model. Compared to controls with HIV, sudden death victims with HIV were more likely to have a history of incarceration, divorce, respiratory disease, alcohol abuse, or dyslipidemia. A qualitative assessment of victims suggested that many died in isolation, suffering from past and current substance abuse and depression. HIV infection appears to be an important risk factor for sudden death, and incarceration history, social isolation, and medical comorbidities contribute to sudden death risk for HIV-positive individuals.
Collapse
Affiliation(s)
- Melissa D Klein
- Department of Medicine, Department of Medicine, Washington University in St. Louis School of Medicine, 63110, St. Louis, Missouri, United States of America.
| | - Susan K Keen
- Preventive Medicine Residency, Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Pranavi Sanka
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Elizabeth Senter
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Feng-Chang Lin
- The North Carolina Translational & Clinical Sciences Institute, Chapel Hill, NC, United States of America
| | - Hannah Jones
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Justin L Vandermolen
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ross J Simpson
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| |
Collapse
|
9
|
Tu SJ, Gallagher C, Elliott AD, Linz D, Pitman BM, Hendriks JML, Lau DH, Sanders P, Wong CX. Alcohol intake and bradyarrhythmia risk: a cohort study of 407 948 individuals. Europace 2022; 24:1469-1474. [PMID: 35178566 PMCID: PMC9559907 DOI: 10.1093/europace/euac007] [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] [Received: 08/28/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS There is a paucity of epidemiological evidence on alcohol and the risk of bradyarrhythmias. We thus characterized associations of total and beverage-specific alcohol consumption with incident bradyarrhythmias using data from the UK Biobank. METHODS AND RESULTS Alcohol consumption reported at baseline was calculated as UK standard drinks (8 g alcohol)/week. Bradyarrhythmia events were defined as sinus node dysfunction (SND), high-level atrioventricular block (AVB), and permanent pacemaker implantations. Outcomes were assessed through hospitalization and death records, and dose-response associations were characterized using Cox regression models with correction for regression dilution bias. We studied 407 948 middle-aged individuals (52.4% female). Over a median follow-up time of 11.5 years, a total of 8 344 incident bradyarrhythmia events occurred. Increasing total alcohol consumption was not associated with an increased risk of bradyarrhythmias. Beer and cider intake were associated with increased bradyarrhythmia risk up to 12 drinks/week; however, no significant associations were observed with red wine, white wine, or spirit intake. When bradyarrhythmia outcomes were analysed separately, a negative curvilinear was observed for total alcohol consumption and risk of SND, but no clear association with AVB was observed. CONCLUSION In this predominantly White British cohort, increasing total alcohol consumption was not associated with an increased risk of bradyarrhythmias. Associations appeared to vary according to the type of alcoholic beverage and between different types of bradyarrhythmias. Further epidemiological and experimental studies are required to clarify these findings.
Collapse
Affiliation(s)
- Samuel J Tu
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Bradley M Pitman
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Jeroen M L Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide SA 5000, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide SA 5000, Australia
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW Sudden cardiac arrest (SCA) remains a major health burden around the globe, most often occurring in the community (out-of-hospital cardiac arrest [OHCA]). SCA accounts for 15-20% of all natural deaths in adults in the USA and Western Europe, and up to 50% of all cardiovascular deaths. To reduce this burden, more knowledge is needed about its key facets such as its incidence in various geographies, its risk factors, and the populations that may be at risk. RECENT FINDINGS SCA results from a complex interaction of inherited and acquired causes, specific to each individual. Resolving this complexity, and designing personalized prevention and treatment, requires an integrated approach in which big datasets that contain all relevant factors are collected, and a multimodal analysis. Such datasets derive from multiple data sources, including all players in the chain-of-care for OHCA. This recognition has led to recently started large-scale collaborative efforts in Europe. SUMMARY Our insights into the causes of SCA are steadily increasing thanks to the creation of big datasets dedicated to SCA research. These insights may be used to earlier recognize of individuals at risk, the design of personalized methods for prevention, and more effective resuscitation strategies for OHCA.
Collapse
|
11
|
Alcohol consumption and risk of ventricular arrhythmias and sudden cardiac death: An observational study of 408,712 individuals. Heart Rhythm 2021; 19:177-184. [DOI: 10.1016/j.hrthm.2021.09.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/18/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022]
|
12
|
Rim SJ, Jo M, Lee JH, Park S. Analyzing Untreated Alcohol Use Disorder and Factors Related to Help-Seeking Status. Psychiatry Investig 2021; 18:936-942. [PMID: 34619821 PMCID: PMC8542744 DOI: 10.30773/pi.2021.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Alcohol use disorder (AUD) is a global burden but is also one of the most undertreated mental disorders. This study estimates the treatment rate (i.e., help-seeking status) of high-risk drinkers and factors associated with not receiving treatment in Korea using nationally representative National Health Insurance Service-National Sample Cohort (NHIS-NSC) data. METHODS Among 1,025,340 participants, we eliminated those under 20 and those who did not respond to the question regarding alcohol consumption. High-risk drinkers were classified based on their frequency and quantity of alcohol consumption (4 or more drinks for women, 5 or more drinks for men per day on average). In total, 32,225 high-risk drinkers were checked for an actual AUD diagnosis to see their treatment-seeking status. RESULTS Among 32,225 high-risk drinkers, only 1.24% had an AUD diagnosis, showing that over 98% of those who could be diagnosed with AUD are not seeking treatment. Factors associated with not seeking treatment were female sex, BMI higher or equal to 18.6, former smoker, middle-aged, and Charlson Comorbidity Index (CCI). CONCLUSION Our data show that many high-risk drinkers do not seek treatment in Korea. Experts, policymakers, and clinicians should promote help-seeking behavior for AUD and pay close attention to those at risk of not receiving treatment for AUD.
