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Cho SH, Kim S, Oh R, Kim JY, Lee YB, Jin SM, Hur KY, Kim G, Kim JH. Metabolic dysfunction-associated fatty liver disease and heavy alcohol consumption increase mortality:A nationwide study. Hepatol Int 2024:10.1007/s12072-024-10671-9. [PMID: 38806774 DOI: 10.1007/s12072-024-10671-9] [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: 11/28/2023] [Accepted: 03/17/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND The effects of excessive alcohol consumption on the prognosis of metabolic dysfunction-associated fatty liver disease (MAFLD) remain unclear. We investigated all-cause and cause-specific mortality according to the amount of alcohol consumed by Asian individuals with MAFLD. METHODS This nationwide retrospective study included 996,508 adults aged 40-79 years who underwent health check-ups between 2009 and 2012. Participants were categorized by the alcohol consumption-non-alcohol, moderate alcohol, and heavy alcohol group (≥ 30 g/day for men, ≥ 20 g/day for women) and by the combination of the presence or absence of MAFLD. Hepatic steatosis was defined as the fatty liver index ≥ 30. Cox analyses were used to analyze the association between alcohol consumption and MAFLD and all-cause and cause-specific mortality. RESULTS MAFLD significantly increased all-cause, liver-, and cancer-related mortality. Individuals with both MAFLD and heavy alcohol consumption expressed the highest mortality risk in liver-related mortality compared to non-MAFLD and non-alcohol group (adjusted hazard ratio (HR), 9.8; 95% confidence interval (CI), 8.20-12.29). Regardless of MAFLD, heavy alcohol consumption increased the risk of liver- and cancer-related mortality. CONCLUSIONS MAFLD and heavy alcohol consumption increased all-cause, liver-, and cancer-related mortality. Heavy alcohol consumption and MAFLD synergistically increase liver-related mortality.
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Affiliation(s)
- So Hyun Cho
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Seohyun Kim
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, 06355, Republic of Korea
| | - Rosa Oh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Ji Yoon Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - You-Bin Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Sang-Man Jin
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Kyu Yeon Hur
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Gyuri Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
| | - Jae Hyeon Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, 06355, Republic of Korea.
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Sarmiento CA, Furniss A, Morris MA, Stransky ML, Thompson DA. Disparities in Smoking and Heavy Drinking Behaviors by Disability Status and Age of Disability Onset: Secondary Analysis of National Health Interview Survey Data. Public Health Rep 2024:333549241249339. [PMID: 38780024 DOI: 10.1177/00333549241249339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES People with childhood-onset disabilities are living into adulthood, and the prevalence of smoking and illicit drug use among adults with disabilities is high. We evaluated the relationship between disability status and age of disability onset, current cigarette smoking status, and heavy alcohol drinking. METHODS We conducted a secondary data analysis of the National Health Interview Survey (NHIS), a US survey on illness and disability. Among 2020 NHIS participants aged 22-80 years (n = 28 225), we compared self-reported prevalence of current cigarette smoking and heavy alcohol drinking among those with and without disabilities and among those with childhood- versus adult-onset disabilities. We used adjusted logistic regression analysis to calculate the adjusted odds ratios (AORs) of current smoking and heavy alcohol drinking based on disability status and age of disability onset. RESULTS Compared with adults without disabilities, adults with disabilities were significantly more likely to report current smoking (23.5% vs 11.2%; P < .001) and significantly less likely to report heavy alcohol drinking (5.3% vs 7.4%; P = .001). The prevalence of these behaviors did not vary significantly by age of disability onset. In adjusted logistic regression models, adults with disabilities had significantly higher odds of current smoking (AOR = 1.76; 95% CI, 1.53-2.03) and similar odds of heavy alcohol drinking (AOR = 0.82; 95% CI, 0.65-1.04) compared with adults without disabilities. The odds of these health behaviors did not vary significantly by age of disability onset. CONCLUSIONS Adults with disabilities overall may be at high risk for these unhealthy behaviors, particularly smoking, regardless of age of disability onset. Routine screening and cessation counseling related to smoking and unhealthy alcohol use are important for all people with disabilities.
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Affiliation(s)
- Cristina A Sarmiento
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Anna Furniss
- Adult and Child Center for Outcomes Research and Delivery Science, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Megan A Morris
- Adult and Child Center for Outcomes Research and Delivery Science, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michelle L Stransky
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
| | - Darcy A Thompson
- Adult and Child Center for Outcomes Research and Delivery Science, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Ku B, Ghim S. Poor Physical Health in Caregivers of Children with ADHD or ASD and its Association with Health Risk Behaviours: NHIS 2016-2018. Int J Behav Med 2024:10.1007/s12529-023-10253-3. [PMID: 38172453 DOI: 10.1007/s12529-023-10253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND There is a dearth of evidence regarding physical health problems and health risk behaviours (e.g., drinking, physical inactivity, smoking, and suboptimal sleep behaviour) in caregivers of children with attention deficit hyperactivity disorder or autism spectrum disorder (CCAA). The purposes of the current study were to examine differences in physical health problems between CCAA and caregivers of children without attention deficit hyperactivity disorder and autism spectrum disorder (CCWAA) and to explore health risk behaviours associated with those problems. METHOD Data from the 2016-2018 National Health Interview Survey were used in the current study. 10 common physical health problems were compared between CCAA and CCWAA by using multivariable logistic regressions. In addition, in order to detect associated health risk behaviours, decision tree analysis was performed for physical health problems in CCAA. RESULTS Of the 10 physical health problems, caregivers of children with ADHD showed significantly higher likelihood of experiencing nine (arthritis, asthma, back pain, high cholesterol, diabetes, heart problems, hypertension, neck pain, obesity), compared to CCWAA. Caregivers of children with autism spectrum disorder (ASD) showed significantly higher likelihoods of experiencing two physical health problems compared to CCWAA. The decision tree analysis revealed that age (> 42 years), and suboptimal sleep behaviour (not 7-8 hours), and smoking (current smoker) were the frequent predictors for physical health problems in CCAA. CONCLUSION The results of the current study represent an important milestone in further investigating physical health problems in CCAA.
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Affiliation(s)
- Byungmo Ku
- Department of Special Physical Education, Sports Sciecne Buliding 8405, 134 Yongindaehak-ro, Samga-dong, Cheoin-gu, Yongin-si, Gyeonggi-do, South Korea
| | - Seungbeen Ghim
- Health Management and Policy, College of Health, Oregon State University, 97333, Corvallis, OR, USA.
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Park S, Shin J, Ihm SH, Kim KI, Kim HL, Kim HC, Lee EM, Lee JH, Ahn SY, Cho EJ, Kim JH, Kang HT, Lee HY, Lee S, Kim W, Park JM. Resistant hypertension: consensus document from the Korean society of hypertension. Clin Hypertens 2023; 29:30. [PMID: 37908019 PMCID: PMC10619268 DOI: 10.1186/s40885-023-00255-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023] Open
Abstract
Although reports vary, the prevalence of true resistant hypertension and apparent treatment-resistant hypertension (aTRH) has been reported to be 10.3% and 14.7%, respectively. As there is a rapid increase in the prevalence of obesity, chronic kidney disease, and diabetes mellitus, factors that are associated with resistant hypertension, the prevalence of resistant hypertension is expected to rise as well. Frequently, patients with aTRH have pseudoresistant hypertension [aTRH due to white-coat uncontrolled hypertension (WUCH), drug underdosing, poor adherence, and inaccurate office blood pressure (BP) measurements]. As the prevalence of WUCH is high among patients with aTRH, the use of out-of-office BP measurements, both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), is essential to exclude WUCH. Non-adherence is especially problematic, and methods to assess adherence remain limited and often not clinically feasible. Therefore, the use of HBPM and higher utilization of single-pill fixed-dose combination treatments should be emphasized to improve drug adherence. In addition, primary aldosteronism and symptomatic obstructive sleep apnea are quite common in patients with hypertension and more so in patients with resistant hypertension. Screening for these diseases is essential, as the treatment of these secondary causes may help control BP in patients who are otherwise difficult to treat. Finally, a proper drug regimen combined with lifestyle modifications is essential to control BP in these patients.
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Affiliation(s)
- Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Sang Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital327 Sosa-Ro, Wonmi-guGyunggi-do, Bucheon-si, 14647, Republic of Korea.
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Republic of Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Shin Young Ahn
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Eun Joo Cho
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sunki Lee
- Hallym University, Dongtan Hospital, Gyeonggi-do, Korea
| | - Woohyeun Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea
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Tsai MK, Gao W, Wen CP. The relationship between alcohol consumption and health: J-shaped or less is more? BMC Med 2023; 21:228. [PMID: 37400823 DOI: 10.1186/s12916-023-02911-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/25/2023] [Indexed: 07/05/2023] Open
Affiliation(s)
- Min-Kuang Tsai
- Program in Global Health and Health Security, College of Public Health, Taipei Medical University, 250 Wuxing Street, 110, Taipei, Taiwan
| | - Wayne Gao
- Program in Global Health and Health Security, College of Public Health, Taipei Medical University, 250 Wuxing Street, 110, Taipei, Taiwan.
| | - Chi-Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- China Medical University Hospital, Taichung, Taiwan
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Tian Y, Liu J, Zhao Y, Jiang N, Liu X, Zhao G, Wang X. Alcohol consumption and all-cause and cause-specific mortality among US adults: prospective cohort study. BMC Med 2023; 21:208. [PMID: 37286970 DOI: 10.1186/s12916-023-02907-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Previous studies have shown inconsistent findings regarding the association of light to moderate alcohol consumption with cause-specific mortality. Therefore, this study sought to examine the prospective association of alcohol consumption with all-cause and cause-specific mortality in the US population. METHODS This was a population-based cohort study of adults aged 18 years or older in the National Health Interview Survey (1997 to 2014) with linkage to the National Death Index records through December 31, 2019. Self-reported alcohol consumption was categorized into seven groups (lifetime abstainers; former infrequent or regular drinkers; and current infrequent, light, moderate, or heavy drinkers). The main outcome was all-cause and cause-specific mortality. RESULTS During an average follow-up of 12.65 years, among the 918,529 participants (mean age 46.1 years; 48.0% male), 141,512 adults died from all causes, 43,979 from cardiovascular disease (CVD), 33,222 from cancer, 8246 from chronic lower respiratory tract diseases, 5572 from accidents (unintentional injuries), 4776 from Alzheimer's disease, 4845 from diabetes mellitus, 2815 from influenza and pneumonia, and 2692 from nephritis, nephrotic syndrome, or nephrosis. Compared with lifetime abstainers, current infrequent, light, or moderate drinkers were at a lower risk of mortality from all causes [infrequent-hazard ratio: 0.87; 95% confidence interval: 0.84 to 0.90; light: 0.77; 0.75 to 0.79; moderate 0.82; 0.80 to 0.85], CVD, chronic lower respiratory tract diseases, Alzheimer's disease, and influenza and pneumonia. Also, light or moderate drinkers were associated with lower risk of mortality from diabetes mellitus and nephritis, nephrotic syndrome, or nephrosis. In contrast, heavy drinkers had a significantly higher risk of mortality from all causes, cancer, and accidents (unintentional injuries). Furthermore, binge drinking ≥ 1 day/week was associated with a higher risk of mortality from all causes (1.15; 1.09 to 1.22), cancer (1.22; 1.10 to 1.35), and accidents (unintentional injuries) (1.39; 1.11 to 1.74). CONCLUSIONS Infrequent, light, and moderate alcohol consumption were inversely associated with mortality from all causes, CVD, chronic lower respiratory tract diseases, Alzheimer's disease, and influenza and pneumonia. Light or moderate alcohol consumption might also have a beneficial effect on mortality from diabetes mellitus and nephritis, nephrotic syndrome, or nephrosis. However, heavy or binge had a higher risk of all-cause, cancer, and accidents (unintentional injuries) mortality.
