Alcohol consumption and cardiovascular disease incidence in men with and without hypertension: the Suita study

Alcohol Intake and Arterial Hypertension: Retelling of a Multifaceted Story

Alcoholic beverages are common components of diets worldwide and understanding their effects on humans' health is crucial. Because hypertension is the leading risk factor for cardiovascular diseases and all-cause mortality, the relationship of alcohol consumption with blood pressure (BP) has been the subject of extensive investigation. For the purpose of this review, we searched the terms "alcohol", "ethanol", and "arterial hypertension" on Pubmed MeSH and selected the most relevant studies. Short-term studies showed a biphasic BP response after ingestion of high doses of alcohol, and sustained alcohol consumption above 30 g/day, significantly, and dose-dependently, increased the risk for hypertension. These untoward effects of alcoholic beverages on BP can be mediated by a multiplicity of neurohormonal mechanisms. In addition to the effects on BP, excess alcohol intake might contribute to cardiac and renal hypertensive organ damage, although some studies suggest possible benefits of moderate alcohol consumption on additional cardiovascular risk factors, such as diabetes and lipoprotein(a). Some intervention studies and cumulative analyses support the evidence of a benefit of the reduction/withdrawal of alcohol consumption on BP and cardiovascular outcomes. This is why guidelines of scientific societies recommend avoidance or limitation of alcohol intake below one unit/day for women and two units/day for men. This narrative article overviews all these topics, providing an update of the current knowledge on the relationship between alcohol and BP.

Associations between alcohol brief intervention in primary care and drinking and health outcomes in adults with hypertension and type 2 diabetes: a population-based observational study

OBJECTIVES

To evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes and 18-month health outcomes among adults with hypertension and type 2 diabetes (T2D).

DESIGN

A population-based observational study using electronic health records data.

SETTING

An integrated healthcare system that implemented system-wide alcohol screening, BI and referral to treatment in adult primary care.

PARTICIPANTS

Adult primary care patients with hypertension (N=72 979) or T2D (N=19 642) who screened positive for unhealthy alcohol use between 2014 and 2017.

MAIN OUTCOME MEASURES

We examined four drinking outcomes: changes in heavy drinking days/past 3 months, drinking days/week, drinks/drinking day and drinks/week from baseline to 12-month follow-up, based on results of alcohol screens conducted in routine care. Health outcome measures were changes in measured systolic and diastolic blood pressure (BP) and BP reduction ≥3 mm Hg at 18-month follow-up. For patients with T2D, we also examined change in glycohaemoglobin (HbA1c) level and 'controlled HbA1c' (HbA1c<8%) at 18-month follow-up.

RESULTS

For patients with hypertension, those who received BI had a modest but significant additional -0.06 reduction in drinks/drinking day (95% CI -0.11 to -0.01) and additional -0.30 reduction in drinks/week (95% CI -0.59 to -0.01) at 12 months, compared with those who did not. Patients with hypertension who received BI also had higher odds for having clinically meaningful reduction of diastolic BP at 18 months (OR 1.05, 95% CI 1.00 to 1.09). Among patients with T2D, no significant associations were found between BI and drinking or health outcomes examined.

CONCLUSIONS

Alcohol BI holds promise for reducing drinking and helping to improve health outcomes among patients with hypertension who screened positive for unhealthy drinking. However, similar associations were not observed among patients with T2D. More research is needed to understand the heterogeneity across diverse subpopulations and to study BI's long-term public health impact.

Alcohol consumption and the risk of heart failure: the Suita Study and meta-analysis of prospective cohort studies

BACKGROUND

Alcohol consumption is a modifiable lifestyle, but its role in heart failure (HF) development is controversial. Herein, we investigated the prospective association between alcohol consumption and HF risk.

METHODS

A total of 2,712 participants (1,149 men and 1,563 women) from the Suita Study were followed up every two years. Cox regression was applied to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of HF risk for heavy drinking (≥46 g/day in men or ≥23 g/day in women) and never drinking compared to light drinking (<23 g/day in men or <11.5 g/day in women). Then, we combined the results of the Suita Study with those from other eligible prospective cohort studies in a meta-analysis using the random-effects model.