Collapse
Affiliation(s)
- Soo Jung Rim
- Department of Research Planning, National Center for Mental Health, Seoul, Republic of Korea
| | - MinKyung Jo
- Department of Research Planning, National Center for Mental Health, Seoul, Republic of Korea
| | - Junghyun H Lee
- National Center for Disaster and Trauma, Seoul, Republic of Korea
| | - Subin Park
- Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| |
Collapse
|
13
|
Manolis TA, Apostolopoulos EJ, Manolis AA, Melita H, Manolis AS. The proarrhythmic conundrum of alcohol intake. Trends Cardiovasc Med 2021; 32:237-245. [PMID: 33762184 DOI: 10.1016/j.tcm.2021.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 12/31/2022]
Abstract
The arrhythmogenic potential of alcohol consumption that leads to cardiac arrhythmia development includes the induction of both atrial and ventricular arrhythmias, with atrial fibrillation (AF) being the commonest alcohol-related arrhythmia, even with low/moderate alcohol consumption. Arrhythmias occur both with acute and chronic alcohol use. The "Holiday Heart Syndrome" relates to the occurrence of AF, most commonly following weekend or public holiday binge drinking; however, other arrhythmias may also occur, including other supraventricular arrhythmias, and occasionally even frequent ventricular premature beats and a rare occurrence of ventricular tachycardia. Arrhythmias in individuals with alcohol use disorder, in addition to AF, may comprise ventricular arrhythmias (VAs) that may be potentially fatal leading to cardiac arrest. The effects of alcohol on triggering VAs appear to be dose-dependent, observed more commonly in heavy drinkers, both in healthy individuals and patients with underlying structural heart disease, including ischemic heart disease and alcoholic cardiomyopathy. Men appear to be affected at higher dosages of alcohol, while women can suffer from arrhythmias at lower dosages. On the other hand, low to moderate consumption of alcohol may confer some protection from serious VAs and cardiac arrest (J- or U-curve phenomenon); however, abstinence is the optimal strategy. These issues as they relate to alcohol-induced proarrhythmia are herein reviewed, with the large studies and meta-analyses tabulated and the arrhythmogenic mechanisms pictorially illustrated.
Collapse
Affiliation(s)
| | | | | | | | - Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
| |
Collapse
|
14
|
Reddiess P, Aeschbacher S, Meyre P, Coslovsky M, Kühne M, Rodondi N, Baretella O, Beer JH, Kobza R, Moschovitis G, Di Valentino M, Müller C, Steiner F, Bonati LH, Sticherling C, Osswald S, Conen D. Alcohol consumption and risk of cardiovascular outcomes and bleeding in patients with established atrial fibrillation. CMAJ 2021; 193:E117-E123. [PMID: 33667180 PMCID: PMC7954562 DOI: 10.1503/cmaj.200778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND: Little is known about the association between alcohol consumption and risk of cardiovascular events in patients with established atrial fibrillation (AF). The main aim of the current study was to investigate the associations of regular alcohol intake with incident stroke or systemic embolism in patients with established AF. METHODS: To assess the association between alcohol consumption and cardiovascular events in patients with established AF, we combined data from 2 comparable prospective cohort studies that followed 3852 patients with AF for a median of 3.0 years. Patients were grouped into 4 categories of daily alcohol intake (none, > 0 to < 1, 1 to < 2 and ≥ 2 drinks/d). The primary outcome was a composite of stroke and systemic embolism. Secondary outcomes were all-cause mortality, myocardial infarction, hospital admission for acute heart failure, and a composite of major and clinically relevant nonmajor bleeding. Associations were assessed using time-updated, multivariable-adjusted Cox proportional hazards models. RESULTS: Mean age (± standard deviation) was 71 ± 10 years (28% were women and 84% were on oral anticoagulants). We observed 136 confirmed strokes or systemic emboli. Compared with nondrinkers, adjusted hazard ratios for the primary outcome event were 0.87, 95% confidence interval (CI) 0.55–1.37 for > 0 to < 1 drinks/d; 0.70, 95% CI 0.39–1.25 for 1 to < 2 drinks/d; and 0.96, 95% CI 0.56–1.67 for ≥ 2 drinks/d (p for linear [quadratic] trend 0.71 [0.22]). There was no significant association between alcohol consumption and bleeding, but there was a nonlinear association with heart failure (p for quadratic trend 0.01) and myocardial infarction (p for quadratic trend 0.007). INTERPRETATION: In patients with AF, we did not find a significant association between low to moderate alcohol intake and risk of stroke or other cardiovascular events. Our findings do not support special recommendations for patients with established AF with regard to alcohol consumption. Trial registration: ClinicalTrials.gov, no. NCT02105844
Collapse
Affiliation(s)
- Philipp Reddiess
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Pascal Meyre
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Michael Coslovsky
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Michael Kühne
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Nicolas Rodondi
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Oliver Baretella
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Jürg H Beer
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Richard Kobza
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Giorgio Moschovitis
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Marcello Di Valentino
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Cyrill Müller
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Fabienne Steiner
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Leo H Bonati
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Christian Sticherling
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - Stefan Osswald
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont
| | - David Conen
- Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont.
| | | |
Collapse
|
15
|
Sattler SM, Skibsbye L, Linz D, Lubberding AF, Tfelt-Hansen J, Jespersen T. Ventricular Arrhythmias in First Acute Myocardial Infarction: Epidemiology, Mechanisms, and Interventions in Large Animal Models. Front Cardiovasc Med 2019; 6:158. [PMID: 31750317 PMCID: PMC6848060 DOI: 10.3389/fcvm.2019.00158] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/18/2019] [Indexed: 12/22/2022] Open
Abstract
Ventricular arrhythmia and subsequent sudden cardiac death (SCD) due to acute myocardial infarction (AMI) is one of the most frequent causes of death in humans. Lethal ventricular arrhythmias like ventricular fibrillation (VF) prior to hospitalization have been reported to occur in more than 10% of all AMI cases and survival in these patients is poor. Identification of risk factors and mechanisms for VF following AMI as well as implementing new risk stratification models and therapeutic approaches is therefore an important step to reduce mortality in people with high cardiovascular risk. Studying spontaneous VF following AMI in humans is challenging as it often occurs unexpectedly in a low risk subgroup. Large animal models of AMI can help to bridge this knowledge gap and are utilized to investigate occurrence of arrhythmias, involved mechanisms and therapeutic options. Comparable anatomy and physiology allow for this translational approach. Through experimental focus, using state-of-the-art technologies, including refined electrical mapping equipment and novel pharmacological investigations, valuable insights into arrhythmia mechanisms and possible interventions for arrhythmia-induced SCD during the early phase of AMI are now beginning to emerge. This review describes large experimental animal models of AMI with focus on first AMI-associated ventricular arrhythmias. In this context, epidemiology of first AMI, arrhythmogenic mechanisms and various potential therapeutic pharmacological targets will be discussed.