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Affiliation(s)
- Yalan Tian
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China
| | - Jiahui Liu
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China
| | - Yue Zhao
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China
| | - Nana Jiang
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China
| | - Xiao Liu
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China
| | - Gang Zhao
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xia Wang
- Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China.
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Li H, Xia N. Alcohol and the vasculature: a love-hate relationship? Pflugers Arch 2023:10.1007/s00424-023-02818-8. [PMID: 37165232 DOI: 10.1007/s00424-023-02818-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
Alcohol consumption is a leading risk factor and increases the risk of liver diseases, cancers, tuberculosis, and injuries. The relationship between alcohol use and cardiovascular risk is complex. While it is well established that heavy alcohol use and binge drinking harm cardiovascular health, the effect of light-to-moderate alcohol consumption remains controversial. Observational studies have repeatedly confirmed the U- or J-shaped relationship between alcohol consumption and cardiovascular disease risk, with the lowest risk observed in the light-to-moderate drinking group. However, the protective effect of low-level alcohol has been challenged by recent genetic epidemiological studies with Mendelian randomization. Such studies have their own limitations, and the application of this methodology in studying alcohol has been questioned. Results from the latest Global Burden of Diseases, Injuries, and Risk Factors Study suggest that the impact of alcohol consumption on health depends on the age structure and the distribution of disease burden and underlying causes in a given population. For young adults, even small amounts of alcohol cause heath loss. For older adults facing a high burden of cardiovascular diseases, light-to-moderate alcohol consumption may improve cardiovascular health outcomes. Mechanistically, all types of alcoholic beverages, including wine, spirits, and beer, have been shown to increase the levels of high-density lipoprotein cholesterol and adiponectin, and reduce the level of fibrinogen. Nonalcoholic components of wine, especially polyphenolic compounds like resveratrol, may additionally enhance endothelial nitric oxide production, and provide antioxidant and anti-inflammatory effects.
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Affiliation(s)
- Huige Li
- Department of Pharmacology, Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Ning Xia
- Department of Pharmacology, Johannes Gutenberg University Medical Center, Langenbeckstr. 1, 55131, Mainz, Germany
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Wang M, Su W, Chen H, Li H. Depressive symptoms and risk of incident cardiometabolic multimorbidity in community-dwelling older adults: The China Health and Retirement Longitudinal Study. J Affect Disord 2023; 335:75-82. [PMID: 37075824 DOI: 10.1016/j.jad.2023.04.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/30/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Depressive symptoms are associated with an increased risk of developing cardiometabolic diseases (CMDs). However, the relationship between depressive symptoms and cardiometabolic multimorbidity (CMM) remains unclear. Therefore, we aimed to examine whether depressive symptoms were associated with an increased risk of incident CMM in middle-aged and older Chinese adults. METHODS This prospective cohort study included 6663 participants who were free of CMM at baseline from the China Health and Retirement Longitudinal Study. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale-10 (CESD-10). Incident CMM refers to the coexistence of ≥2 CMDs (heart disease, stroke, or diabetes). Multivariable logistic regressions and restricted cubic splines were performed to assess the association between depressive symptoms and incident CMM. RESULTS The median CESD-10 score at baseline was 7 (IQR: 3 to 12). Over 4 years of follow-up, 309 participants (4.6 %) developed CMM. After adjusting for sociodemographic, behavioral, and traditional clinical risk factors, a higher frequency of depressive symptoms was associated with an increased risk of incident CMM (per 9-point higher CESD-10 score OR: 1.73; 95 % CI: 1.48-2.03). The association between the CESD-10 score and incident CMM was more obvious in women (OR: 2.02; 95 % CI: 1.63-2.51) than in men (OR: 1.16; 95 % CI: 0.86-1.56) (Pinteraction = 0.005). LIMITATIONS Heart diseases and stroke were determined based on self-reported physician diagnoses. CONCLUSIONS A higher frequency of depressive symptoms at baseline increased the risk of incident CMM within four years among middle-aged and older individuals in China.
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Affiliation(s)
- Man Wang
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wen Su
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China.
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Henrique de Moraes Cellia P, Lima EG, Agrizzi de Angeli LR, Martins EB, Rached FH, Pitta FG, Cassaro Strunz CM, Serrano CV. Evaluation of cardiovascular risk biomarkers after moderate consumption of red wine and cachaça in a randomized crossover trial: The Wine and Cachaça Study (WICAS). Clin Nutr ESPEN 2022; 52:113-118. [PMID: 36513442 DOI: 10.1016/j.clnesp.2022.10.014] [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: 06/08/2022] [Revised: 10/07/2022] [Accepted: 10/23/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Moderate daily consumption of alcohol (MDCA) is associated with cardiovascular risk (CVR) reduction in observational studies. Some researches have suggested that this benefit may be associated not only with red wine consumption but also with other beverages. However, there are no clinical trials evaluating the possible CVR benefit of Brazilian spirit (cachaça) in humans. METHODS This is a prospective, randomized, crossover study including healthy individuals initially assigned to a MDCA of cachaça or red wine for a period of 4 weeks. After a one-week abstinence period, the type of drink was changed for another 4 weeks of intervention. The MDCA for both beverages was determined as a dose equivalent to 28 g of ethanol per day for men and 14 g for women. CVR biomarkers analyses were performed before and after each intervention to assess the serologic status of C-reactive protein, lipid profile, platelet aggregation and glycemic profile. This study is registered on the ISRCTN platform under number 15978506. RESULTS Of the 42 subjects initially randomized, 2 refused to continue in the study. The median age was 44.3 ± 10.3 years and 19 were male (47.5%). Adherence to the protocol was considered ideal with 100% regular use in both interventions and only 3 individuals in each intervention group reported alcohol abuse. There was no significant variation in anthropometric measurements during the study, except for weight gain (0.7 kg) in the red wine group (p = 0.005). The median of the delta of platelet aggregation for MDCA of cachaça was 1.2% (-1.1 to 5.3) and the median of the delta to the MDCA of wine was -1.6% (-4.5 to 2) (p = 0.02). The other biomarkers didn't show any statistically significant variation. CONCLUSION Moderate consumption of wine and cachaça was related to variation in laboratory biomarkers of CVR related to atherosclerosis. There was significant weight gain during the period of wine consumption and there was observed a difference between platelet aggregation values after both interventions.
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Krittanawong C, Isath A, Rosenson RS, Khawaja M, Wang Z, Fogg SE, Virani SS, Qi L, Cao Y, Long MT, Tangney CC, Lavie CJ. Alcohol Consumption and Cardiovascular Health. Am J Med 2022; 135:1213-1230.e3. [PMID: 35580715 PMCID: PMC9529807 DOI: 10.1016/j.amjmed.2022.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Studies evaluating alcohol consumption and cardiovascular diseases have shown inconsistent results. METHODS We performed a systematic review of peer-reviewed publications from an extensive query of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception to March 2022 for all studies that reported the association between alcohol consumption in terms of quantity (daily or weekly amounts) and type of beverage (wine, beer or spirit) and cardiovascular disease events. RESULTS The study population included a total of 1,579,435 individuals based on 56 cohorts from several countries. We found that moderate wine consumption defined as 1-4 drinks per week was associated with a reduction in risk for cardiovascular mortality when compared with beer or spirits. However, higher risk for cardiovascular disease mortality was typically seen with heavier daily or weekly alcohol consumption across all types of beverages. CONCLUSIONS It is possible that the observational studies may overestimate the benefits of alcohol for cardiovascular disease outcomes. Although moderate wine consumption is probably associated with low cardiovascular disease events, there are many confounding factors, in particular, lifestyle, genetic, and socioeconomic associations with wine drinking, which likely explain much of the association with wine and reduced cardiovascular disease events. Further prospective study of alcohol and all-cause mortality, including cancer, is needed.
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Affiliation(s)
- Chayakrit Krittanawong
- The Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Cardiology, Baylor College of Medicine, Houston, Texas.
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla
| | - Robert S Rosenson
- Cardiometabolic Unit, Mount Sinai Hospital, Mount Sinai Heart, New York, NY; Mayo Clinic Evidence-based Practice Center, Rochester, Minn
| | - Muzamil Khawaja
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Zhen Wang
- Cardiometabolic Unit, Mount Sinai Hospital, Mount Sinai Heart, New York, NY; Mayo Clinic Evidence-based Practice Center, Rochester, Minn; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Sonya E Fogg
- Library and Learning Resource Center, Texas Heart Institute, Houston
| | - Salim S Virani
- The Michael E. DeBakey VA Medical Center, Houston, Texas; Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Lu Qi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, La
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Mo
| | - Michelle T Long
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Mass
| | - Christy C Tangney
- Department of Clinical Nutrition, Rush University Medical Center, Chicago, Ill
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, La
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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.