RESULTS

In the Suita Study, within a median follow-up period of 8 years, 319 HF cases (162 in men and 157 in women) were detected. In men, but not women, never and heavy drinking carried a higher risk of HF than light drinking: HRs (95% CIs) = 1.65 (1.00, 2.73) and 2.14 (1.26, 3.66), respectively. Alike, the meta-analysis showed a higher risk of HF among heavy drinkers: HR (95% CI) = 1.37 (1.15, 1.62) and abstainers: HR (95% CI) = 1.18 (1.02, 1.37).

CONCLUSION

We indicated a J-shaped association between alcohol consumption and HF risk among Japanese men. The results of the meta-analysis came in line with the Suita Study. Heavy-drinking men should be targeted for lifestyle modification interventions.

The effect of acute alcohol ingestion on systemic hemodynamics and sleep architecture in young, healthy men

Objective Heightened nocturnal blood pressure (BP) may be attributed to the disruption of sleep, a condition worsened by alcohol ingestion. This study investigated the effects of acute alcohol ingestion on hemodynamics and sleep architecture in a young, healthy cohort of male. METHODS: Subjects (n = 17) underwent acute alcohol ingestion reaching a breath alcohol content of 0.08. Each subject endured a battery of hemodynamic tests and had their sleep architecture and nocturnal blood pressure monitored pre- and post-ingestion. Results: Systolic blood pressure (SBP) increased both 30 minutes and 12 hours after alcohol. Ambulatory nocturnal SBP significantly increased after alcohol compared to baseline measures. Minutes of total, rapid eye movement, and light sleep all increased after alcohol ingestion, while a decrease was observed for sleep latency. Conclusions: An acute bout of heavy alcohol consumption may attenuate nocturnal BP dipping that, in turn, may hasten the progression of hypertension-related cardiovascular disease.

Assessment of the Impact of Alcohol Consumption Patterns on Heart Rate Variability by Machine Learning in Healthy Young Adults

Background and Objectives: Autonomic nervous system (ANS) dysfunction is present in early stages of alcohol abuse and increases the likelihood of cardiovascular events. Given the nonlinear pattern of dynamic interaction between sympathetic nervous system (SNS) and para sympathetic nervous system (PNS) and the complex relationship with lifestyle factors, machine learning (ML) algorithms are best suited for analyzing alcohol impact over heart rate variability (HRV), because they allow the analysis of complex interactions between multiple variables. This study aimed to characterize autonomic nervous system dysfunction by analysis of HRV correlated with cardiovascular risk factors in young individuals by using machine learning. Materials and Methods: Total of 142 young adults (28.4 ± 4.34 years) agreed to participate in the study. Alcohol intake and drinking patterns were assessed by the AUDIT (Alcohol Use Disorders Identification Test) questionnaire and the YAI (Yearly Alcohol Intake) index. A short 5-min HRV evaluation was performed. Post-hoc analysis and machine learning algorithms were used to assess the impact of alcohol intake on HRV. Results: Binge drinkers presented slight modification in the frequency domain. Heavy drinkers had significantly lower time-domain values: standard deviation of RR intervals (SDNN) and root mean square of the successive differences (RMSSD), compared to casual and binge drinkers. High frequency (HF) values were significantly lower in heavy drinkers (p = 0.002). The higher low-to-high frequency ratio (LF/HF) that we found in heavy drinkers was interpreted as parasympathetic inhibition. Gradient boosting machine learner regression showed that age and alcohol consumption had the biggest scaled impact on the analyzed HRV parameters, followed by smoking, anxiety, depression, and body mass index. Gender and physical activity had the lowest impact on HRV. Conclusions: In healthy young adults, high alcohol intake has a negative impact on HRV in both time and frequency-domains. In parameters like HRV, where a multitude of risk factors can influence measurements, artificial intelligence algorithms seem to be a viable alternative for correct assessment.

Clinical characteristics of patients with alcohol dependence comorbid with hypertension among regular drinkers: An internet-based, cross-sectional study in Japan