Collapse
Affiliation(s)
- Stefan Michael Sattler
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.,Medical Department I, University Hospital Grosshadern, LMU Munich, Munich, Germany
| | - Lasse Skibsbye
- Department of Exploratory Toxicology, H. Lundbeck A/S, Copenhagen, Denmark
| | - Dominik Linz
- Medical Department III, Universitätsklinikum des Saarlandes, Homburg, Germany.,Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Anniek Frederike Lubberding
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
16
|
Laukkanen JA, Kunutsor SK. Is sauna bathing protective of sudden cardiac death? A review of the evidence. Prog Cardiovasc Dis 2019; 62:288-293. [PMID: 31102597 DOI: 10.1016/j.pcad.2019.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
Sudden cardiac death (SCD) is a global public health burden accounting for 15-20% of all deaths. Though established atherosclerotic risk factors explain a large proportion of the risk of SCD, these factors are often absent in a large proportion of SCD victims and the pathogenesis of SCD is still not fully established. It therefore appears that additional factors may be involved. Sauna bathing is a traditional Finnish activity that is mainly used for the purposes of relaxation and pleasure. Beyond its use for these purposes, sauna bathing has been linked with several health benefits. Emerging evidence suggests that sauna bathing is associated with reduced risk of adverse cardiovascular (CV) disease (CVD) and non-CVD outcomes as well as mortality. A number of reports have linked sauna bathing with reduced or increased risk of SCD, but the evidence is uncertain. This review summarizes available studies linking sauna bathing with SCD, the postulated mechanistic pathways underlying these associations, outlines areas of outstanding uncertainty, and the implications for prevention. We employed a comprehensive search for observational studies, randomized controlled trials (RCTs), and non-RCTs from MEDLINE and Embase since their inception until March 2019. Observational data suggest that regular sauna bathing is associated with a substantial risk reduction in SCD. Furthermore, the data suggest that a combination of regular physical activity and sauna baths confers substantial risk reduction for SCD compared with either modality alone. Few reports have linked sauna baths with SCDs, but these single case incidents have been attributed to the effects of dehydration, hypotension, and cardiac arrhythmias due to a combination of sauna exposure and alcohol consumption. Sauna bathing is generally safe for most healthy people and even among patients with stable CVD, if used sensibly and with caution. Plausible pathways underlying the protective effect of sauna bathing on SCD may be linked to the impact on CV function via reduced arterial stiffness, decreases in inflammation and oxidative stress, stabilization of the autonomic nervous system, beneficial changes in circulating lipid profiles and other CVD risk markers, and lowering of systemic blood pressure. Sauna is a potential novel tool to promote SCD prevention in addition to other known means, being an enjoyable way to take care of general health and well-being.
Collapse
Affiliation(s)
- Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Central Finland Healthcare District, Department of Internal Medicine, Jyväskylä, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK
| |
Collapse
|
17
|
Wong CX, Brown A, Lau DH, Chugh SS, Albert CM, Kalman JM, Sanders P. Epidemiology of Sudden Cardiac Death: Global and Regional Perspectives. Heart Lung Circ 2019; 28:6-14. [DOI: 10.1016/j.hlc.2018.08.026] [Citation(s) in RCA: 180] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 02/07/2023]
|
18
|
Hata Y, Kinoshita K, Nishida N. An Autopsy Case of Sudden Unexpected Death of a Young Adult in a Hot Bath: Molecular Analysis Using Next-Generation DNA Sequencing. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2017; 10:1179547617702884. [PMID: 28469501 PMCID: PMC5398417 DOI: 10.1177/1179547617702884] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/11/2017] [Indexed: 11/17/2022]
Abstract
We report a case of sudden unexpected death of a young woman who was found in a bathtub of hot water. The autopsy concluded that all possible causes of sudden loss of consciousness, except cardiac origin, could be excluded. However, the heart did not show any obvious pathological changes. We used next-generation DNA sequencing (NGS) to examine 73 genes and detected 3 rare, potentially pathogenic variants with minor allele frequencies ⩽1.0%. The pathogenicity of these variants was evaluated using 8 in silico predictive algorithms, and SCN5A_p.Gly289Ser, CACNB2_p.Ser502Leu, and MYH11_p.Lys1573Glu were detected as possible pathogenic variants. Inherited heart disease is a likely cause of sudden unexpected deaths of young people in hot baths, even before the clinical manifestation of the disease. In the future, molecular analysis by NGS may help to predict young to early middle-aged people who could be at risk of sudden arrhythmogenic fatality in hot baths.
Collapse
Affiliation(s)
- Yukiko Hata
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Koshi Kinoshita
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| |
Collapse
|
19
|
Bell S, Daskalopoulou M, Rapsomaniki E, George J, Britton A, Bobak M, Casas JP, Dale CE, Denaxas S, Shah AD, Hemingway H. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ 2017; 356:j909. [PMID: 28331015 PMCID: PMC5594422 DOI: 10.1136/bmj.j909] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives To investigate the association between alcohol consumption and cardiovascular disease at higher resolution by examining the initial lifetime presentation of 12 cardiac, cerebrovascular, abdominal, or peripheral vascular diseases among five categories of consumption.Design Population based cohort study of linked electronic health records covering primary care, hospital admissions, and mortality in 1997-2010 (median follow-up six years).Setting CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records).Participants 1 937 360 adults (51% women), aged ≥30 who were free from cardiovascular disease at baseline.Main outcome measures 12 common symptomatic manifestations of cardiovascular disease, including chronic stable angina, unstable angina, acute myocardial infarction, unheralded coronary heart disease death, heart failure, sudden coronary death/cardiac arrest, transient ischaemic attack, ischaemic stroke, intracerebral and subarachnoid haemorrhage, peripheral arterial disease, and abdominal aortic aneurysm.Results 114 859 individuals received an incident cardiovascular diagnosis during follow-up. Non-drinking was associated with an increased risk of unstable angina (hazard ratio 1.33, 95% confidence interval 1.21 to 1.45), myocardial infarction (1.32, 1.24 to1.41), unheralded coronary death (1.56, 1.38 to 1.76), heart failure (1.24, 1.11 to 1.38), ischaemic stroke (1.12, 1.01 to 1.24), peripheral arterial disease (1.22, 1.13 to 1.32), and abdominal aortic aneurysm (1.32, 1.17 to 1.49) compared with moderate drinking (consumption within contemporaneous UK weekly/daily guidelines of 21/3 and 14/2 units for men and women, respectively). Heavy drinking (exceeding guidelines) conferred an increased risk of presenting with unheralded coronary death (1.21, 1.08 to 1.35), heart failure (1.22, 1.08 to 1.37), cardiac arrest (1.50, 1.26 to 1.77), transient ischaemic attack (1.11, 1.02 to 1.37), ischaemic stroke (1.33, 1.09 to 1.63), intracerebral haemorrhage (1.37, 1.16 to 1.62), and peripheral arterial disease (1.35; 1.23 to 1.48), but a lower risk of myocardial infarction (0.88, 0.79 to 1.00) or stable angina (0.93, 0.86 to 1.00).Conclusions Heterogeneous associations exist between level of alcohol consumption and the initial presentation of cardiovascular diseases. This has implications for counselling patients, public health communication, and clinical research, suggesting a more nuanced approach to the role of alcohol in prevention of cardiovascular disease is necessary.Registration clinicaltrails.gov (NCT01864031).
