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Effect of the ALDH2 Variant on the Prevalence of Atrial Fibrillation in Habitual Drinkers. JACC: ASIA 2022; 2:62-70. [PMID: 36340257 PMCID: PMC9627901 DOI: 10.1016/j.jacasi.2021.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/12/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022]
Abstract
Background Alcohol—a risk factor for atrial fibrillation (AF)—is metabolized by aldehyde dehydrogenase 2 (ALDH2). Dysfunctional alleles of ALDH2 (ALDH2-deficient variants) are prevalent among East Asians. Objectives Because the prevalence of AF is estimated to be high in ALDH2-deficient variant carriers, we investigated the correlation between AF and ALDH2-deficient variant carriers, including the association with habitual alcohol consumption. Methods A total of 656 consecutive patients were included in this investigation. ALDH2 genotypes were divided into ALDH2 homozygous wild-type (∗1/∗1), ALDH2 heterozygous-deficient allele (∗1/∗2), and ALDH2 homozygous-deficient allele (∗2/∗2). Multivariate analyses were applied to determine the correlation between ALDH2 genotype and AF. Results ALDH2∗1/∗2 and ALDH2∗2/∗2 carriers who were ALDH2-deficient variant carriers comprised 199 (30.3%) and 27 (4.1%) patients, respectively. Among these patients, the proportions of habitual alcohol consumption were 26.1% and 0%, respectively. Multivariate analysis revealed that ALDH2∗1/∗2 itself was not a risk factor for AF (odds ratio [OR]: 1.28; P = 0.21). However, habitual alcohol consumption in ALDH2∗1/∗2 carriers was an independent risk factor of AF (OR: 4.13; P = 0.001). Contrary to expectations, ALDH2∗2/∗2 itself had a lower incidence of AF among other risk factors (OR: 0.37; P = 0.03). Conclusions Although the ALDH2∗1/∗2 itself was not associated with AF, ALDH2∗1/∗2 carriers with habitual alcohol consumption could experience AF because of slow alcohol metabolism. In contrast, ALDH2∗2/∗2 itself had a lower incidence of AF. This might be related to the absence to habitual alcohol consumption in ALDH2∗2/∗2 carriers because of the negligible activity of ALDH2. Thus, abstaining from alcohol consumption might prevent the development of AF in patients who are ALDH2∗1/∗2 carriers.
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Brunner S, Winter R, Werzer C, von Stülpnagel L, Clasen I, Hameder A, Stöver A, Graw M, Bauer A, Sinner MF. Impact of acute ethanol intake on cardiac autonomic regulation. Sci Rep 2021; 11:13255. [PMID: 34168256 PMCID: PMC8225621 DOI: 10.1038/s41598-021-92767-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/01/2021] [Indexed: 12/21/2022] Open
Abstract
Acute alcohol consumption may facilitate cardiac arrhythmias underlying the ‘Holiday Heart Syndrome’. Autonomic imbalance is promoting atrial arrhythmias. We analyzed the effects of alcohol on measures of the cardiac autonomic nervous system and their relation to arrhythmias. In 15 healthy individuals, alcohol was administered parenterally until a breath alcohol concentration of 0.50 mg/l. High-resolution digital 30-min ECGs were recorded at baseline, at the time of maximum alcohol concentration, and after alcohol concentration returned to near baseline. Using customized software, we assessed periodic repolarization dynamics (PRD), deceleration capacity (DC), standard measures of heart rate variability (SDNN; RMSSD; LF; HF), and standard ECG parameters (mean heart rate; PQ; QRS; QTc interval). At the maximum alcohol concentration, PRD levels were significantly increased compared to baseline [1.92 (IQR 1.14–3.33) deg2 vs. 0.85 (0.69–1.48) deg2; p = 0.001]. PRD levels remained slightly increased when alcohol concentrations returned to baseline. DC levels were significantly decreased at the maximum alcohol concentration compared to baseline [7.79 (5.89–9.62) ms vs. 9.97 (8.20–10.99) ms; p = 0.030], and returned to baseline levels upon reaching baseline levels of alcohol. Standard HRV measures were reduced at maximum alcohol concentration. The mean heart rate increased significantly during alcohol administration. QRS and QTc duration were significantly prolonged, whereas PQ interval showed no change. Our findings revealed an increase of sympathetic activity and a reduction of parasympathetic activity under the influence of alcohol administration, resulting in autonomic imbalance. This imbalance might ultimately trigger arrhythmias underlying the ‘Holiday Heart Syndrome’.