While evidence suggests a strong association between alcohol and hypertension, little is known about the profile of patients with alcohol dependence comorbid with hypertension. This study aimed to clarify the clinical characteristics and health problems of this population through a web-based questionnaire survey using a research company's panel of adults in Japan. Of 20 000 regular drinkers, 176 on treatment for hypertension and with alcohol dependence (confirmed and/or an Alcohol Use Disorders Identification Test score ≥15 points) were included. Participants were asked about their health-related quality of life, work productivity, blood pressure (BP) control, receipt of brief interventions, and awareness of their alcohol dependence. Results were compared between the BP-controlled and BP-uncontrolled groups. The mean EQ-5D utility score was 0.838 in the entire population, and 0.786 vs. 0.892 in the groups (p < 0.0001). When 133 'employed' participants were compared, productivity loss was more apparent in the BP-uncontrolled group (presenteeism, 27.3% vs. 6.1%, p < 0.0001; absenteeism, 10.7% vs. 1.0%, p = 0.0003). The rate of dissatisfaction with BP control was 55.1% in the entire population (most [76.3%] of those dissatisfied considered alcohol a cause of inadequate BP control), ~78% in the uncontrolled group, and ~34% in the controlled group. Of those previously advised to reduce drinking or abstain from alcohol (60.2% of all participants), 63% (BP-uncontrolled group) and 55% (BP-controlled group) decreased their drinking. Though more than twice as many participants thought themselves to be alcohol-dependent in the BP-uncontrolled group than in the controlled group (41% vs. 15%), most (59% vs. 85%) showed no self-awareness of alcohol dependence. Patients with alcohol dependence comorbid with hypertension had impaired health status and reduced work productivity. They thought alcohol was the most common cause of inadequate BP control. Treatment beyond brief interventions is needed to enhance their awareness of alcohol dependence and their motivation to reduce drinking.

The Effect of Alcohol on Cardiovascular Risk Factors: Is There New Information?

The effects of alcohol on cardiovascular health are heterogeneous and vary according to consumption dose and pattern. These effects have classically been described as having a J-shaped curve, in which low-to-moderate consumption is associated with less risk than lifetime abstention, and heavy drinkers show the highest risk. Nonetheless, the beneficial effects of alcohol have been questioned due to the difficulties in establishing a safe drinking threshold. This review focuses on the association between alcohol consumption and cardiovascular risk factors and the underlying mechanisms of damage, with review of the literature from the last 10 years.

Association between alcohol consumption and hypertension in Chinese adults: Findings from the CHNS

OBJECTIVES

To obtain information about alcohol consumption (henceforth "drinking") among Chinese adults from 1991 to 2011, and to explore the association between drinking behavior and hypertension.

METHODS

According to the longitudinal data obtained in the China Health and Nutrition Survey (1991-2011), 50,013 records of 12,577 adults were selected by applying eligibility criteria. The chi-test was employed to explore the association between drinking and hypertension, by considering the frequency of drinking, daily alcohol intake, alcohol type, and the prevalence of hypertension. A multilevel logistic regression model was used to analyze the longitudinal association between drinking frequency and the prevalence of hypertension.

RESULTS

The prevalence of hypertension was higher in participants with a high drinking frequency than in those with a low drinking frequency among both males and females (p < 0.001). A step increase in daily alcohol intake was not associated with any obvious changes in the prevalence of hypertension in males, but the prevalence in each drinking group was higher than that in the nondrinking group, the prevalence of hypertension in females was lowest among those with a daily alcohol intake below 15 g. The types of alcohol consumed differed significantly between males and females (p < 0.001). Longitudinal analysis results showed that compared with the nondrinking group, drinking frequency ≤2 times/week was positively correlated with hypertension in both males (OR = 1.51, 95% CI = 1.26-1.82, p < 0.001) and females (OR = 1.67, 95% CI = 1.08-2.58, p < 0.05) after adjusting for covariates, meanwhile, the same positive correlation also occurred in males with drinking frequency >2 times/week (OR = 2.13, 95% CI = 1.77-2.56, p < 0.05), the risk of hypertension increased with the increase in drinking frequency.

CONCLUSIONS

Drinking can increase the prevalence of hypertension in Chinese males and females. From the analysis results of longitudinal data, drinking alcohol is still an important risk factor for hypertension among Chinese subjects, especially those who drink with high frequency.

The protective effect of alcohol consumption on the incidence of cardiovascular diseases: is it real? A systematic review and meta-analysis of studies conducted in community settings

BACKGROUND

This study investigated the dose-response relationship between alcohol consumption and CVD incidence, conducting a meta-analysis of studies focusing on residents from local communities. Further, we examined whether light to moderate alcohol consumption had a protective effect on CVD incidence through a sub-group analysis.