Collapse
Affiliation(s)
- Steven Bell
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
- Research Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Marina Daskalopoulou
- Department of Infection and Population Health, University College London, Royal Free Hospital, London NW3 2PF, UK
| | - Eleni Rapsomaniki
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Julie George
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Annie Britton
- Research Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Juan P Casas
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Caroline E Dale
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Spiros Denaxas
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Anoop D Shah
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| | - Harry Hemingway
- Farr Institute of Health Informatics Research (London), University College London, London NW1 2DA, UK
| |
Collapse
|
20
|
May N, Eliott J, Crabb S. ‘Everything causes cancer’: how Australians respond to the message that alcohol causes cancer. CRITICAL PUBLIC HEALTH 2016. [DOI: 10.1080/09581596.2016.1235260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Natalie May
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Jaklin Eliott
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Shona Crabb
- School of Public Health, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
21
|
Hung CL, Gonçalves A, Lai YJ, Lai YH, Sung KT, Lo CI, Liu CC, Kuo JY, Hou CJY, Chao TF, Bulwer BE, Lin SJ, Yeh HI, Lam CSP. Light to Moderate Habitual Alcohol Consumption Is Associated with Subclinical Ventricular and Left Atrial Mechanical Dysfunction in an Asymptomatic Population: Dose-Response and Propensity Analysis. J Am Soc Echocardiogr 2016; 29:1043-1051.e4. [PMID: 27639812 DOI: 10.1016/j.echo.2016.07.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effects of light to moderate alcohol consumption on cardiac mechanics remain poorly understood. The aim of this study was to investigate the dose-response relationship between alcohol consumption and left ventricular (LV) and left atrial (LA) function using myocardial deformation. METHODS In total 3,946 asymptomatic participants (mean age, 49.7 ± 10.7 years; 65% men) were consecutively studied using comprehensive echocardiography and two-dimensional speckle-tracking in a cross-sectional, retrospective manner. Global LV longitudinal and circumferential strain and LA strain were assessed and related to habitual alcohol consumption pattern (fewer than one, one to six, or more than six drinks per week) before and after propensity matching. RESULTS With increasing weekly alcohol consumption, participants displayed greater LV eccentric remodeling, impaired diastolic function, and more attenuated global longitudinal strain, LA strain (adjusted coefficients, -1.07 [95% CI, -1.95 to -0.19] and -3.73 [95% CI, -5.36 to -2.11]), and early diastolic strain rates (adjusted coefficients, 0.07 [95% CI, 0.03-0.11] and 0.33 [95% CI, 0.24-0.42]) for one to six and more than six drinks per week, respectively (P < .05 for all) in a dose-response manner. Participants with recent alcohol abstinence displayed cardiac mechanics intermediate between those of nondrinkers and current drinkers. After propensity matching (n = 1,140), participants currently consuming more than one drink per week continued to have significantly attenuated global longitudinal strain and all LA mechanics compared with those consuming fewer than one drink per week (P < .05 for all). CONCLUSIONS Habitual alcohol consumption, even at light to moderate doses, is associated with both reduced LV and LA mechanics in a dose-dependent manner. Whether such observations are reversible or related to future atrial fibrillation deserves further study.
Collapse
Affiliation(s)
- Chung-Lieh Hung
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan; Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Alexandra Gonçalves
- University of Porto Medical School, Porto, Portugal; Brigham and Women's Hospital, Boston, Massachusetts
| | - Yu-Jun Lai
- Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
| | - Yau-Huei Lai
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
| | - Kuo-Tzu Sung
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
| | - Chi-In Lo
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
| | - Chuan-Chuan Liu
- Health Evaluation Center, Mackay Memorial Hospital, Taipei, Taiwan; Graduate Institute of Health Care Organization Administration, College of Public Health National Taiwan University, Taipei, Taiwan; Department of Medical Technology, Yuanpei University of Science and Technology, Hsinchu, Taiwan
| | - Jen-Yuan Kuo
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Charles Jia-Yin Hou
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Tze-Fan Chao
- Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | | | - Shing-Jong Lin
- Institute of Clinical Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan; Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Hung-I Yeh
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan.
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| |
Collapse
|
22
|
Yedlapati SH, Mendu A, Stewart SH. Alcohol-related diagnoses and increased mortality in acute myocardial infarction patients: An analysis of the nationwide inpatient sample. J Hosp Med 2016; 11:563-7. [PMID: 27043326 DOI: 10.1002/jhm.2584] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/01/2016] [Accepted: 02/28/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Moderate alcohol consumption has been associated with lower risk of coronary heart disease death, but heavy alcohol consumption may increase risk. OBJECTIVE We sought to determine the association of alcohol-related diagnoses with in-hospital mortality in patients with acute myocardial infarction (AMI). DESIGN/SETTING/PATIENTS Discharge data collected from all admissions recorded in the Nationwide Inpatient Sample (NIS) database from 2011. A cross-sectional analysis was performed using regression methods appropriate for the NIS sample design. MEASURES The outcome measures were in-hospital mortality, length of stay, and cardiac procedures. RESULTS AMI accounted for 610,963 (1.9%) of adult in-patient admissions, with an in-hospital mortality rate of 5.3%. Alcohol-related diagnoses were associated with increased mortality in AMI patients after controlling for factors associated with alcoholism including age, sex, liver disease, hypertension, diabetes, renal failure, peripheral vascular disease, arrhythmias, drug abuse, gastrointestinal bleed, and smoking (adjusted odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.2-1.7, P < 0.001). This association was significant in both ST-elevation myocardial infarction patients (adjusted OR: 1.7, 95% CI: 1.4-2.2, P < 0.001) and non-ST-elevation myocardial infarction patients (adjusted OR: 1.3, 95% CI: 1.0-1.7, P = 0.025). Chronic alcohol-related diagnoses were significantly associated with death, but acute alcohol effects (as estimated by withdrawal and intoxication) were not associated. CONCLUSION Chronic alcohol-related diagnoses were associated with a modest increase in the risk for death in individuals presenting with AMI. This risk was not accounted for by common alcohol-related comorbidities. As a component of global efforts to limit hospital deaths from AMI, future research should identify the factors underlying this association. Journal of Hospital Medicine 2016;11:563-567. © 2016 Society of Hospital Medicine.