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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
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12
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Medling T, Gobeil K, Sawalha K, Abozenah M, Tavares P, Friedmann P, Naimi T, Pack Q. Relation of Patient's Opinion of Alcohol's Health Effects and Drinking Habits Among Hospitalized Patients With Cardiovascular Disease. Am J Cardiol 2022; 179:31-38. [PMID: 35914974 PMCID: PMC10061998 DOI: 10.1016/j.amjcard.2022.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022]
Abstract
Media reports frequently cite observational studies and meta-analyses to promote the reputed cardiovascular benefits of moderate alcohol consumption; however, it is unclear whether public opinion or drinking behavior align with these reports. We administered an anonymous, single-center, 35-question, cross-sectional survey among patients hospitalized for acute cardiac illnesses from June to September 2019, who were eligible for cardiac rehabilitation. We assessed patient opinions toward alcohol use, perceptions of alcohol's health impact, and role of media in forming these beliefs. We hypothesized that drinking habits are associated with beliefs about the health benefits of alcohol consumption. Of 300 patients approached, 290 completed the survey (97%). Most (69%) reported having heard moderate alcohol use is heart healthy from 1 or more sources including: TV (61%), family/friends (33%), newspapers (21%), and the internet (10%); although, only 19% reported believing these reports. In total, 12 patients (4%) reported intentionally increasing alcohol intake because of the reported beneficial health effects. There was a strong association between binge drinking and increasing alcohol used to improve cardiac health (odds ratio 8.8, 95% confidence interval 2.7, 29). Given the known cardiotoxic effects of alcohol, particularly in large doses, strategies aimed at population-based education regarding the unhealthy cardiovascular impact of alcohol use is needed, especially among binge drinkers.
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Affiliation(s)
- Theodore Medling
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kyle Gobeil
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Cardiovascular Disease, Baystate Medical Center, Springfield, Massachusetts
| | - Khalid Sawalha
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Mohammed Abozenah
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Cardiovascular Disease, Baystate Medical Center, Springfield, Massachusetts
| | - Paolo Tavares
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Peter Friedmann
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Institute of Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts
| | - Timothy Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Quinn Pack
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts; Department of Cardiovascular Disease, Baystate Medical Center, Springfield, Massachusetts; Institute of Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts.
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13
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Dietary factors and onset of natural menopause: A systematic review and meta-analysis. Maturitas 2022; 159:15-32. [DOI: 10.1016/j.maturitas.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022]
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14
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Schrauben SJ, Apple BJ, Chang AR. Modifiable Lifestyle Behaviors and CKD Progression: A Narrative Review. KIDNEY360 2022; 3:752-778. [PMID: 35721622 DOI: 10.34067/kid.0003122021] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/07/2022] [Indexed: 12/19/2022]
Abstract
Living a healthy lifestyle is one of the safest and most cost-effective ways to improve one's quality of life and prevent and/or manage chronic disease. As such, current CKD management guidelines recommend that patients adhere to a healthy diet, perform ≥150 minutes per week of physical activity, manage their body weight, abstain from tobacco use, and limit alcohol. However, there are limited studies that investigate the relationship between these lifestyle factors and the progression of CKD among people with established CKD. In this narrative review, we examine the reported frequencies of health lifestyle behavior engagement among individuals with non-dialysis-dependent CKD and the existing literature that examines the influences of diet, physical activity, weight management, alcohol consumption, and tobacco use on the progression of CKD, as measured by decline in GFR, incident ESKD, or elevated proteinuria or albuminuria in individuals with CKD. Many of the available studies are limited by length of follow-up and small sample sizes, and meta-analyses were limited because the studies were sparse and had heterogeneous classifications of behaviors and/or referent groups and of CKD progression. Further research should be done to determine optimal methods to assess behaviors to better understand the levels at which healthy lifestyle behaviors are needed to slow CKD progression, to investigate the effect of combining multiple lifestyle behaviors on important clinical outcomes in CKD, and to develop effective techniques for behavior change. Despite the lack of evidence of efficacy from large trials on the ability of lifestyle behaviors to slow CKD progression, maintaining a healthy lifestyle remains a cornerstone of CKD management given the undisputed benefits of healthy lifestyle behaviors on cardiovascular health, BP control, and survival.
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Affiliation(s)
- Sarah J Schrauben
- Renal, Electrolyte-Hypertension Division, Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin J Apple
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Alex R Chang
- Kidney Health Research Institute, Department of Population Health Sciences, Geisinger Health, Danville, Pennsylvania
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15
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Hoek AG, van Oort S, Mukamal KJ, Beulens JWJ. Alcohol Consumption and Cardiovascular Disease Risk: Placing New Data in Context. Curr Atheroscler Rep 2022; 24:51-59. [PMID: 35129737 PMCID: PMC8924109 DOI: 10.1007/s11883-022-00992-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review A clear link between excessive alcohol consumption and cardiovascular disease (CVD) has been established, but no consensus exists on the effects of moderate alcohol consumption on CVD. Recent Findings A lower risk of coronary heart disease and myocardial infarction among moderate drinkers compared to abstainers has been consistently observed in epidemiological studies and meta-analyses of these studies. However, ambiguity remains on the effect of alcohol on other CVDs and all-cause mortality. Short-term randomized controlled trials (RCT) have identified potentially beneficial effects of alcohol consumption on cardiovascular risk factors, but studies investigating genetic polymorphisms that influence alcohol consumption (i.e., Mendelian randomization) have yielded inconclusive results. To date, a long-term RCT providing causal evidence is lacking but urgently needed. Summary Triangulation of evidence from different study designs, including long-term RCTs, pragmatic trials and the evaluation of policy measures, combined will lead to the best available evidence.
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Affiliation(s)
- Anna G Hoek
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Data Science, Amsterdam Cardiovascular Sciences Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Sabine van Oort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Data Science, Amsterdam Cardiovascular Sciences Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Kenneth J Mukamal
- Beth Israel Deaconess Medical Center, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Joline W J Beulens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Data Science, Amsterdam Cardiovascular Sciences Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands.,University Medical Centre Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
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16
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Negreira-Caamaño M, Abellán-Huerta J. La paradoja del consumo de alcohol: cautela ante una evidencia en desarrollo. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Negreira-Caamaño M, Abellán-Huerta J. The alcohol-intake paradox: caution in a field of developing evidence. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:190-191. [PMID: 34657830 DOI: 10.1016/j.rec.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - José Abellán-Huerta
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain.
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18
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Shuval K, Leonard D, Chartier KG, Barlow CE, Fennis BM, Katz DL, Abel K, Farrell SW, Pavlovic A, Defina LF. Fit and Tipsy? The Interrelationship between Cardiorespiratory Fitness and Alcohol Consumption and Dependence. Med Sci Sports Exerc 2022; 54:113-119. [PMID: 34431829 DOI: 10.1249/mss.0000000000002777] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine whether higher levels of cardiorespiratory fitness are related to increased alcohol consumption and dependence among a large sample of adults attending a preventive medicine clinic. METHODS A cross-sectional study of 38,653 apparently healthy patients who visited the Cooper Clinic (Dallas, TX) for preventive medical examinations (1988-2019) and enrolled in the Cooper Center Longitudinal Study. The primary independent variable was cardiorespiratory fitness, based on a maximal treadmill test, and the dependent variables were alcohol consumption and dependence (self-reported). The relations between fitness category (low, moderate, high) and alcohol consumption (low, moderate, heavy) and suggested alcohol dependence (Cut down, Annoyed, Guilty, Eye opener score ≥2) among women and men were estimated via multivariable regression while adjusting for covariates (e.g., age, birth year cohort, marital status, and body mass index). RESULTS Women within the moderate and high fitness categories had 1.58 (95% confidence interval [CI], 1.32-1.91) and 2.14 (95% CI, 1.77-2.58) greater odds of moderate/heavy alcohol consumption, respectively, in comparison to their low fitness counterparts. Similarly, moderate and high fit men had 1.42 (95% CI, 1.30-1.55) and 1.63 (95% CI, 1.49-1.80) times greater odds of moderate-to-heavy alcohol consumption, respectively, in comparison to the low fitness group. In addition, among men who were heavy drinkers (but not women), higher fitness levels were related to lower rates of suggested alcohol dependence. Specifically, these men had 45.7%, 41.7%, and 34.9% proportions of clinically relevant alcohol problems across low, moderate, and high fitness categories (adjusted P for trend <0.001). CONCLUSIONS Higher fitness levels are significantly related to greater alcohol consumption among a large cohort of adult patients. Interventions focusing on increasing fitness (via physical activity promotion) might consider concurrently aiming to reduce alcohol consumption.
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Affiliation(s)
| | - David Leonard
- Division of Research, The Cooper Institute, Dallas, TX
| | - Karen G Chartier
- School of Social Work and Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
| | | | - Bob M Fennis
- Department of Marketing, Faculty of Economics and Business, University of Groningen, Groningen, THE NETHERLANDS
| | | | - Katelyn Abel
- Division of Research, The Cooper Institute, Dallas, TX
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19
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Howell SJ, Marcus GM. Does the holiday heart syndrome extend to the ventricles? Heart Rhythm 2021; 19:185-186. [PMID: 34798353 DOI: 10.1016/j.hrthm.2021.11.018] [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: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Stacey J Howell
- Section of Electrophysiology, Division of Cardiology, University of California San Francisco, San Francisco, California
| | - Gregory M Marcus
- Section of Electrophysiology, Division of Cardiology, University of California San Francisco, San Francisco, California.
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20
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Torenfält I, Dimberg L. Stroke and death-findings from a 25-year follow-up of a cohort of employed Swedish middle-aged men of the Coeur study. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01667-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Abstract
Aim
In 1993, a study of 1000 automotive workers in Sweden and France looked into national differences of cardiovascular disease. Here, we evaluate the proportion of the Swedish cohort that suffered a stroke or died over a 25-year period and associated risk factors.
Subject and methods
Data from 1993 included a life-style questionnaire, a health examination and laboratory data. Figures on stroke and survival status up until the end of 2018 were collected from national registers. Survival analysis was used for both univariable and multivariable analyses to study associations between potential risk factors and stroke and death, respectively.
Results
By the end of 2018, 65 individuals had suffered a stroke and 160 had died. In the univariable analysis, we found age, systolic blood pressure, Framingham risk index and diabetes at baseline to be significantly associated with stroke during follow-up.
For death, most of the traditional risk factors were significantly associated with the outcome, as was blue-collar work and living alone. In the multivariable analysis, age and diabetes at baseline remained significantly associated with stroke, whereas eight factors (age, blue-collar work, living alone, systolic blood pressure, waist–hip ratio, smoking habits, diabetes and hypertension at baseline) were significantly associated with death during follow-up.
Conclusion
Few of the traditional risk factors were significantly associated with stroke possibly explained by low power and/or different pathogenetic mechanism than for myocardial infarction.
Partly because death occurred more often, we did find a number of potential risk factors to be significantly associated with this outcome.