METHODS

This study conducted a meta-analysis of the relationship between alcohol consumption and CVD incidence, selecting journals published up to December 2017. The alcohol consumption level was classified into non-consumers, light (0.01-10.0 g/day), light to moderate (10.1-20.0 g/day), moderate (20.1-40.0 g/day), moderate to high (40.1-60.0 g/day), and high (> 60.0 g/day) groups. The sub-group analysis was conducted according to the number of comorbidities and age.

RESULTS

Seven articles were selected in total for the meta-analysis. The mean Newcastle-Ottawa scale score was 8.14 points, suggesting studies were of high quality. There was a J-shaped dose-response relationship between alcohol consumption level and CVD incidence only in men. In general, light to moderate and moderate consumption lowered CVD incidence (Relative risk (RR) [95% confidence interval (CI)] was 0.68 [0.57-0.81] and 0.72 [0.58-0.90], respectively). In men with 3-4 comorbidities, there were no protective effects of light to moderate and moderate consumption on CVD incidence. In either groups of only men or men and women there were protective effects of light to moderate and moderate consumption on CVD incidence only in those aged between 41 and 65.

DISCUSSION

We found that light to moderate and moderate alcohol consumption had a protective effect on CVD incidence, there was no protective effect either in those with at least three comorbidities or people aged 40 or younger.

CONCLUSIONS

We conclude that not all local community residents experience a protective effect of light to moderate consumption on CVD incidence. As such, it is necessary to recommend a moderate amount of drinking or less for each individual.

Relation of Alcohol Consumption to Risk of Heart Failure in Patients Aged 65 to 84 Years With Hypertension

Although a high level of alcohol consumption is associated with cardiomyopathy, the benefit or risk of moderate alcohol consumption on incident heart failure (HF) is unknown. This study examined the association between alcohol consumption and risk for HF in older adults with hypertension. The study analyzed data from a cohort of 6,083 participants aged 65 to 84 years at baseline (1995 to 2001) followed for a median of 10.8 years during and after the Second Australian National Blood Pressure Study. Frequency and amount of alcohol consumption were self-reported at baseline and during the clinical trial. The percentages of current drinkers, former drinkers, and never-drinkers at baseline were 4,400 (72%), 394 (6%), and 1,289 (21%), respectively. Incident HF was diagnosed in 183 men and 136 women. After adjustment for multiple confounders, alcohol consumption was not significantly associated with HF. Compared with never-drinkers, the adjusted hazard ratios (95% confidence interval) for those who consume 1 to 7, 8 to 14, and >14 drinks/week at baseline were 0.87 (0.59 to 1.30), 0.96 (0.57 to 1.60), and 0.71 (0.25 to 2.02), respectively in women, and 0.81 (0.47 to 1.38), 0.77 (0.43 to 1.38), and 1.04 (0.59 to 1.84), respectively in men. The findings of lack of an association between alcohol consumption and risk of HF persisted in the analyses comparing the risk of HF across each level of drinking at baseline or at follow-up with never-drinkers. In the present study, there was no evidence for benefit or risk of alcohol consumption, reported at baseline or at follow-up, in relation to incident HF in both men and women.

Relationship between alcohol drinking and arterial hypertension in indigenous people of the Mura ethnics, Brazil

OBJECTIVE

To identify the consumption of alcoholic beverage and the relation with hypertension, their prevalence and associated factors, in indigenous Mura, Brazil.

METHODS

A cross-sectional population-based study was conducted with 455 adult indigenous aged 18 years or more of Mura ethnics in Amazonia, Brazil. Interview was conducted and the alcohol intake was assessed by the Alcohol Use Disorders Identification Test. Blood pressure was measured in three measurements and the mean of the last two measurements was used. Physical examination included the following data: weight, height, waist and neck circumference, bioimpedance, and capillary measurement of glucose, triglycerides and cholesterol. Through multivariate Logistic regression in stepwise, the odds ratios for alcohol consumption and associated factors were identified.

RESULTS

The prevalence of alcoholic beverage was 40.2%, with no significant difference for hypertension in those who drink (23.0%) and those who did not drink (29.0%). Referred hypertension in indigenous was associated to less use of alcoholic beverages (14.2% vs 24.3%, P = 0.009). After an adjusted analysis (Odds Ratio, 95% CI), there was a positive association between alcoholic drink intake and male sex (10.27, CI: 5.76-18.30), smoking (4.72, CI: 2.35-9.46) and live in rural areas (9.77, CI: 5.08-18.79). On the other hand, age (0.95, IC: 0.94-0.97), and absence of dyslipidemia (0.41, CI: 0.19-0.89) were associated to lower alcohol consumption.