Collapse
Affiliation(s)
- Siva Harsha Yedlapati
- Division of General Internal Medicine, University at Buffalo, State University of New York, Buffalo, New York
| | - Anuradha Mendu
- Division of General Internal Medicine, University at Buffalo, State University of New York, Buffalo, New York
| | - Scott H Stewart
- Division of General Internal Medicine, University at Buffalo, State University of New York, Buffalo, New York
| |
Collapse
|
23
|
Mostofsky E, Mukamal KJ, Giovannucci EL, Stampfer MJ, Rimm EB. Key Findings on Alcohol Consumption and a Variety of Health Outcomes From the Nurses' Health Study. Am J Public Health 2016; 106:1586-91. [PMID: 27459455 DOI: 10.2105/ajph.2016.303336] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To review critical contributions from the Nurses' Health Study (NHS) on alcohol consumption and health outcomes. METHODS We performed a narrative review of NHS (1980-2012) and NHS II (1989-2011) publications. RESULTS Using detailed information on self-reported alcohol drinking patterns obtained approximately every 4 years combined with extensive information on diet, lifestyle habits, and physician-diagnosed health conditions, NHS investigators have prospectively examined the risks and benefits associated with alcohol consumption. Moderate intake, defined as up to 1 drink a day, is associated with a lower risk of hypertension, myocardial infarction, stroke, sudden cardiac death, gallstones, cognitive decline, and all-cause mortality. However, even moderate intake places women at higher risk for breast cancer and bone fractures, and higher intake increases risk for colon polyps and colon cancer. CONCLUSIONS Regular alcohol intake has both risks and benefits. In analyses using repeated assessments of alcohol over time and deaths from all causes, women with low to moderate intake and regular frequency (> 3 days/week) had the lowest risk of mortality compared with abstainers and women who consumed substantially more than 1 drink per day.
Collapse
Affiliation(s)
- Elizabeth Mostofsky
- Elizabeth Mostofsky is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, and the Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Kenneth J. Mukamal is with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center. Kenneth J. Mukamal is also with the Department of Nutrition, Harvard T. H. Chan School of Public Health. Ed L. Giovannucci, Meir J. Stampfer, and Eric B. Rimm are with the Department of Nutrition, Harvard T. H. Chan School of Public Health and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston
| | - Kenneth J Mukamal
- Elizabeth Mostofsky is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, and the Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Kenneth J. Mukamal is with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center. Kenneth J. Mukamal is also with the Department of Nutrition, Harvard T. H. Chan School of Public Health. Ed L. Giovannucci, Meir J. Stampfer, and Eric B. Rimm are with the Department of Nutrition, Harvard T. H. Chan School of Public Health and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston
| | - Ed L Giovannucci
- Elizabeth Mostofsky is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, and the Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Kenneth J. Mukamal is with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center. Kenneth J. Mukamal is also with the Department of Nutrition, Harvard T. H. Chan School of Public Health. Ed L. Giovannucci, Meir J. Stampfer, and Eric B. Rimm are with the Department of Nutrition, Harvard T. H. Chan School of Public Health and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston
| | - Meir J Stampfer
- Elizabeth Mostofsky is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, and the Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Kenneth J. Mukamal is with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center. Kenneth J. Mukamal is also with the Department of Nutrition, Harvard T. H. Chan School of Public Health. Ed L. Giovannucci, Meir J. Stampfer, and Eric B. Rimm are with the Department of Nutrition, Harvard T. H. Chan School of Public Health and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston
| | - Eric B Rimm
- Elizabeth Mostofsky is with the Department of Epidemiology, Harvard T. H. Chan School of Public Health, and the Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Kenneth J. Mukamal is with the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center. Kenneth J. Mukamal is also with the Department of Nutrition, Harvard T. H. Chan School of Public Health. Ed L. Giovannucci, Meir J. Stampfer, and Eric B. Rimm are with the Department of Nutrition, Harvard T. H. Chan School of Public Health and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston
| |
Collapse
|
24
|
Acute effects of ethanol on action potential and intracellular Ca(2+) transient in cardiac ventricular cells: a simulation study. Med Biol Eng Comput 2015; 54:753-62. [PMID: 26280513 DOI: 10.1007/s11517-015-1366-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 08/03/2015] [Indexed: 01/08/2023]
Abstract
Alcohol consumption may result in electrocardiographic changes and arrhythmias, at least partly due to effects of ethanol on cardiac ionic currents. Contractility and intracellular Ca(2+) dynamics seem to be altered as well. In this study, we integrated the available (mostly animal) experimental data into previously published models of the rat and human ventricular myocytes to assess the share of ionic current components in ethanol-induced changes in AP configuration and cytosolic Ca(2+) transient in ventricular cardiomyocytes. The rat model reproduced well the experimentally observed changes in AP duration (APD) under ethanol (slight prolongation at 0.8 mM and shortening at ≥8 mM). These changes were almost exclusively caused by the ethanol-induced alterations of I K1. The cytosolic Ca(2+) transient decreased gradually with the increasing ethanol concentration as a result of the ethanol-induced inhibition of I Ca. In the human model, ethanol produced a dose-dependent APD lengthening, dominated by ethanol effect on I Kr, the key repolarising current in human ventricles. This effect might contribute to the clinically observed proarrhythmic effects of ethanol in predisposed individuals.