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Affiliation(s)
- Stefan Brunner
- Department of Medicine I, University Hospital, Ludwig Maximilians University (LMU) Munich, Ziemssenstrasse 1, 80336, Munich, Germany.
| | - Raphaela Winter
- Department of Medicine I, University Hospital, Ludwig Maximilians University (LMU) Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Christina Werzer
- Department of Medicine I, University Hospital, Ludwig Maximilians University (LMU) Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Lukas von Stülpnagel
- Department of Medicine I, University Hospital, Ludwig Maximilians University (LMU) Munich, Ziemssenstrasse 1, 80336, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany.,Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Ina Clasen
- Institute of Legal Medicine, LMU Munich, Munich, Germany
| | - Annika Hameder
- Institute of Legal Medicine, LMU Munich, Munich, Germany
| | - Andreas Stöver
- Institute of Legal Medicine, LMU Munich, Munich, Germany
| | - Matthias Graw
- Institute of Legal Medicine, LMU Munich, Munich, Germany
| | - Axel Bauer
- German Center for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany.,Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Moritz F Sinner
- Department of Medicine I, University Hospital, Ludwig Maximilians University (LMU) Munich, Ziemssenstrasse 1, 80336, Munich, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany.
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Voskoboinik A, McDonald C, Chieng D, O'Brien J, Gutman S, Ngu P, Sugumar H, Wong G, Kalman JM, Taylor AJ, Kistler PM. Acute electrical, autonomic and structural effects of binge drinking: Insights into the 'holiday heart syndrome'. Int J Cardiol 2021; 331:100-105. [PMID: 33548379 DOI: 10.1016/j.ijcard.2021.01.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Binge drinking is a common atrial fibrillation (AF) trigger, however the mechanisms are poorly understood. OBJECTIVE To investigate the effects of alcohol intoxication and hangover with rhythm monitoring and cardiac MRI. METHODS Patients underwent serial cardiac MRI pre- and post-binge with continuous Holter monitoring. Time periods analyzed: baseline (24 h pre-binge), consumption, hangover (0- 24 h post-consumption) and post-hangover (24-48 h post-consumption). RESULTS 50 patients (age 49 ± 15 years, 40% paroxysmal AF) completed the study (intake 8.4 ± 3.1 standard drinks). Mean heart rate increased from 72 ± 10 to 80 ± 13 beats per minute (bpm) during consumption (p < 0.001). The hangover period was characterised by higher daily atrial ectopic count (50, IQR 10-132 vs baseline 43, IQR 10-113; p = 0.04) and reduced heart rate variability (SDNN 55 ms, IQR 40-65 versus 62 ms, IQR 51-66; p = 0.007). There was evidence of heightened parasympathetic activity post-hangover with heart rate slowing (mean HR 54 ± 6 bpm; p = 0.03) and increased activity in the High frequency band when separating the complex heart rate variability waveform into its component rhythms (291 ms2, 97-538 versus baseline 237 ms2, IQR 104-332; p = 0.04). Three patients developed AF 11, 29 and 34 h post-binge. Cardiac MRI (2.7 ± 0.7 days post-binge) demonstrated a decrease in left atrial (LA) emptying fraction (57.9 ± 8.5 to 53.5 ± 6.7%; p = 0.003) but no change in LA volume, left ventricular ejection fraction or markers of ventricular inflammation. CONCLUSION Binge drinking is associated with sympathetic activation followed by a 'rebound' parasympathetic response and atrial mechanical dysfunction which may explain the propensity and temporal association between binge drinking and AF.
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Affiliation(s)
- Aleksandr Voskoboinik
- Heart Centre, The Alfred Hospital, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | | | - David Chieng
- Heart Centre, The Alfred Hospital, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Australia
| | | | - Sarah Gutman
- Heart Centre, The Alfred Hospital, Melbourne, Australia
| | - Phillip Ngu
- Heart Centre, The Alfred Hospital, Melbourne, Australia
| | - Hariharan Sugumar
- Heart Centre, The Alfred Hospital, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Geoffrey Wong
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Andrew J Taylor
- Heart Centre, The Alfred Hospital, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia
| | - Peter M Kistler
- Heart Centre, The Alfred Hospital, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia.