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21
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Yu A, Cooke AB, Scheffler P, Doonan RJ, Daskalopoulou SS. Alcohol Exerts a Shifted U-Shaped Effect on Central Blood Pressure in Young Adults. J Gen Intern Med 2021; 36:2975-2981. [PMID: 33674917 PMCID: PMC8481396 DOI: 10.1007/s11606-021-06665-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Consumption of 1-2 alcoholic beverages daily has been associated with a lower risk of cardiovascular disease and all-cause mortality in middle-aged and older adults. Central blood pressure has emerged as a better predictor of cardiovascular risk than peripheral blood pressure. However, the effects of habitual alcohol consumption on central blood pressure particularly in young adults, who are among the largest consumers of alcohol in North America, have yet to be investigated. OBJECTIVE We aimed to study the effect of alcohol consumption on central and peripheral blood pressure, and arterial stiffness in young adults. DESIGN Cross-sectional observational study. MAIN MEASURES Using a standardized questionnaire, alcohol consumption (drinks/week) was queried; participants were classified as non- (< 2), light (2-6), moderate (women 7-9, men 7-14), and heavy drinkers (women > 9, men > 14). Central blood pressure and arterial stiffness were measured using applanation tonometry. KEY RESULTS We recruited 153 healthy, non-smoking, non-obese individuals. We found a U-shaped effect of alcohol consumption on blood pressure. Light drinkers had significantly lower central systolic and mean arterial blood pressure, but not peripheral blood pressure when compared to non- and moderate/heavy drinkers (P < 0.05). No significant associations with arterial stiffness parameters were noted. CONCLUSIONS A U-shaped relationship was found between alcohol consumption and central and mean arterial blood pressure in young individuals, which importantly, was shifted towards lower levels of alcohol consumption than currently suggested. This is the first study, to our knowledge, that examines the effect of alcohol consumption on central blood pressure and arterial stiffness exclusively in young individuals. Prospective studies are needed to confirm the relationships observed herein.
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Affiliation(s)
- Alice Yu
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alexandra B Cooke
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Patrick Scheffler
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robert J Doonan
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
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22
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Gobeil K, Medling T, Tavares P, Sawalha K, Abozenah M, Friedmann PD, Naimi T, Pack QR. Frequency of Hazardous and Binge Drinking Alcohol Among Hospitalized Cardiovascular Patients. Am J Cardiol 2021; 153:119-124. [PMID: 34210505 PMCID: PMC8316379 DOI: 10.1016/j.amjcard.2021.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 11/19/2022]
Abstract
Excessive alcohol use is a risk factor for most cardiac diseases. The prevalence of unhealthy alcohol use among hospitalized cardiac patients is uncertain as is the frequency with which it is addressed. We performed a single center, patient-level anonymous survey among hospitalized cardiac patients eligible for cardiac rehabilitation. Hazardous drinking was defined as an Alcohol Use Disorders Identification Test (AUDIT) score of 8 or greater. Binge drinking was defined as 5+ drinks for men or 4+ for women on ≥1 occasion within the past 30 days. Unhealthy drinking was defined as either hazardous or binge drinking. Of 300 patients approached, 290 (96.7%) completed the survey. Mean ( ± SD) age was 69 ± 11 years; 70% were male and 31% were cardiac surgical patients. The proportion (95% CI) of hazardous, binge, and unhealthy drinking was 12% (9 to 16), 16% (12 to 20), and 18% (14-23), respectively. Overall, 58% of subjects reported being screened for alcohol use, mostly by nurses (56%). Those with unhealthy drinking reported being counseled more frequently about their alcohol use compared to non-unhealthy drinkers (11% versus 3%, p = 0.03), but the large majority (89%) of unhealthy drinkers reported receiving no advice about their alcohol use while admitted. In conclusion, almost one-fifth of hospitalized cardiac patients reported unhealthy drinking, these patients were only screened about half of the time, and were rarely counseled about their alcohol use.
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Affiliation(s)
- Kyle Gobeil
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield Massachusetts; Department of Cardiovascular Disease, University of Massachusetts Medical School - Baystate, Springfield Massachusetts
| | - Theodore Medling
- University of Massachusetts Medical School, Worcester Massachusetts
| | - Paolo Tavares
- University of Massachusetts Medical School, Worcester Massachusetts
| | - Khalid Sawalha
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield Massachusetts
| | - Mohammed Abozenah
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield Massachusetts
| | - Peter D Friedmann
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield Massachusetts; Institute of Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield Massachusetts
| | - Timothy Naimi
- Department of Medicine, Boston University School of Medicine, Boston Massachusetts
| | - Quinn R Pack
- Department of Medicine, University of Massachusetts Medical School - Baystate, Springfield Massachusetts; Department of Cardiovascular Disease, University of Massachusetts Medical School - Baystate, Springfield Massachusetts; Institute of Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield Massachusetts.
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23
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Heredia NI, Nguyen N, Martinez BA, Obasi EM, McNeill LH. The positive association between physical activity and alcohol use in African American adults. Prev Med Rep 2021; 23:101487. [PMID: 34381666 PMCID: PMC8333140 DOI: 10.1016/j.pmedr.2021.101487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/26/2021] [Accepted: 07/03/2021] [Indexed: 12/27/2022] Open
Abstract
Alcohol intake positively associated with physical activity in African Americans. This association appears to be driven by females, with no association in males. Alcohol intake not associated with Body Mass Index in this African American sample.
African Americans have highest incidence and mortality from obesity-related cancers. Physical activity (PA), minimal alcohol use, and maintaining a low body mass index (BMI) are important cancer prevention behaviors, though there is little research on how these behaviors are associated with one another in African Americans. The purpose of this study is to assess the relationship between PA, alcohol use, and BMI using secondary data from an African American cohort recruited from Houston-area churches. Self-administered questionnaires measured self-reported PA, alcohol use, height, weight, and sociodemographic factors. Univariate and multivariable analyses assessed the relation between PA, alcohol use, BMI, controlling for covariates. Participants (N = 1009) were mostly female (77%), employed (72%), and college graduates (55%). Most (53%) reported both light-to-moderate alcohol use & moderate-to-high levels of PA. There was a statistically significant positive linear association between PA and alcohol use (Pearson’s r = 0.15, p < 0.001). We also found that every one hour increase per week in PA was associated with 3% increased odds of being a heavy drinker (>2 drinks/day men, >1 drink/day women), as compared to an abstainer (Adjusted OR = 1.03, 95%CI 1.01–1.06). There was a statistically significant inverse association between PA and BMI, but no statistically significant association between alcohol use and BMI. In this sample of African Americans, PA and alcohol use were positively associated, mirroring results among Non-Hispanic Whites. However, alcohol use and BMI were not statistically significantly associated. Cancer and obesity prevention for African Americans should stress PA promotion while emphasizing messaging to curtail any associated increases in alcohol use.
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Affiliation(s)
- Natalia I. Heredia
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
- Corresponding author.
| | - Nga Nguyen
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Bryan A. Martinez
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Ezemenari M. Obasi
- University of Houston, HEALTH Research Institute, Houston, TX, United States
| | - Lorna H. McNeill
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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24
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A Matched Control Analysis on the Effects of Alcohol Use Disorder After Primary Total Knee Arthroplasty in Medicare Patients. J Am Acad Orthop Surg 2021; 29:e593-e600. [PMID: 32991387 DOI: 10.5435/jaaos-d-20-00466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/24/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Several studies have found the negative impact of alcohol use disorder (AUD), most notably coagulation derangements. We sought to investigate the effects of AUD after primary total knee arthroplasty (TKA) for (1) postoperative complications, (2) lengths of stay, and (3) costs of care. METHODS This was a retrospective database analysis of Medicare patients with AUD undergoing primary TKA performed between 2005 and 2014. Patients with AUD were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 354,690 TKA patients: 59,126 with AUD and 295,564 without AUD. RESULTS Patients with AUD had significantly greater odds ratio (OR) of medical complications, including venous thromboembolism (VTE) within 90 days (OR: 1.41, P < 0.0001) and at 1 year (OR: 1.51, P < 0.0001) and greater 2-year implant-related complications after primary TKA. Furthermore, patients with AUD had significantly longer lengths of stay (4 versus 3 days, P < 0.0001) and incurred a significantly higher episode of care costs ($15,569.76 versus $13,763.06, P < 0.0001). DISCUSSION The present study demonstrated a significant association between AUD and the development of VTE. We hope this research will aid in risk stratification and tailoring of VTE chemoprophylaxis and postoperative management in this at-risk group after TKA. LEVEL OF EVIDENCE Level III.
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25
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Grubb AF, Greene SJ, Fudim M, Dewald T, Mentz RJ. Drugs of Abuse and Heart Failure. J Card Fail 2021; 27:1260-1275. [PMID: 34133967 DOI: 10.1016/j.cardfail.2021.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
Substance use is common among those with heart failure (HF) and is associated with worse clinical outcomes. Alcohol, tobacco, cannabis, and cocaine are commonly abused substances that can contribute to the development and worsening of HF. Heavy alcohol consumption can lead to dilated cardiomyopathy, whereas moderate intake may decrease incident HF. Tobacco increases the risk of HF through coronary artery disease and coronary artery disease-independent mechanisms. Continued smoking worsens outcomes for those with HF and cessation is associated with an improved risk of major adverse cardiac events. Cannabis has complex interactions on the cardiovascular system depending on the method of consumption, amount consumed, and content of cannabinoids. Delta-9-tetrahydrocannabinol can increase sympathetic tone, cause vascular dysfunction, and may increase the risk of myocardial infarction. Cannabidiol is cardioprotective in preclinical studies and is a potential therapeutic target. Cocaine increases sympathetic tone and is a potent proarrhythmogenic agent. It increases the risk of myocardial infarction and can also lead to a dilated cardiomyopathy. The use of beta-blockers in those with HF and cocaine use is likely safe and effective. Future studies are needed to further elucidate the impact of these substances both on the development of HF and their effects on those who have HF.
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Affiliation(s)
- Alex F Grubb
- Department of Medicine, Duke University Hospital, Durham, North Carolina.
| | - Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Tracy Dewald
- Department of Medicine, Division of Clinical Pharmacology Durham, North Carolina
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Masip J, Germà Lluch JR. Alcohol, health and cardiovascular disease. Rev Clin Esp 2021; 221:359-368. [PMID: 31353015 DOI: 10.1016/j.rce.2019.05.013] [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: 03/18/2019] [Revised: 05/15/2019] [Accepted: 05/27/2019] [Indexed: 11/15/2022]
Abstract
Recent epidemiological studies have shown that alcohol consumption can increase the risk of arterial hypertension, atrial fibrillation and gastrointestinal and breast cancer. Various sectors are therefore promoting abstinence from alcohol. However, light alcohol consumption has once again been shown to reduce the risk of myocardial infarction and diabetes but with an unclear effect on cerebrovascular disease. The decision to consume alcohol should therefore be an individual one based on personal factors. A level of consumption <100g/week for men (less for women) appears not to increase all-cause mortality, while high consumption or binge drinking significantly increases mortality risk. All measures to prevent this type of consumption, especially among the younger population, should therefore be applied. There are data indicating an advantage of wine over other beverages, but they are not conclusive.