Collapse
|
25
|
Abstract
Sudden cardiac death (SCD) from cardiac arrest is a major international public health problem accounting for an estimated 15%-20% of all deaths. Although resuscitation rates are generally improving throughout the world, the majority of individuals who experience a sudden cardiac arrest will not survive. SCD most often develops in older adults with acquired structural heart disease, but it also rarely occurs in the young, where it is more commonly because of inherited disorders. Coronary heart disease is known to be the most common pathology underlying SCD, followed by cardiomyopathies, inherited arrhythmia syndromes, and valvular heart disease. During the past 3 decades, declines in SCD rates have not been as steep as for other causes of coronary heart disease deaths, and there is a growing fraction of SCDs not due to coronary heart disease and ventricular arrhythmias, particularly among certain subsets of the population. The growing heterogeneity of the pathologies and mechanisms underlying SCD present major challenges for SCD prevention, which are magnified further by a frequent lack of recognition of the underlying cardiac condition before death. Multifaceted preventative approaches, which address risk factors in seemingly low-risk and known high-risk populations, will be required to decrease the burden of SCD. In this Compendium, we review the wide-ranging spectrum of epidemiology underlying SCD within both the general population and in high-risk subsets with established cardiac disease placing an emphasis on recent global trends, remaining uncertainties, and potential targeted preventive strategies.
Collapse
Affiliation(s)
- Meiso Hayashi
- From the Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (M.H., W.S.); and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.M.A.)
| | - Wataru Shimizu
- From the Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (M.H., W.S.); and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.M.A.).
| | - Christine M Albert
- From the Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (M.H., W.S.); and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.M.A.).
| |
Collapse
|
26
|
Conen D. Alcohol consumption and incident cardiovascular disease: not just one unifying hypothesis. Eur Heart J 2015; 36:897-8. [PMID: 25660054 DOI: 10.1093/eurheartj/ehv021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- David Conen
- Department of Medicine, Cardiovascular Research Institute Basel, University Hospital, Basel, Switzerland
| |
Collapse
|
27
|
Gonçalves A, Claggett B, Jhund PS, Rosamond W, Deswal A, Aguilar D, Shah AM, Cheng S, Solomon SD. Alcohol consumption and risk of heart failure: the Atherosclerosis Risk in Communities Study. Eur Heart J 2015; 36:939-45. [PMID: 25602025 DOI: 10.1093/eurheartj/ehu514] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/19/2014] [Indexed: 11/14/2022] Open
Abstract
AIM Alcohol is a known cardiac toxin and heavy consumption can lead to heart failure (HF). However, the relationship between moderate alcohol consumption and risk for HF, in either men or women, remains unclear. METHODS AND RESULTS We examined 14 629 participants of the Atherosclerosis Risk in Communities (ARIC) study (54 ± 6 years, 55% women) without prevalent HF at baseline (1987-89) who were followed for 24 ± 1 years. Self-reported alcohol consumption was assessed as the number of drinks/week (1 drink = 14 g of alcohol) at baseline, and updated cumulative average alcohol intake was calculated over 8.9 ± 0.3 years. Using multivariable Cox proportional hazards models, we examined the relation of alcohol intake with incident HF and assessed whether associations were modified by sex. Overall, most participants were abstainers (42%) or former drinkers (19%), with 25% reporting up to 7 drinks per week, 8% reporting ≥7 to 14 drinks per week, and 3% reporting ≥14-21 and ≥21 drinks per week, respectively. Incident HF occurred in 1271 men and 1237 women. Men consuming up to 7 drinks/week had reduced risk of HF relative to abstainers (hazard ratio, HR 0.80, 95% CI 0.68-0.94, P = 0.006); this effect was less robust in women (HR 0.84, 95% CI 0.71-1.00, P = 0.05). In the higher drinking categories, the risk of HF was not significantly different from abstainers, either in men or in women. CONCLUSION In the community, alcohol consumption of up to 7 drinks/week at early-middle age is associated with lower risk for future HF, with a similar but less definite association in women than in men. These findings suggest that despite the dangers of heavy drinking, modest alcohol consumption in early-middle age may be associated with a lower risk for HF.
Collapse
Affiliation(s)
- Alexandra Gonçalves
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA University of Porto Medical School, Porto, Portugal
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Pardeep S Jhund
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Wayne Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Anita Deswal
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - David Aguilar
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Susan Cheng
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| |
Collapse
|
28
|
Rubin E. To Drink or Not to Drink: That Is the Question. Alcohol Clin Exp Res 2015; 38:2889-92. [DOI: 10.1111/acer.12585] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/31/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Emanuel Rubin
- Department of Pathology; Thomas Jefferson University; Philadelphia Pennsylvania
| |
Collapse
|
29
|
Jabbari R, Engstrøm T, Glinge C, Risgaard B, Jabbari J, Winkel BG, Terkelsen CJ, Tilsted HH, Jensen LO, Hougaard M, Chiuve SE, Pedersen F, Svendsen JH, Haunsø S, Albert CM, Tfelt-Hansen J. Incidence and risk factors of ventricular fibrillation before primary angioplasty in patients with first ST-elevation myocardial infarction: a nationwide study in Denmark. J Am Heart Assoc 2015; 4:e001399. [PMID: 25559012 PMCID: PMC4330064 DOI: 10.1161/jaha.114.001399] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting. METHODS AND RESULTS In this case-control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPCI and 441 controls without preceding VF were enrolled. Of the 219 case patients, 182 (83%) had STEMI with out-of-hospital cardiac arrest due to VF, and 37 (17%) had cardiac arrest upon arrival to the emergency room. Medical history was collected by standardized interviews and by linkage to national electronic health records. The incidence of VF before PPCI among STEMI patients was 11.6%. Multivariable logistic regression analysis identified novel associations between atrial fibrillation and alcohol consumption with VF. Patients with a history of atrial fibrillation had a 2.80-fold odds of experiencing VF before PPCI (95% CI 1.10 to 7.30). Compared with nondrinkers, patients who consumed 1 to 7 units, 8 to 14 units, or >15 units of alcohol per week had an odds ratio (OR) of 1.30 (95% CI, 0.80 to 2.20), 2.30 (95% CI, 1.20 to 4.20), or 3.30 (95% CI, 1.80 to 5.90), respectively, for VF. Previously reported associations for preinfarction angina (OR 0.46; 95% CI 0.32 to 0.67), age of <60 years (OR 1.75; 95% CI 1.20 to 2.60), anterior infarction (OR 2.10; 95% CI 1.40 to 3.00), preprocedural thrombolysis in myocardial infarction flow grade 0 (OR 1.65; 95% CI 1.14 to 2.40), and family history of sudden death (OR 1.60; 95% CI 1.10 to 2.40) were all associated with VF. CONCLUSION Several easily assessed risk factors were associated with VF occurring out-of-hospital or on arrival at the emergency room before PPCI in STEMI patients, thus providing potential avenues for investigation regarding improved identification and prevention of life-threatening ventricular arrhythmias.