CONCLUSION

The prevalence of alcoholic beverage was high and associated with referred hypertension, but this association was not maintained after adjusted analysis. Changes to habits and inappropriate lifestyles in indigenous populations and living in urban areas may contribute to increase risk for cardiovascular diseases. Therefore, health policies should be implemented to meet the uniqueness of indigenous people.

Impact of drinking and smoking habits on cerebrovascular disease risk among male employees

OBJECTIVE

We aimed to analyze the impact of drinking and smoking behavior on the risk of developing cerebrovascular diseases among male employees aged 20-46 years. Twenty years of follow-up data of male employees enrolled in the DENSO Health Insurance Program were used for analyses.

SUBJECTS AND METHODS

Of 29,048 male employees aged 20-46 years who were enrolled in the insurance program in 1994, 25,084 (86.4%) employees underwent annual health check-ups until 2003 without missing an appointment. Of these 25,084 employees, the data of 11,784 (40.6%) employees who self-reported drinking and smoking habits were used for analyses. The hazard ratio and 95% confidence intervals (CIs) for developing cerebrovascular disease in 2004-2013 were calculated in four risk groups categorized as per drinking and smoking behavior in the young group who were in their 20s and the middle-aged group who were in their 30s-40s in 1994. Based on their drinking behavior, participants were categorized into two groups: "not drinking or drinking sometimes" and "drinking every day." Based on their smoking behavior, participants were also categorized into two groups: "not smoking for 10 years" and "smoking for 10 years."

RESULTS

A Cox's proportional hazard model revealed that after controlling for body mass index, systolic blood pressure, triglycerides, total cholesterol, fasting plasma glucose, and age, the hazard ratios for "smoking and drinking every day" were 3.82 (95% CI: 1.40-10.41) in the young group and 2.31 (95% CI: 1.27-4.17) in the middle-aged group.

DISCUSSION

Male employees who had been drinking and smoking for 10 years had a higher risk of developing cerebrovascular diseases. To prevent cerebrovascular diseases among male employees, it may be effective to offer behavior change interventions for both drinking and smoking habits, regardless of the age group.

[Wine consumption and prevention of coronary artery disease]

There is a J-shaped correlation between the amount of alcohol consumed per day and overall mortality risk and an inverse correlation between the amount of alcohol consumed per day and cardiovascular mortality. The evidence is stronger for men than for women. The correlations are independent of the type of alcoholic beverage predominantly consumed. Possible mechanisms explaining the cardioprotective, antiatherosclerotic effects of moderate alcohol consumption are inhibition of platelet aggregation, increase in serum high density lipoprotein (HDL) levels and prevention of diabetes mellitus. The two latter mechanisms can also explain a delayed progression of atherosclerosis due to alcohol consumption. The beneficial effects are counteracted by detrimental effects of alcohol on the incidence of cancer diseases, liver cirrhosis, violence and accidents; therefore, alcohol consumption in general cannot be recommended for prevention of cardiovascular diseases.

The relationship between mild alcohol consumption and mortality in Koreans: a systematic review and meta-analysis

Background

A recent systematic review reported that mild drinking showed beneficial effects on mortality. However, this relationship between alcohol consumption and mortality differs by race, and there are few studies on Koreans. In this study, we reviewed previous studies conducted on Koreans to investigate the association between mild drinking and mortality.

Methods

Four databases (Medline, Web of Science, KoreaMed, and DBpia) were searched. Studies investigating the risk of alcohol consumption on three types of mortality (all-cause mortality, cancer-related mortality, and cardiovascular mortality) for Koreans were included.

Results

A total of 16 studies assessed alcohol consumption as a risk factor for mortality. Nine studies reported on the risk of alcohol consumption in relation to all-cause mortality, eight to cancer-related mortality, and three to cardiovascular mortality. Among these, only studies assessing alcohol amount not drink status or drink frequency were included in meta-analysis. The results of the meta-analysis did not show a significant effect of mild alcohol consumption on all-cause mortality (5 studies, OR: 0.85, 95 % CI: 0.72, 1.01). While meta-analysis of studies using all-cancer mortality showed significant effect of alcohol consumption (4 studies, OR: 0.89, 95 % CI: 0.85, 0.94), results of studies including all-caner and specific type of cancer was not significant (7 studies, OR: 1.02, 95 % CI: 0.9, 1.15). Although a meta-analysis of cardiovascular mortality could not be conducted owing to a lack of studies, all studies reported a non-significant effect of occasional or mild alcohol consumption.