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Affiliation(s)
- J Masip
- Servei de Medicina Intensiva, Consorci Sanitari Integral, Barcelona, España; Servicio de Cardiología, Hospital CIMA Sanitas, Barcelona, España; Universidad de Barcelona, Barcelona, España.
| | - J R Germà Lluch
- Universidad de Barcelona, Barcelona, España; Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, España; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
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Aremu T, Anibijuwon IB, John-Akinola YO, Oluwasanu M, Oladepo O. Prevalence and Factors Associated With Alcohol Use in Selected Urban Communities in Ibadan, Nigeria. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 43:203-209. [PMID: 33840290 DOI: 10.1177/0272684x211006515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nigeria is ranked high among African countries in the consumption of alcohol and the national adult per capita consumption was estimated at 12.3litres. Harmful alcohol use is the sixth leading cause of disability and deaths in Nigeria. This study assessed the prevalence and factors associated with alcohol use in selected urban communities in Ibadan, Nigeria. This community-based cross sectional study was conducted among 500 respondents in two selected urban communities in Ibadan, Nigeria. The World Health Organization STEPS tool was used to collect data on socio-demographic characteristics of respondents and the history of alcohol use. Alcohol users were categorized into ever consumed, current consumers, consumers within last 12 months, and frequent consumers within 30 days (low, medium, and high consumers).Chi-square analysis was used to identify factors associated with the different categories of alcohol consumption. The mean age of the respondents was 35.36 ± 12.24 years. Almost one third of the participants (29.0%) reported they had ever consumed alcohol and (13.6%) had consumed alcohol within 30 days prior to the study. Factors significantly associated with the ever-use of alcohol were gender (p = 0.000), and income (p = 0.000). Current use of alcohol had a statistically significant relationship with male gender (p = 0.000). The prevalence of high alcohol use is low in the sample of urban communities studied, and factors influencing include sex, marital status, level of education, income. These results should inform policy decisions to address the alcohol use in urban communities in Southwest Nigeria.
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Affiliation(s)
- Tolulope Aremu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
| | - Ifeoluwa B Anibijuwon
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
| | - Yetunde O John-Akinola
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
| | - Mojisola Oluwasanu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
| | - Oladimeji Oladepo
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
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Pavicic Ivelja M, Dolic K, Tandara L, Perkovic N, Mestrovic A, Ivic I. Blood markers of endothelial dysfunction and their correlation to cerebrovascular reactivity in patients with chronic hepatitis C infection. PeerJ 2021; 9:e10723. [PMID: 33520470 PMCID: PMC7811780 DOI: 10.7717/peerj.10723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/16/2020] [Indexed: 01/14/2023] Open
Abstract
Although liver cirrhosis and hepatocellular carcinoma are major consequences of hepatitis C (HCV), there has been an increasing number of studies examining extrahepatic manifestations, especially those caused by systemic chronic inflammation and metabolic complications that might predispose HCV patients to atherosclerosis and ischemic cerebrovascular disease (CVD). The aim of our study was to assess E-selectin, VCAM-1, ICAM-1 and VEGF-A serum levels in patients with chronic HCV infection and to correlate them with cerebrovascular reactivity. A blood sample was taken from eighteen patients with chronic hepatitis C infection and from the same number of healthy blood donors in the control group. The aim was to analyse markers of endothelial dysfunction and to correlate them with cerebrovascular reactivity expressed as breath-holding index (BHI) determined using transcranial color Doppler. The obtained results revealed significant differences between the groups in all endothelial markers except for the E selectin. While the ICAM-1 and sVCAM-1 were significantly increased in the hepatitis group, VEGF-A was significantly decreased. A significant reduction of 0.5 (95% CI 0.2, 0.8) in the mean BHI was found in the hepatitis group (mean BHI 0.64) compared to controls (mean BHI 1.10). No significant association between the BHI and any of the endothelial markers was found in the control group, while in the hepatitis group, the scatter plot of ICAM-1 vs BHI suggested that the association might be present. In conclusion, the results of this study confirm an association between a chronic HCV infection and altered cerebrovascular reactivity as well as higher levels of markers of endothelial activation (ICAM-1, VCAM-1) as possible indicators of an increased CVD risk.
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Affiliation(s)
- Mirela Pavicic Ivelja
- University of Split School of Medicine, University Hospital of Split, Department of Infectious Diseases, Split, Croatia, Croatia
| | - Kresimir Dolic
- University of Split School of Medicine, University Hospital of Split, Department of Radiology, Split, Croatia, Croatia
| | - Leida Tandara
- University of Split School of Medicine, University Hospital of Split, Department of Medical Laboratory Diagnostics, Split, Croatia, Croatia
| | - Nikola Perkovic
- University of Split School of Medicine, University Hospital of Split, Department of Gastroenterology, Split, Croatia, Croatia
| | - Antonio Mestrovic
- University of Split School of Medicine, University Hospital of Split, Department of Gastroenterology, Split, Croatia, Croatia
| | - Ivo Ivic
- University of Split School of Medicine, University Hospital of Split, Department of Infectious Diseases, Split, Croatia, Croatia
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Grønbæk M, Ellison RC, Skovenborg E. The J-shaped curve-conceptual and methodological challenges. DRUGS AND ALCOHOL TODAY 2021. [DOI: 10.1108/dat-09-2020-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to review the conceptual and methodological challenges of a J-shaped association between alcohol consumption (AC), coronary heart disease (CHD) and all-cause mortality. In associated papers in this journal, Skovenborg et al., 2021 reviews the evidence for the J-shaped curve, and Ellison et al., 2021 examines the advantages and drawbacks of Mendelian randomization studies of the J-shaped curve.
Design/methodology/approach
A number of methodological problems are common in observational research in general, and some of the methodological problems suggested for the J-shaped alcohol-CHD-associations are discussed. The extent of the methodological problems in studies of the J-shaped curve is reviewed, and the possibility that the J-shaped curve is an artifact created by reverse causality and residual confounding is discussed. Further, the issue of interaction with drinking pattern and type of alcohol is discussed.
Findings
Imprecise categorization of alcohol intake information seems to have had little effect on the J-shaped alcohol-CHD-associations, nor has it affected the ability of these studies to show increasing mortality from a range of causes with increasing AC. The problem of “sick quitters” has been resolved by large studies using lifelong abstainers or infrequent drinkers as reference group. Many studies lack information on drinking patterns with regard to regular, moderate consumption versus binge drinking. Stratified analyses by important risk factors for CHD have not significantly changed the J-shaped association observed in most epidemiologic studies.
Originality/value
Potential biases and residual confounding probably do not overcome the J-shaped alcohol-CDH-association observed in most epidemiologic studies; however, the existence of a J-shaped curve is challenged by some degree of uncertainty. The actual review together with the associated papers by Skovenborg et al., 2021 and Ellison et al., 2021 offers a possibility to “update your priors” and achieve greater certainty when giving your patients information on the pros and cons of alcohol intake.
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Krivanek TJ, Gale SA, McFeeley BM, Nicastri CM, Daffner KR. Promoting Successful Cognitive Aging: A Ten-Year Update. J Alzheimers Dis 2021; 81:871-920. [PMID: 33935078 PMCID: PMC8293659 DOI: 10.3233/jad-201462] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.
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Affiliation(s)
- Taylor J. Krivanek
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Seth A. Gale
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Brittany M. McFeeley
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Casey M. Nicastri
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Kirk R. Daffner
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
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Tisdel DM, Gadberry JJ, Burke SL, Carlini NA, Fleenor BS, Campbell MS. Dietary fat and alcohol in the prediction of indices of vascular health among young adults. Nutrition 2020; 84:111120. [PMID: 33515808 DOI: 10.1016/j.nut.2020.111120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/04/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Arterial stiffness, particularly of the aorta, is an independent predictor of future cardiovascular disease, all-cause mortality, and hypertension. Arterial stiffening may be caused or exacerbated by the composition of the diet. Current research has indicated that habitual dietary patterns may influence arteriosclerosis, or the thickening and hardening of the artery walls, but has yet to identify a specific food group as the culprit. In young, college-aged adults, dietary fat intake and alcohol consumption tend to be higher compared to other periods throughout the life cycle. Therefore, the purpose of this study was to determine the influence of dietary fat and alcohol consumption on the vascular health of apparently healthy young adults. METHODS The data collected were assessed to determine if dietary fat and alcohol in young (18-30 y), college-aged adults (n = 50) were independent predictors of an increase in arterial stiffening. Vascular health was determined by the carotid-femoral pulse-wave velocity and the augmentation index corrected for a heart rate of 75 beats/min; dietary patterns were assessed using the Dietary Health Questionnaire II. RESULTS The gold standard marker of aortic stiffness, carotid femoral pulse-wave velocity, was positively correlated with cheese consumption (R2 = 0.092, P = 0.033), alcohol consumption (R2 = 0.102, P = 0.024), and total energy/calories (%) from alcohol (R2 = 0.118, P = 0.015) in univariate analysis. In forward-selection multiple regression analysis, energy from alcohol and cheese consumption accounted for 23.7% of the variance in carotid-femoral pulse-wave velocity (P = 0.009). The augmentation index wave reflection marker was positively correlated with total dietary fat (R2 = 0.110, P = 0.019), trans fatty acids (R2 = 0.092, P = 0.032), saturated fatty acids (R2 = 0.124, P = 0.012), monounsaturated fatty acids (R2 = 0.012, P = 0.015), red-meat consumption (R2 = 0.094, P = 0.030), and discretionary fat from solids in univariate analysis (R2 = 0.137, P = 0.008). Discretionary fat from solids accounted for 13.7% of the variation in augmentation index in forward-selection multiple regression analysis (P = 0.008). CONCLUSIONS These results indicate the potential roles of dietary fat and alcohol consumption in early vascular aging by stiffening the arteries of young, college-aged adults, which may in turn contribute to future adverse cardiovascular disease outcomes.
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Affiliation(s)
- Dorothy M Tisdel
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Jessica J Gadberry
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Summer L Burke
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA
| | - Nicholas A Carlini
- Clinical Exercise Physiology, Ball State University, Muncie, Indiana, USA
| | - Bradley S Fleenor
- Clinical Exercise Physiology, Ball State University, Muncie, Indiana, USA
| | - Marilyn S Campbell
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA.