Collapse
Affiliation(s)
- Reza Jabbari
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | - Thomas Engstrøm
- Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.)
| | - Charlotte Glinge
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | - Bjarke Risgaard
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | - Javad Jabbari
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | - Bo Gregers Winkel
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | | | - Hans-Henrik Tilsted
- Department of Cardiology, Aalborg University Hospital, Copenhagen, Denmark (H.H.T.)
| | | | - Mikkel Hougaard
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., M.H.)
| | - Stephanie E Chiuve
- Center for Arrhythmia Prevention, Division of Preventive Medicine, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.E.C., C.M.A.)
| | - Frants Pedersen
- Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.)
| | - Jesper Hastrup Svendsen
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.)
| | - Stig Haunsø
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.)
| | - Christine M Albert
- Center for Arrhythmia Prevention, Division of Preventive Medicine, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.E.C., C.M.A.)
| | - Jacob Tfelt-Hansen
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.)
| |
Collapse
|
30
|
Nogueira L, Couri S, Trugo N, Lollo P. The effect of different alcoholic beverages on blood alcohol levels, plasma insulin and plasma glucose in humans. Food Chem 2014; 158:527-33. [DOI: 10.1016/j.foodchem.2014.02.097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 11/16/2022]
|
31
|
Wilsnack SC, Wilsnack RW. Focus on: women and the costs of alcohol use. Alcohol Res 2014; 35:219-28. [PMID: 24881330 PMCID: PMC3908713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Although light-to-moderate drinking among women is associated with reduced risks of some cardiovascular problems, strokes, and weakening of bones, such levels of drinking also are associated with increased risks of breast cancer and liver problems, and heavy drinking increases risks of hypertension and bone fractures and injuries. Women's heavy-drinking patterns and alcohol use disorders are associated with increased likelihood of many psychiatric problems, including depression, posttraumatic stress disorder, eating disorders, and suicidality, as well as increased risks of intimate partner violence and sexual assault, although causality in the associations of drinking with psychiatric disorders and with violence remains unclear. It is important for women to be aware of the risks associated with alcohol use, especially because gaps between U.S. men's and women's drinking may have narrowed. However, analyses of health risks and benefits need mprovement to avoid giving women oversimplified advice about drinking.
Collapse
|
32
|
Poli A, Marangoni F, Avogaro A, Barba G, Bellentani S, Bucci M, Cambieri R, Catapano AL, Costanzo S, Cricelli C, de Gaetano G, Di Castelnuovo A, Faggiano P, Fattirolli F, Fontana L, Forlani G, Frattini S, Giacco R, La Vecchia C, Lazzaretto L, Loffredo L, Lucchin L, Marelli G, Marrocco W, Minisola S, Musicco M, Novo S, Nozzoli C, Pelucchi C, Perri L, Pieralli F, Rizzoni D, Sterzi R, Vettor R, Violi F, Visioli F. Moderate alcohol use and health: a consensus document. Nutr Metab Cardiovasc Dis 2013; 23:487-504. [PMID: 23642930 DOI: 10.1016/j.numecd.2013.02.007] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/29/2013] [Accepted: 02/27/2013] [Indexed: 02/07/2023]
Abstract
AIMS The aim of this consensus paper is to review the available evidence on the association between moderate alcohol use, health and disease and to provide a working document to the scientific and health professional communities. DATA SYNTHESIS In healthy adults and in the elderly, spontaneous consumption of alcoholic beverages within 30 g ethanol/d for men and 15 g/d for women is to be considered acceptable and do not deserve intervention by the primary care physician or the health professional in charge. Patients with increased risk for specific diseases, for example, women with familiar history of breast cancer, or subjects with familiar history of early cardiovascular disease, or cardiovascular patients should discuss with their physician their drinking habits. No abstainer should be advised to drink for health reasons. Alcohol use must be discouraged in specific physiological or personal situations or in selected age classes (children and adolescents, pregnant and lactating women and recovering alcoholics). Moreover, the possible interactions between alcohol and acute or chronic drug use must be discussed with the primary care physician. CONCLUSIONS The choice to consume alcohol should be based on individual considerations, taking into account the influence on health and diet, the risk of alcoholism and abuse, the effect on behaviour and other factors that may vary with age and lifestyle. Moderation in drinking and development of an associated lifestyle culture should be fostered.
Collapse
Affiliation(s)
- A Poli
- NFI (Nutrition Foundation of Italy), Viale Tunisia 38, 20124 Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Bertoia ML, Triche EW, Michaud DS, Baylin A, Hogan JW, Neuhouser ML, Freiberg MS, Allison MA, Safford MM, Li W, Mossavar-Rahmani Y, Rosal MC, Eaton CB. Long-term alcohol and caffeine intake and risk of sudden cardiac death in women. Am J Clin Nutr 2013; 97:1356-63. [PMID: 23615825 PMCID: PMC3652927 DOI: 10.3945/ajcn.112.044248] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Alcohol and caffeine intakes may play a role in the development of sudden cardiac death (SCD) because of their effects on cholesterol, blood pressure, heart rate variability, and inflammation. OBJECTIVE Our objective was to examine the association between long-term alcohol and caffeine intakes and risk of SCD in women. DESIGN We examined 93,676 postmenopausal women who participated in the Women's Health Initiative Observational Study. Women were enrolled between 1993 and 1998 and were followed until August 2009. Women completed a food-frequency questionnaire at baseline and again at year 3. We modeled exposure to alcohol 3 ways: by using baseline intake only, a cumulative average of baseline and year 3 intake, and the most recent reported intake (a simple time-varying analysis). RESULTS Intake of 5-15 g alcohol/d (about one drink) was associated with a nonsignificantly reduced risk of SCD compared with 0.1-5 g/d of baseline intake (HR: 0.64; 95% CI: 0.40, 1.02), of cumulative average intake (HR: 0.69; 95% CI: 0.43, 1.11), and of most recent intake (HR: 0.58; 95% CI: 0.35, 0.96), with adjustment for age, race, income, smoking, body mass index, physical activity, hormone use, and total energy. No association was found between SCD and total caffeine intake (mg/d) or cups of caffeinated coffee, decaffeinated coffee, and caffeinated tea. CONCLUSIONS Our results suggest that about one drink per day (or 5.1-15 g/d) may be associated with a reduced risk of SCD in this population; however, this association was only statistically significant for a model using the most recent alcohol intake. Total caffeine, regular coffee, decaffeinated coffee, and regular tea intake were not associated with the risk of SCD. This trial was registered at clinicaltrials.gov as NCT00000611.