Discussion

In this study, mild alcohol consumption in Korean did not show beneficial effect on mortality and it might be caused by three factors: criterion of mild drinking, the subjects, and sample size. The criterion of mild alcohol consumption was diverse in included studies. The effect of alcohol consumption could differ based on subjects’ sex, age as well as race. In addition, the effect of alcohol consumption might be different from previous one due to the small number of studies.

Conclusions

Mild alcohol consumption did not show any beneficial effects in relation to all-cause, cancer-related, and cardiovascular mortality. Additional studies are necessary to verify any association between mild drinking and mortality in Koreans.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2263-7) contains supplementary material, which is available to authorized users.

Neighborhood characteristics associated with the availability of alcohol outlets in quebec, Canada

Objectives. The objectives of this study were to examine the spatial accessibility to alcohol outlets in Quebec and to assess the association between neighborhood level characteristics and availability of alcohol outlets. Methods. The Tobit Model was used to assess the association between neighborhood level characteristics and the availability of alcohol outlets within 500, 1000, 2000, and 3000 metres, respectively. Results. Alcohol outlets were found to be most available in the two largest metropolitan areas of the province of Quebec (Montréal and Québec City). Within 1000 metres, alcohol outlets are more available in neighbourhoods with the following characteristics: highest concentration of men, least materially deprived highest concentration of persons aged 20 years or more, and location either in a metropolitan area or in a small town. Finally, the number of bars with video lottery terminals increases with the level of social and material deprivation. Conclusion. In Québec, there is no rule governing the location of alcohol outlets. Thus, there is an abundant literature indicating that the regulation of alcohol outlet density could be an effective means of controlling risk attributable to alcohol consumption.

Alcohol consumption, hospitalization and medical expenditure: a large epidemiological study on the medical insurance system in Japan

AIMS

This study investigated the relationship between alcohol drinking habits and the onset of high medical expenditure in a Japanese male population.

METHODS

The cohort comprised 94,307 male beneficiaries 40-69 years of age of the Japanese medical insurance system, who had daily alcohol drinking habits. The likelihood of incurring high medical expenditure, defined as the ≥90th percentile of the medical expenditure distribution in the study population 1 year after baseline, as well as the likelihood of undergoing hospitalization that year were compared among the participants grouped according to their alcohol consumption amount (<2, 2-3.9, 4-5.9, ≥6 drinks/day).

RESULTS

Participants who ranked in the top 10% medical expenditure group within the 1 year after baseline each incurred at least 2152 euros/year. The top 10% medical expenditure group accounted for 61.1% of the total medical expenditure in the study population. The odds ratios (95% confidence intervals) for ranking in the top 10% group during the 1-year period, compared with the <2 drinks (23 g of alcohol)/day group, were 1.08 (1.02-1.15) for 2-3.9 drinks/day, 1.11 (1.05-1.19) for 4-5.9 drinks/day, and 1.31 (1.18-1.45) for ≥6 drinks/day after adjustment for age, body mass index, and smoking and exercise habits. The adjusted odds ratios for undergoing hospitalization were 1.11 (1.04-1.19), 1.14 (1.06-1.24) and 1.39 (1.24-1.56), respectively.

CONCLUSION

The likelihood of incurring high medical expenditure and undergoing hospitalization increased with daily alcohol consumption amount.

Hypertension, alcohol drinking and stroke incidence: a population-based prospective cohort study among inner Mongolians in China

OBJECTIVES

The purpose of this study was to evaluate the effect of hypertension and alcohol drinking on stroke incidence and whether alcohol drinking would increase the risk of stroke in hypertension participants among Inner Mongolians.

METHODS

A prospective cohort study from June 2003 to July 2012 was conducted among 2535 people aged 20 years and older from Inner Mongolia, China. We categorized the participants into four subgroups according to blood pressure and drinking status. The cumulative risks of stroke among the four subgroups were estimated with the Kaplan-Meier curves and compared by log-rank test. Cox proportional hazards models and receiver operating characteristic (ROC) curves were employed to evaluate the association between hypertension, alcohol drinking and stroke incidence.