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Zhang NH, Luo R, Cheng YC, Ge SW, Xu G. Leisure-Time Physical Activity and Mortality in CKD: A 1999-2012 NHANES Analysis. Am J Nephrol 2020; 51:919-929. [PMID: 33207339 DOI: 10.1159/000511685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND For patients with CKD, evidence on the optimal dose of physical activity and possible harm with excessive exercise is limited. This study aimed to analyze the dose-response association between leisure-time physical activity (LTPA) and mortality in those with CKD and explore the optimal dose or possible harm associated with increased levels of LTPA. METHODS 4,604 participants with CKD from the 1999 to 2012 National Health and Nutrition Examination Surveys with linked mortality data obtained through 2015 were classified into 6 groups: 0, 1-149, 150-299, 300-599, 600-899, and ≥900 min/week based on the total duration of the self-reported LTPA. Multivariable-adjusted Cox proportional hazards models were used to examine dose-response associations between LTPA and mortality. RESULTS During the median follow-up of 114 months, 1,449 (31%) all-cause deaths were recorded. Compared to the inactive group (0 min/week), we observed a 22% lower risk of all-cause mortality (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.63-0.97) among participants who performed 1-149 min per week for LTPA. The corresponding HRs and 95% CIs for all-cause mortality for 150-299 and 300-599 min/week of LTPA were 0.79 (0.64-0.97) and 0.74 (0.56-0.98). The benefit appeared to reach a threshold of a 43% (HR, 0.57; 95% CI, 0.36-0.91) lower risk of all-cause mortality among individuals performing 600-899 min/week for LTPA. Importantly, for ≥900 min/week of LTPA, the continued benefits were observed (HR, 0.62; 95% CI, 0.44-0.87). CONCLUSION LTPA was associated with lower mortality in those with CKD. The optimal dose was observed at the LTPA level of approximately 600-899 min/week, and there were still benefits rather than the excess risk with LTPA levels as high as ≥900 min/week. Therefore, clinicians should encourage inactive CKD patients to perform LTPA and do not need to discourage CKD patients who already adhere to long-term physical activity.
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Affiliation(s)
- Nan-Hui Zhang
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Luo
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi-Chun Cheng
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu-Wang Ge
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,
| | - Gang Xu
- Division of Internal Medicine, Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
Although research on alcohol-related disparities among women is a highly understudied area, evidence shows that racial/ethnic minority women, sexual minority women, and women of low socioeconomic status (based on education, income, or residence in disadvantaged neighborhoods) are more likely to experience alcohol-related problems. These problems include alcohol use disorder, particularly after young adulthood, and certain alcohol-related health, morbidity, and mortality outcomes. In some cases, disparities may reflect differences in alcohol consumption, but in other cases such disparities appear to occur despite similar and possibly lower levels of consumption among the affected groups. To understand alcohol-related disparities among women, several factors should be considered. These include age; the duration of heavy drinking over the life course; the widening disparity in cumulative socioeconomic disadvantage and health in middle adulthood; social status; sociocultural context; genetic factors that affect alcohol metabolism; and access to and quality of alcohol treatment services and health care. To inform the development of interventions that might mitigate disparities among women, research is needed to identify the factors and mechanisms that contribute most to a group's elevated risk for a given alcohol-related problem.
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Affiliation(s)
- Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Kara M Bensley
- Alcohol Research Group, Public Health Institute, Emeryville, California
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Association of Liver Transaminase Levels and Long-Term Blood Pressure Variability in Military Young Males: The CHIEF Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176094. [PMID: 32825751 PMCID: PMC7504620 DOI: 10.3390/ijerph17176094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022]
Abstract
Background: An inverse relationship of serum liver transaminases and mortality might be due to better blood pressure control in hypertensive patients. Whether it holds true regarding such an association for long-term blood pressure variability (BPV) in those without antihypertensive therapy is unclear. Methods: A population of 1112 military males without antihypertensive medications, aged 32 years, was collected from a retrospective longitudinal study in Taiwan. Serum liver aspartate and alanine transaminase (AST and ALT) levels were obtained from a 12 h-fast blood sample of each participant. BPV was assessed by standard deviation (SD) and average real variability (ARV) of systolic and diastolic blood pressure (SBP and DBP), respectively across 4 visits during the study period (2012–2014, 2014–2015, 2015–2016, and 2016–2018). Multivariable linear regression analysis was utilized to determine the association adjusting for demographics, anthropometric indexes, SBP, DBP, and lipid profiles. Results: In the unadjusted model, ALT was significantly and positively correlated with SDDBP and ARVDBP (β (standard errors) = 0.36 (0.16) and 0.24 (0.12), respectively), and so was AST (β = 0.19 (0.08) and 0.14 (0.06), respectively). All the associations were insignificant with adjustments. However, ALT was significantly and negatively correlated with SDSBP and ARVSBP (β = −0.35 (0.14) and −0.25 (0.11), respectively) and so was AST (β = −0.14 (0.07) and −0.12 (0.06), respectively) with adjustments. Conclusion: Our findings suggested that serum liver transaminases were negatively correlated with long-term systolic BPV in young male adults without antihypertensive therapy, and the clinical relevance needs further investigations.
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Gwinnutt JM, Verstappen SM, Humphreys JH. The impact of lifestyle behaviours, physical activity and smoking on morbidity and mortality in patients with rheumatoid arthritis. Best Pract Res Clin Rheumatol 2020; 34:101562. [PMID: 32646673 DOI: 10.1016/j.berh.2020.101562] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Rheumatoid arthritis (RA) is associated with pain, disability and increased risk of developing comorbidities and premature mortality. While these poor outcomes have improved in line with advances in the treatment of RA, they still persist to some degree today. Physical activity and smoking are two areas of patients' lives where changes may have a substantial impact on the poor outcomes associated with RA. Physical activity in RA has been well studied, with many randomised trials indicating the benefits of physical activity on pain and disability. A number of observational studies have assessed the impact of smoking on RA, also indicating the benefits of quitting smoking on RA-related outcomes, but with less consistent findings, potentially due to epidemiological challenges (e.g. collider bias, recall bias). There are also a number of barriers preventing patients making these positive lifestyle changes, such as lack of time and motivation, lack of knowledge and advice, as well as disease-specific barriers, such as pain and fatigue.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Suzanne Mm Verstappen
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Jenny H Humphreys
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Andrade-Lima A, Werneck AO, Szwarcwald CL, Schuch FB, Stubbs B, Bastos AA, Silva DR. The role of physical activity in the association between multimorbidity and depressive symptoms: Data from 60,202 adults from the Brazilian National Health Survey. J Psychosom Res 2020; 134:110122. [PMID: 32403057 DOI: 10.1016/j.jpsychores.2020.110122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 04/18/2020] [Accepted: 04/19/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Depression is commonly associated to physical multimorbidity and there is an urgent need to identify modifiable risk factors. Physical activity (PA) is good for health, but the association between PA and multimorbidity with depressive symptoms is unclear. Thus, we investigated whether meeting weekly recommended PA guidelines influences the association between multimorbidity and depressive symptoms. METHODS Data were used from a national survey conducted in Brazil in 2013 with 60,202 adults (≥ 18 years). Information regarding depressive symptoms (PHQ-9), PA, and chronic disease was collected via interview-administered questionnaires. Data on covariates (age, educational status, employment status, tobacco smoking, alcohol consumption, and TV-viewing) were also assessed. Adjusted logistic regression models were used. RESULTS Overall, men and women with one or more chronic conditions who were inactive (engaging in <150 min PA per week) had higher odds of elevated depressive symptoms than active individuals with no chronic condition. However, only in men, physical inactivity interacts with heart disease (OR: 2.59; 95%CI: 1.10 to 6.09), cancer (OR: 21.54; 95%CI: 2.67 to 173.94) and chronic obstructive pulmonary disease (COPD) (OR: 8.26; 95%CI: 2.20 to 31.01) regarding elevated depressive symptoms. CONCLUSION Our data suggest that engaging in weekly recommended PA targets may attenuate association of heart disease, cancer and COPD with depressive symptoms among men.
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Affiliation(s)
- Aluísio Andrade-Lima
- Department of Physical Education, Federal University of Sergipe, Sergipe, Brazil.
| | - André O Werneck
- Scientific Research Group Related to Physical Activity (GICRAF), Laboratory of Investigation in Exercise (LIVE), Department of Physical Education, São Paulo State University (UNESP), Presidente Prudente, Brazil
| | | | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Afrânio A Bastos
- Department of Physical Education, Federal University of Sergipe, Sergipe, Brazil
| | - Danilo R Silva
- Department of Physical Education, Federal University of Sergipe, Sergipe, Brazil
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Song L, Wang Y, Chen B, Yang T, Zhang W, Wang Y. The Association between Health Insurance and All-Cause, Cardiovascular Disease, Cancer and Cause-Specific Mortality: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1525. [PMID: 32120888 PMCID: PMC7084505 DOI: 10.3390/ijerph17051525] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to evaluate the association of insurance status with all-cause and cause-specific mortality. A total of 390,881 participants, aged 18-64 years and interviewed from 1997 to 2013 were eligible for a mortality follow-up in December 31, 2015. Cox proportional hazards models were used to calculate the hazards ratios (HR) and 95% confidence intervals (CI) to determine the association between insurance status and all-cause and cause-specific mortality. The sample group cumulatively aged 4.22 million years before their follow-ups, with a mean follow-up of 10.4 years, and a total of 22,852 all-cause deaths. In fully adjusted models, private insurance was significantly associated with a 17% decreased risk of mortality (HR = 0.83; 95% CI = 0.80-0.87), but public insurance was associated with a 21% increased risk of mortality (HR = 1.21; 95% CI = 1.15-1.27). Compared to noninsurance, private coverage was associated with about 21% lower CVD mortality risk (HR = 0.79, 95% CI = 0.70-0.89). In addition, public insurance was associated with increased mortality risk of kidney disease, diabetes and CLRD, compared with noninsurance, respectively. This study supports the current evidence for the relationship between private insurance and decreased mortality risk. In addition, our results show that public insurance is associated with an increased risk of mortality.