Collapse
|
34
|
Affiliation(s)
- Rajat Deo
- Section of Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | |
Collapse
|
35
|
Liu K, Daviglus ML, Loria CM, Colangelo LA, Spring B, Moller AC, Lloyd-Jones DM. Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age: the Coronary Artery Risk Development in (Young) Adults (CARDIA) study. Circulation 2012; 125:996-1004. [PMID: 22291127 DOI: 10.1161/circulationaha.111.060681] [Citation(s) in RCA: 253] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A low cardiovascular disease risk profile (untreated cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, never smoking, and no history of diabetes mellitus or myocardial infarction) in middle age is associated with markedly better health outcomes in older age, but few middle-aged adults have this low risk profile. We examined whether adopting a healthy lifestyle throughout young adulthood is associated with the presence of the low cardiovascular disease risk profile in middle age. METHODS AND RESULTS The Coronary Artery Risk Development in (Young) Adults (CARDIA) study sample consisted of 3154 black and white participants 18 to 30 years of age at year 0 (1985-1986) who attended the year 0, 7, and 20 examinations. Healthy lifestyle factors defined at years 0, 7, and 20 included average body mass index <25 kg/m(2), no or moderate alcohol intake, higher healthy diet score, higher physical activity score, and never smoking. Mean age (25 years) and percentage of women (56%) were comparable across groups defined by number of healthy lifestyle factors. The age-, sex-, and race-adjusted prevalences of low cardiovascular disease risk profile at year 20 were 3.0%, 14.6%, 29.5%, 39.2%, and 60.7% for people with 0 or 1, 2, 3, 4, and 5 healthy lifestyle factors, respectively (P for trend <0.0001). Similar graded relationships were observed for each sex-race group (all P for trend <0.0001). CONCLUSIONS Maintaining a healthy lifestyle throughout young adulthood is strongly associated with a low cardiovascular disease risk profile in middle age. Public health and individual efforts are needed to improve the adoption and maintenance of healthy lifestyles in young adults.
Collapse
Affiliation(s)
- Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, 680 N Lake Shore Dr, Ste 1400, Chicago, IL 60611, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Deo R, Vittinghoff E, Lin F, Tseng ZH, Hulley SB, Shlipak MG. Risk factor and prediction modeling for sudden cardiac death in women with coronary artery disease. ACTA ACUST UNITED AC 2011; 171:1703-9. [PMID: 21788534 DOI: 10.1001/archinternmed.2011.328] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND To our knowledge, the risk of sudden cardiac death (SCD) and the assessment of risk factors in prediction models have not been evaluated in women with coronary artery disease (CAD). We sought to evaluate the incidence of SCD as well as its risk factors and their predictive accuracy among a population of women with CAD. METHODS The Heart and Estrogen/progestin Replacement Study evaluated the effects of hormone replacement therapy on cardiovascular events among 2763 postmenopausal women with CAD. Sudden cardiac death was defined as death resulting from a cardiac origin that occurred within 1 hour of symptom onset. The associations between candidate predictor variables and SCD were evaluated in a Cox proportional hazards model. The C-index was used to compare the predictive value of the clinical risk factors with left ventricular ejection fraction (LVEF) alone and in combination. The net reclassification improvement was also computed. RESULTS Over a mean follow-up of 6.8 years, SCD comprised 136 of the 254 cardiac deaths. The annual SCD event rate was 0.79% (95% confidence interval, 0.67-0.94). The following variables were independently associated with SCD in the multivariate model: myocardial infarction, heart failure, an estimated glomerular filtration rate of less than 40 mL/min/1.73 m(2), atrial fibrillation, physical inactivity, and diabetes. The incidences of SCD among women with 0 (n = 683), 1 (n = 1224), 2 (n = 610), and 3 plus (n = 246) risk factors at baseline were 0.3%, 0.5%, 1.2%, and 2.9% per year, respectively. The combination of clinical risk factors and LVEF (C-index, 0.681) were better predictors of SCD than LVEF alone (C-index, 0.600) and resulted in a net reclassification improvement of 0.20 (P < .001). CONCLUSIONS Sudden cardiac death comprised the majority of cardiac deaths among postmenopausal women with CAD. Independent predictors of SCD, including myocardial infarction, congestive heart failure, an estimated glomerular filtration rate of less than 40 mL/min/1.73 m(2), atrial fibrillation, physical inactivity, and diabetes, improved SCD prediction when they were considered in addition to LVEF.
Collapse
Affiliation(s)
- Rajat Deo
- Section of Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Eapen DJ, Manocha P, Valiani K, Mantini N, Sperling L, McGorisk GM. Alcohol and the heart: an ounce of prevention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:313-25. [PMID: 21562797 DOI: 10.1007/s11936-011-0131-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OPINION STATEMENT Moderate alcohol intake is beneficial to the heart and cardiovascular system. A J- or U-shaped response has been shown in the majority of studies examining alcohol's effect on cardiovascular mortality and downstream cardio-metabolic effects, with heavy alcohol intake associated with worse outcomes. These effects apply to individuals with and without underlying coronary artery disease. However, care must be taken in defining "moderate" intake between the sexes. Males appear to have a wider therapeutic window and can afford 2 to 3 drinks per day whereas women should limit intake to 1 to 2 drinks per day (a "drink" being classified as 10 to 14 grams of alcohol). More than half of alcohol's cardioprotective effects can be attributed to its effect on lipoproteins, specifically an increase in high-density lipoprotein. Interestingly, the risk of cardiovascular mortality in former heavy drinkers has been shown to ultimately approach the risk seen in lifelong abstainers.
Collapse
Affiliation(s)
- Danny J Eapen
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1364 Clifton Rd, D 407-B, Atlanta, GA, 30322, USA,
| | | | | | | | | | | |
Collapse
|
38
|
Vest RN, Gold MR. Alcohol consumption and the risk of sudden cardiac death in women: An evaluation from the Nurses' Health Study. Heart Rhythm 2010; 7:1381-2. [DOI: 10.1016/j.hrthm.2010.06.023] [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: 06/14/2010] [Indexed: 11/28/2022]
|