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Abstract
Abstract
Over the past years, prevention and control of risk factors has begun to play an important role in the management of patients prone to develop atrial fibrillation (AF). A considerable number of risk factors that contribute to the creation of a predisposing substrate for AF has been identified over the years. Although certain AF risk factors such as age, gender, genetic predisposition, or race are unmodifiable, controlling modifiable risk factors may represent an invaluable tool in the management of AF patients. In the recent decades, numerous studies have evaluated the mechanisms linking different risk factors to AF, but the exact degree of atrial remodeling induced by each factor remains unknown. Elucidating these mechanisms is essential for initiating personalized therapies in patients prone to develop AF. The present review aims to provide an overview of the most relevant modifiable risk factors involved in AF occurrence, with a focus on the mechanisms by which these factors lead to AF initiation and perpetuation.
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Roy É, Nolin MA, Traoré I, Leclerc P, Vasiliadis HM. Nonmedical Use of Prescription Medication Among Adolescents Using Drugs in Quebec. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:556-63. [PMID: 26720824 PMCID: PMC4679164 DOI: 10.1177/070674371506001206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 07/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the prevalence and factors associated with nonmedical use of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17 years) in Quebec. METHOD Secondary data analyses were carried out with data from a 6-month study, namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale survey that sought to gain a better understanding of the health and well-being of young Quebecers in high school. Bivariate and multivariate logistic regression analyses were conducted to study NMUPM among adolescents who use drugs, according to sociodemographic characteristics, peer characteristics, health indicators (anxiety, depression, or attention-deficit disorder [ADD] with or without hyperactivity), self-competency, family environment, and substance use (alcohol and drug use) factors. RESULTS Among adolescents who had used drugs in the previous 12 months, 5.4% (95% CI 4.9% to 6.0%) reported NMUPM. Based on multivariate analyses, having an ADD (adjusted odds ratio [AOR] 1.47; 95% CI 1.13 to 1.91), anxiety disorder (AOR 2.14; 95% CI 1.57 to 2.92), low self-esteem (AOR 1.62; 95% CI 1.26 to 2.08), low self-control (AOR 1.95; 95% CI 1.55 to 2.45), low parental supervision (AOR 1.43; 95% CI 1.11 to 1.83), regular alcohol use (AOR 1.72; 95% CI 1.36 to 2.16), and polysubstance use (AOR 4.09; 95% CI 3.06 to 5.48) were associated with increased odds of reporting NMUPM. CONCLUSIONS The observed prevalence of NMUPM was lower than expected. However, the associations noted with certain mental health disorders and regular or heavy use of other psychoactive substances are troubling. Clinical implications are discussed.
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Affiliation(s)
- Élise Roy
- Full Professor, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec; Researcher, Research Chair on Addiction, Université de Sherbrooke, Sherbrooke, Quebec
| | - Marc-Antoine Nolin
- Graduate Student, Clinical Sciences Program, Université de Sherbrooke, Sherbrooke, Quebec
| | - Issouf Traoré
- Research Assistant, Direction des statistiques de santé, Institut de la statistique du Québec, Montreal, Quebec
| | - Pascale Leclerc
- Public Health Officer, Direction de santé publique de l'agence de la santé et des services sociaux de Montréal, Montreal, Quebec
| | - Helen-Maria Vasiliadis
- Associate Professor, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec; Researcher, Charles LeMoyne Hospital Research Centre, Greenfield Park, Quebec
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Tonelo D, Providência R, Gonçalves L. Holiday heart syndrome revisited after 34 years. Arq Bras Cardiol 2013; 101:183-9. [PMID: 24030078 PMCID: PMC3998158 DOI: 10.5935/abc.20130153] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 10/13/2012] [Accepted: 01/30/2013] [Indexed: 11/20/2022] Open
Abstract
The cardiovascular effects of alcohol are well known. However, most research has focused on the beneficial effects (the "French paradox") of moderate consumption or the harmful consequences, such as dilated cardiomyopathy, associated with heavy consumption over an extended period. An association between the ingestion of acute alcohol and onset of cardiac arrhythmias was first reported in the early 70's. In 1978, Philip Ettinger described "Holiday heart syndrome" (HHS) for the first time, as the occurrence, in healthy people without heart disease known to cause arrhythmia, of an acute cardiac rhythm disturbance, most frequently atrial fibrillation, after binge drinking. The name is derived from the fact that episodes were initially observed more frequently after weekends or public holidays. Since the original description of HHS, 34 years have passed and new research in this field has increased the volume of knowledge related to this syndrome. Throughout this paper the authors will comprehensively review most of the available data concerning HHS and highlight the questions that remain unresolved.