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Affiliation(s)
- Liying Song
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China;
| | - Yan Wang
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China;
- Mianyang Taxation Bureau of Sichuan Province, State Taxation Administration, Mianyang 621000, China
| | - Baodong Chen
- Department of Accounting, School of Management, Xi’an Polytechnic University, No.19, Jinhua South Road, Xincheng District, Xi’an 710048, China;
| | - Tan Yang
- School of Finance and Accounting, Xi’an University of Technology, No. 58, Yanxiang Road, Yanta District, Xi’an 710054, China;
| | - Weiliang Zhang
- School of Economics and Finance, Xi’an International Studies University, South Wenyuan Road, Chang’an District, Xi’an 710128, China;
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China
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Nie J, Wang J, Aune D, Huang W, Xiao D, Wang Y, Chen X. Association between employment status and risk of all-cause and cause-specific mortality: a population-based prospective cohort study. J Epidemiol Community Health 2020; 74:428-436. [DOI: 10.1136/jech-2019-213179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/08/2020] [Accepted: 02/03/2020] [Indexed: 12/25/2022]
Abstract
BackgroundUnemployment has been reported to be associated with an increased risk of mortality. While most available studies focused on the effects of temporary unemployment on mortality, it remains unclear whether similar trends can be found in subjects who were never employed or are retirement. Therefore, this study examined the associations between temporary unemployment, never employed and retirement, integrating the risk of all-cause and cause-specific mortality in US adults.MethodsData from the National Health Interview Survey from 2001 to 2013 Linked Mortality files through 31 December 2015 were used. A total of 282 364 participants aged 18 to 65 years were included. Their employment status was categorised into four groups: employed, never employed, temporary unemployed and retired.ResultsDuring the mean follow-up time of 8.2 years, 12 645 subjects died from a variety of causes. Compared with employed participants, temporary unemployed, never employed or retired participants faced an increased risk of mortality for all-cause (temporary unemployed HR 1.76, 95% CI 1.67 to 1.86; never employed HR 1.63, 95% CI 1.47 to 1.81; retired HR 1.27, 95% CI 1.17 to 1.37). Cause-specific mortality analysis showed that compared with employed participants, temporary unemployed or never employed participants faced a significantly increased risk of mortality from cancer, cardiovascular disease, chronic lower respiratory disease, diabetes and kidney disease.ConclusionThis study showed that retired, temporary unemployed and never employed participants aged 18 to 65 years were strongly associated with higher mortality, indicating that both temporary and long-term unemployment are associated with a higher risk of mortality and adversely affect longevity.
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Health risk behaviours and allostatic load: A systematic review. Neurosci Biobehav Rev 2020; 108:694-711. [DOI: 10.1016/j.neubiorev.2019.12.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/05/2019] [Accepted: 12/11/2019] [Indexed: 12/26/2022]
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Zhang NH, Luo R, Cheng YC, Ge SW, Xu G. Leisure-Time Physical Activity and Mortality in CKD: A 1999–2012 NHANES Analysis. Am J Nephrol 2020. [DOI: 10.1159/000511685
expr 827068279 + 951355476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
<b><i>Background:</i></b> For patients with CKD, evidence on the optimal dose of physical activity and possible harm with excessive exercise is limited. This study aimed to analyze the dose-response association between leisure-time physical activity (LTPA) and mortality in those with CKD and explore the optimal dose or possible harm associated with increased levels of LTPA. <b><i>Methods:</i></b> 4,604 participants with CKD from the 1999 to 2012 National Health and Nutrition Examination Surveys with linked mortality data obtained through 2015 were classified into 6 groups: 0, 1–149, 150–299, 300–599, 600–899, and ≥900 min/week based on the total duration of the self-reported LTPA. Multivariable-adjusted Cox proportional hazards models were used to examine dose-response associations between LTPA and mortality. <b><i>Results:</i></b> During the median follow-up of 114 months, 1,449 (31%) all-cause deaths were recorded. Compared to the inactive group (0 min/week), we observed a 22% lower risk of all-cause mortality (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.63–0.97) among participants who performed 1–149 min per week for LTPA. The corresponding HRs and 95% CIs for all-cause mortality for 150–299 and 300–599 min/week of LTPA were 0.79 (0.64–0.97) and 0.74 (0.56–0.98). The benefit appeared to reach a threshold of a 43% (HR, 0.57; 95% CI, 0.36–0.91) lower risk of all-cause mortality among individuals performing 600–899 min/week for LTPA. Importantly, for ≥900 min/week of LTPA, the continued benefits were observed (HR, 0.62; 95% CI, 0.44–0.87). <b><i>Conclusion:</i></b> LTPA was associated with lower mortality in those with CKD. The optimal dose was observed at the LTPA level of approximately 600–899 min/week, and there were still benefits rather than the excess risk with LTPA levels as high as ≥900 min/week. Therefore, clinicians should encourage inactive CKD patients to perform LTPA and do not need to discourage CKD patients who already adhere to long-term physical activity.
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Nixon SJ, Lewis B. Clarifying the neurobehavioral sequelae of moderate drinking lifestyles and acute alcohol effects with aging. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 148:39-78. [PMID: 31733667 DOI: 10.1016/bs.irn.2019.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Epidemiological estimates indicate not only an increase in the proportion of older adults, but also an increase in those who continue moderate alcohol consumption. Substantial literatures have attempted to characterize health benefits/risks of moderate drinking lifestyles. Not uncommonly, reports address outcomes in a single outcome, such as cardiovascular function or cognitive decline, rather than providing a broader overview of systems. In this narrative review, retaining focus on neurobiological considerations, we summarize key findings regarding moderate drinking and three health domains, cardiovascular health, Type 2 diabetes (T2D), and cognition. Interestingly, few investigators have studied bouts of low/moderate doses of alcohol consumption, a pattern consistent with moderate drinking lifestyles. Here, we address both moderate drinking as a lifestyle and as an acute event. Review of health-related correlates illustrates continuing inconsistencies. Although substantive reductions in risk for cardiovascular and T2D events are reported, robust conclusions remain elusive. Similarly, whereas moderate drinking is often associated with enhanced cognition and lower dementia risk, few benefits are noted in rates of decline or alterations in brain structure. The effect of sex/gender varies across health domains and by consumption levels. For example, women appear to differentially benefit from alcohol use in terms of T2D, but experience greater risk when considering aspects of cardiovascular function. Finally, we observe that socially relevant alcohol doses do not consistently impair performance in older adults. Rather, older drinkers demonstrate divergent, but not necessarily detrimental, patterns in neural activation and some behavioral measures relative to younger drinkers. Taken together, the epidemiological and laboratory studies reinforce the need for greater attention to key individual differences and for the conduct of systematic studies sensitive to age-related shifts in neurobiological systems.
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Affiliation(s)
- Sara Jo Nixon
- University of Florida, Department of Psychiatry, Gainesville, FL, United States; University of Florida Center for Addiction Research & Education, Gainesville, FL, United States.
| | - Ben Lewis
- University of Florida, Department of Psychiatry, Gainesville, FL, United States; University of Florida Center for Addiction Research & Education, Gainesville, FL, United States
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Goldwater D, Karlamangla A, Merkin SS, Seeman T. Compared to non-drinkers, individuals who drink alcohol have a more favorable multisystem physiologic risk score as measured by allostatic load. PLoS One 2019; 14:e0223168. [PMID: 31568479 PMCID: PMC6768542 DOI: 10.1371/journal.pone.0223168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/13/2019] [Indexed: 01/11/2023] Open
Abstract
Aims Alcohol use is associated with both positive and negative effects on individual cardiovascular risk factors, depending upon which risk factor is assessed. The present analysis uses a summative multisystem index of biologic risk, known as allostatic load (AL), to evaluate whether the overall balance of alcohol-associated positive and negative cardiovascular risk factors may be favorable or unfavorable. Methods This analysis included 1255 adults from the Midlife in the United States (MIDUS) biomarker substudy. Participants, average age 54.5 (±11) years, were divided into 6 alcohol-use categories based on self-reported drinking habits. Current non-drinkers were classified as lifelong abstainers and former light drinkers, former moderate drinkers, or former heavy drinkers. Current alcohol users were classified as light, moderate, or heavy drinkers. A total AL score was calculated using 24 biomarkers grouped into 7 physiologic systems including cardiovascular, inflammation, glucose metabolism, lipid metabolism, sympathetic and parasympathetic nervous systems, and the hypothalamic-pituitary-adrenal axis. Mixed-effects regression models were fit to determine the relationship between alcohol use categories and AL with controls for covariates that may influence the relationship between alcohol use and AL. Results 468 (37.6%) individuals were current non-drinkers while 776 (62.4%) were current drinkers. In adjusted mixed-effects regression models, all 3 groups of current drinkers had significantly lower average AL scores than the lifelong abstainer/former light drinker group (light: -0.23, 95% CI -0.40, -0.07, p < 0.01; moderate: -0.20, 95% CI -0.38, -0.02, p < 0.05; heavy: -0.30, 95% CI -0.57, -0.04, p < 0.05), while the average AL scores of former moderate and former heavy drinkers did not differ from the lifelong abstainer/former light drinker group. Conclusions Current alcohol use is associated cross-sectionally with a favorable multisystem physiologic score known to be associated with better long-term health outcomes, providing evidence in support of long-term health benefits related to alcohol consumption.
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Affiliation(s)
- Deena Goldwater
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- * E-mail:
| | - Arun Karlamangla
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Sharon Stein Merkin
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Teresa Seeman
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e484-e594. [PMID: 30354654 DOI: 10.1161/cir.0000000000000596] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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Masip J, Germà Lluch JR. Alcohol, health and cardiovascular disease. Rev Clin Esp 2019; 221:359-368. [PMID: 34059235 DOI: 10.1016/j.rceng.2019.07.001] [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: 03/18/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022]
Abstract
Recent epidemiological studies have shown that alcohol consumption can increase the risk of arterial hypertension, atrial fibrillation and gastrointestinal and breast cancer. Various sectors are therefore promoting abstinence from alcohol. However, light alcohol consumption has once again been shown to reduce the risk of myocardial infarction and diabetes but with an unclear effect on cerebrovascular disease. The decision to consume alcohol should therefore be an individual one based on personal factors. A level of consumption <100 g/week for men (less for women) appears not to increase all-cause mortality, while high consumption or binge drinking significantly increases mortality risk. All measures to prevent this type of consumption, especially among the younger population, should therefore be applied. There are data indicating an advantage of wine over other beverages, but they are not conclusive.