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Affiliation(s)
- David Tonelo
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Rui Providência
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbras Hospital Centre and University, Coimbra - Portugal
| | - Lino Gonçalves
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbras Hospital Centre and University, Coimbra - Portugal
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Currie CL, Wild TC. Adolescent use of prescription drugs to get high in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:745-51. [PMID: 23228233 DOI: 10.1177/070674371205701206] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To present epidemiologic information on adolescent use of prescription drugs to get high, and not for medical purposes, in Canada. METHODS Data were obtained from 44 344 adolescents in grades 7 to 12 living across Canada's 10 provinces who completed the Youth Smoking Survey in 2008/2009. RESULTS Nationally, 5.9% of adolescents in grades 7 to 12 reported the use of prescription drugs to get high in the past 12 months in 2008/2009. Females were more likely to report use of pain relievers, sedatives, or tranquilizers to get high, while males were more likely to report the use of prescription stimulants for this purpose. The use of prescription drugs to get high was elevated among older youth, those living in British Columbia, and those who identified as First Nations, Métis, or Inuit. School connectedness was associated with a reduction in this form of prescription drug misuse for all adolescents; however, this protective effect was particularly strong for Aboriginal youth, and may be an important preventative factor for this population. CONCLUSIONS Use of prescription drugs to get high was prevalent among adolescents in Canada in 2008/2009. Findings highlight the need for clinicians to include questions about prescription drugs when screening adolescents for substance abuse in Canada. Findings also highlight the need for evidence-informed strategies to reduce prescription drug misuse among Aboriginal youth living outside First Nations communities in Canada. The results of this study suggest school connectedness may be a particularly important target for these interventions.
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Affiliation(s)
- Cheryl L Currie
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta.
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Currie CL, Schopflocher DP, Wild TC. Prevalence and correlates of 12-month prescription drug misuse in Alberta. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:27-34. [PMID: 21324240 DOI: 10.1177/070674371105600106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examined the prevalence and correlates of prescription drug misuse (PDM) in a population-based sample of adults from Alberta. METHODS Data were collected from 3511 adults in Alberta aged 18 years and older in 2002 using a computer-aided telephone survey; the survey response rate was 57.4%. RESULTS The prevalence of 12-month PDM in Alberta was 8.2% in 2002. Opiates were the most frequently misused drug class, followed by sedatives, stimulants, and tranquilizers. Current disability was particularly associated with PDM. Odds of PDM were also elevated among adult students and adults with a high school diploma relative to adults with a post-secondary degree. Past-year problem gambling, illicit drug use, and alcohol use and dependence were each associated with PDM, while past-year binge drinking and daily smoking were not. CONCLUSIONS Findings suggest PDM was an important public health concern in Alberta in 2002. Estimates suggest prescription use and misuse have increased substantially in Canada since that time. There is an urgent need for an ongoing assessment of this evolving problem so that effective prevention and therapeutic strategies can be developed.
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Affiliation(s)
- Cheryl L Currie
- School of Public Health, University of Alberta, 7-30 University Terrace, Edmonton, Alberta.
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Vetter VL, Elia J, Erickson C, Berger S, Blum N, Uzark K, Webb CL. Cardiovascular monitoring of children and adolescents with heart disease receiving medications for attention deficit/hyperactivity disorder [corrected]: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing. Circulation 2008; 117:2407-23. [PMID: 18427125 DOI: 10.1161/circulationaha.107.189473] [Citation(s) in RCA: 229] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
We used the patch-clamp technique to study the effects of amphetamine on the membrane currents responsible for rat cardiac action-potential duration. Amphetamine has no effect on the slow inward Ca2+ current (I(Ca)-L), the inwardly rectifying K+ current (I(K1) and the outward K+ delayed rectifier (I(K)) and sustained (I(SS)) currents. Amphetamine blocks the transient outward K+ current (I(to)) both in the open and in the rested state. The transient outward K+ current is largely responsible for action-potential repolarization and for the regional differences in action-potential duration in rat ventricle. Therefore, the reduction of the transient outward K+ current (I(to)) caused by amphetamine may facilitate the appearance of ventricular tachycardia and fibrillation, a reported cause of death in amphetamine users.
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Affiliation(s)
- O Casis
- Department of Physiology, School of Pharmacy, University of the Basque Country, Bilbao, Spain.
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