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Affiliation(s)
- J Masip
- Servei de Medicina Intensiva, Consorci Sanitari Integral, Barcelona, Spain; Servicio de Cardiología, Hospital CIMA Sanitas, Barcelona, Spain; Universidad de Barcelona, Barcelona, Spain.
| | - J R Germà Lluch
- Universidad de Barcelona, Barcelona, Spain; Institut Català d'Oncologia (ICO), Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
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Association between hours worked in paid employment and diet quality, frequency of eating out and consuming takeaways in the UK. Public Health Nutr 2019; 22:3368-3376. [PMID: 31407640 DOI: 10.1017/s1368980019002222] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine associations between hours worked and diet quality, frequency of eating out and consuming takeaways. DESIGN Data were taken from the National Diet and Nutrition Survey (2008-2014). Associations between hours worked in paid employment and diet quality, assessed using the Diet Quality Index (DQI) and selected foods and nutrients, were tested using linear regression models. Associations between hours worked and frequency of eating out and consuming takeaways were tested using ordinal logistic regression models. All models were adjusted for sex, age, equivalised household income, household composition and household food role. SETTING UK. PARTICIPANTS Adults (n 2154) aged 19-64 years in employment. RESULTS Mean (95 % CI) hours worked per week was 36·1 (35·6, 36·6) and mean DQI score was 41·9 (41·2, 42·5) %. Hours worked was not associated with DQI score, frequency of eating out or consuming takeaways. Hours worked was positively associated with consuming red meat, processed meat and alcohol intake. Adults working more hours had lower intake of fibre but higher total fat and saturated fat intakes if they lived in households with children. CONCLUSIONS Working hours may not be the main factor driving poor-quality diets among this sample of UK adults in employment. Focusing on consumption of foods prepared outside the household may not be the most efficient way to improve diet quality as effort is needed at all levels. Although it is unclear what is driving the differences in nutrient intakes according to household composition, they are important to consider when developing interventions to improve healthy eating.
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Guideline-conform statin use reduces overall mortality in patients with compensated liver disease. Sci Rep 2019; 9:11674. [PMID: 31406146 PMCID: PMC6690990 DOI: 10.1038/s41598-019-47943-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 07/10/2019] [Indexed: 02/06/2023] Open
Abstract
Statins reduce cardiovascular risk. However, “real-life” data on statin use in patients with chronic liver disease and its impact on overall and liver-related survival are limited. Therefore, we assessed 1265 CLD patients stratified as advanced (ACLD) or non-advanced (non-ACLD) stage. Statin indication was evaluated according to the 2013 ACC/AHA guidelines and survival-status was verified by national death registry data. Overall, 122 (9.6%) patients had an indication for statin therapy but did not receive statins, 178 (14.1%) patients were on statins and 965 (76.3%) patients had no indication for statins. Statin underutilization was 34.2% in non-ACLD and 48.2% in ACLD patients. In non-ACLD patients, survival was worse without a statin despite indication as compared to patients on statin or without indication (log-rank p = 0.018). In ACLD patients, statin use did not significantly impact on survival (log-rank p = 0.264). Multivariate cox regression analysis confirmed improved overall survival in patients with statin as compared to patients with indication but no statin (HR 0.225; 95%CI 0.053–0.959; p = 0.044) and a trend towards reduced liver-related mortality (HR 0.088; 95%CI 0.006–1.200; p = 0.068). This was not observed in ACLD patients. In conclusion, guideline-confirm statin use is often withhold from patients with liver disease and this underutilization is associated with impaired survival in non-ACLD patients.
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Baggett TP, Liauw SS, Hwang SW. Cardiovascular Disease and Homelessness. J Am Coll Cardiol 2019; 71:2585-2597. [PMID: 29852981 DOI: 10.1016/j.jacc.2018.02.077] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Samantha S Liauw
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
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Hajifathalian K, Sagvand BT, McCullough AJ. Effect of Alcohol Consumption on Survival in Nonalcoholic Fatty Liver Disease: A National Prospective Cohort Study. Hepatology 2019; 70:511-521. [PMID: 30125379 PMCID: PMC6380949 DOI: 10.1002/hep.30226] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/10/2018] [Indexed: 02/06/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) comprises more than two thirds of patients with chronic liver disease in the United States. The effect of alcohol consumption on survival in patients with NAFLD is not clear. We gathered data on National Health and Nutrition Examination Survey participants from 1988 to 2010, and linked them to the National Death Index for follow-up of their survival. We diagnosed NAFLD based on a previously validated biochemical model (Hepatic Steatosis Index). We built multivariate Cox proportional hazards models to evaluate the effect of alcohol consumption on survival of patients with NAFLD. After excluding participants with significant alcohol use, viral hepatitis, or increased transferrin saturation, 4,568 participants with NAFLD were included in the analysis. In a Cox model adjusted for age, sex, and smoking history, drinking 0.5-1.5 drinks per day decreased the risk of overall mortality by 41% (hazard ratio [HR] = 0.59, 95% confidence interval [CI] 0.40-0.85, P = 0.005) compared with not drinking. Drinking ≥1.5 drinks per day showed a trend toward harm (HR = 1.16, 95% CI 0.99-1.36, P = 0.119). After further adjustment for race, physical activity, education level, diabetes, and fiber and polyunsaturated fatty acid intake, drinking 0.5-1.5 drinks per day continued to show a significant protective effect (HR = 0.64, 95% CI 0.42-0.97, P = 0.035), and drinking ≥1.5 drinks per day showed a significant harmful effect on mortality (HR = 1.45, 95% CI 1.01-2.10, P = 0.047). Among patients with NAFLD, modest alcohol consumption is associated with a significant decrease in all-cause mortality, whereas drinking ≥1.5 drinks per day is associated with an increase in mortality. These results help to inform the discussion of potential risks and benefits of alcohol use in patients with NAFLD.
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Affiliation(s)
- Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York
- Corresponding Author: Kaveh Hajifathalian, MD MPH, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, Address: 1305 York Avenue, 4th floor, Manhattan, NY 10021, , Phone: (339) 225-8235, Fax: (646) 962-0110
| | | | - Arthur J McCullough
- Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
- Department of Pathobiology, Cleveland Clinic Foundation, Cleveland, Ohio
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Pavicic Ivelja M, Ivic I, Dolic K, Mestrovic A, Perkovic N, Jankovic S. Evaluation of cerebrovascular reactivity in chronic hepatitis C patients using transcranial color Doppler. PLoS One 2019; 14:e0218206. [PMID: 31185040 PMCID: PMC6559645 DOI: 10.1371/journal.pone.0218206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/27/2019] [Indexed: 12/18/2022] Open
Abstract
Hepatitis C viral (HCV) infection is associated with systemic inflammation and metabolic complications that might predispose patients to atherosclerosis, including cerebrovascular atherosclerosis. The aim of this study was to assess cerebrovascular reactivity in patients with chronic hepatitis C. Seventeen patients with chronic hepatitis C infection, as well as 11 healthy blood donors in the control group, were assessed for cerebrovascular reactivity according to the well-established breath-holding test that uses the transcranial color Doppler for measurement of blood flow velocity. Results obtained during the breath-holding revealed significantly lower average peak systolic (AvPS start, P = 0.018), end-diastolic (AvED start, P = 0.031) and mean velocity values at the very beginning of the breath-holding procedure (AvmeanV start, P = 0.02), as well as a lower mean peak systolic velocity at the end of the breath-holding test (AvPS max, P = 0.02) in the hepatitis C group. Vascular reactivity values, calculated as the breath-holding index, were also significantly lower (P = 0.045) in the hepatitis C group. In conclusion, the results of this study suggest an association between chronic HCV infection and altered cerebrovascular reactivity which may ultimately have an unfavorable effect on cerebrovascular hemodynamics and lead to increased risk of cerebrovascular diseases.
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Affiliation(s)
- Mirela Pavicic Ivelja
- Department of Infectious Diseases, University Hospital Split, Split, Croatia
- * E-mail:
| | - Ivo Ivic
- Department of Infectious Diseases, University Hospital Split, Split, Croatia
| | - Kresimir Dolic
- Department of Radiology, University Hospital Split, Split, Croatia
| | - Antonio Mestrovic
- Department of Gastroenterology and Hepatology, University Hospital Split, Split, Croatia
| | - Nikola Perkovic
- Department of Gastroenterology and Hepatology, University Hospital Split, Split, Croatia
| | - Stipan Jankovic
- Department of Radiology, University Hospital Split, Split, Croatia
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Eby JM, Majetschak M. Effects of ethanol and ethanol metabolites on intrinsic function of mesenteric resistance arteries. PLoS One 2019; 14:e0214336. [PMID: 30893362 PMCID: PMC6426218 DOI: 10.1371/journal.pone.0214336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/11/2019] [Indexed: 12/14/2022] Open
Abstract
Evidence suggests that ethanol-induced hypertension is associated with increased cardiovascular responsiveness to vasopressors in vivo and enhanced reactivity of isolated arteries to vasopressors ex vivo. The underlying mechanisms are not well understood and the contribution of ethanol metabolites to vascular effects induced by ethanol consumption are unclear. Mesenteric resistance arteries were harvested from Sprague-Dawley rats. Pressure myography was utilized to test effects of ethanol, acetaldehyde and phosphatidylethanol on myogenic tone and on vasoconstriction induced by phenylephrine, arginine vasopressin (aVP), endothelin-1 and KCl. Ethanol, acetaldehyde and phosphatidylethanol concentrations were monitored during the experiments. Ethanol concentrations in the vessel bath decreased with a half-life of 25min; acetaldehyde and phosphatidylethanol concentrations remained constant. Pretreatment with ethanol dose-dependently increased the potency of phenylephrine to induce vasoconstriction 4-fold (p<0.01). These effects were comparable when arteries were pre-treated with a single dose of ethanol for 30min and when ethanol concentrations were kept constant during 30min and 60min of pretreatment. While ethanol also dose-dependently increased the potency of aVP to induce vasoconstriction 1.7-fold (p<0.05), it did not affect vasoconstriction induced by endothelin-1 or KCl. Acetaldehyde pre-treatment (30 min) dose-dependently increased the potency of phenylephrine to induce vasoconstriction 2.7-fold (p<0.01) but did not affect other vasoconstrictor responses. Phosphatidylethanol did not affect any vasoconstrictor responses. Ethanol and its metabolites did not affect myogenic tone. These data suggest that ethanol and acetaldehyde selectively sensitize intrinsic constrictor responses upon activation of vascular α1-adrenergic and/or vasopressin receptors at clinically relevant concentrations. Our findings support the concept that enhanced vasoreactivity to vasoactive hormones contributes to the development of hypertension induced by ethanol consumption. Ex vivo exposure of resistance arteries to ethanol and acetaldehyde resembles effects of chronic ethanol consumption on intrinsic vascular function, and thus could serve as test platform to evaluate interventions aimed to mitigate vascular effects associated with ethanol consumption.
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Affiliation(s)
- Jonathan M. Eby
- Department of Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States of America
- Alcohol Research Program (ARP), Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States of America
| | - Matthias Majetschak
- Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
- * E-mail:
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