RESULTS

A total of 120 stroke patients were observed during the follow-up period. The multivariate-adjusted hazard ratios (95% confidential intervals) of stroke for nonhypertension/drinkers, hypertension/nondrinkers and hypertension/drinkers were 1.03 (0.48-2.22), 2.64 (1.45-4.81) and 2.89 (1.55-5.39), respectively, compared with nonhypertension/nondrinkers. The area under ROC curve (AUC) for a model containing hypertension and drinking status along with conventional factors (AUC = 0.684) was significantly (P = 0.005) larger than one containing only conventional factors (AUC = 0.660).

CONCLUSION

These findings suggest that hypertension is an independent risk factor of stroke in Inner Mongolians. Drinkers with hypertension seem to be more susceptible to stroke; larger-sample prospective cohort studies are still required to examine the cumulative effect of drinking and hypertension on stroke incidence.

Association between alcohol consumption and risk of cardiovascular disease and all-cause mortality in patients with hypertension: a meta-analysis of prospective cohort studies

OBJECTIVE

To conduct a meta-analysis summarizing the risk of cardiovascular disease (CVD) and all-cause mortality (ACM) in relation to alcohol consumption in patients with hypertension, focusing on clarifying dose-response associations.

PATIENTS AND METHODS

PubMed and EMBASE were searched for eligible prospective cohort studies from December 3, 1949, through January 18, 2014. The semi-parameter method and dose-response analysis were used.

RESULTS

Nine studies (11 cohorts) were included in the meta-analysis. Compared with the lowest alcohol level (abstainers/occasional drinkers), the pooled relative risk (RR) was 0.72 (95% CI, 0.68-0.77) for the third highest category (median, 10 g/d), 0.81 (95% CI, 0.71-0.93) for the second highest category (median, 20 g/d), and 0.60 (95% CI, 0.54-0.67) for the highest category (median, 30 g/d). A J-shaped relationship between alcohol use and ACM was observed, and the nadir (RR, 0.82; 95% CI, 0.76-0.88) was found to be at a dose of 8 to 10 g of alcohol consumption per day.

CONCLUSION

Findings of this meta-analysis suggest that low-to-moderate alcohol consumption was inversely significantly associated with the risk of CVD and ACM in patients with hypertension.

Reducing the modifiable risks of cardiovascular disease in Turkish patients with type 2 diabetes: the effectiveness of training

Our goal was to reduce the number of modifiable risk factors for cardiovascular disease (CVD) through providing lifestyle adjustment training and counseling to patients with type 2 diabetes. In this pre-post intervention study, 139 patients with diabetes were provided with training to reduce the modifiable risks of CVD. One hundred three patients attended the post-training evaluation. Two phone counseling sessions were provided with 1-month intervals. Consumption of red meat and processed food decreased and water consumption, carrying on the recommended diet, and the frequency of exercise increased (p = .000), A1C decreased (p = .05), and the use of aspirin increased (p = .03). Thus, a contribution to the reduction of CVD risk factors in patients with type 2 diabetes was achieved. The training program for reducing CVD risk factors in patients with type 2 diabetes was effective in improving nutrition and lifestyle behaviors and decreasing glycemic control.

Incidence of cardiovascular diseases and associated risk factors among subjects with type 2 diabetes - an 11-year follow up study

Aims

This study was planned to assess the development of cardiovascular disease (CVD) events over an 11-year period and to identify the associated risk factors that could predict the onset of CVD among subjects with type 2 diabetes.

Methods

Retrospective data of 249 patients (M:F 149:100) with type 2 diabetes, from a cohort of 7800 patients, attending a tertiary care center for diabetes from January 2000 to December 2011 were retrieved and analyzed for this study. Sociodemographic and habitual risk factors, baseline diabetes duration, HbA1c and time of onset of CVD and its risk factors were collected from case records. Person-years method was used to calculate incident rate of CVD. Binary logistic regression analyses were done to identify predictors associated with CVD and its risk factors.

Results

Incidence of CVD among subjects with diabetes was 5.6 cases/1000 person-years. Nearly 60% developed hypertension and dyslipidemia or both during the 11-year period. The most common complication was neuropathy (14.4%). Smoking [OR (95%CI)] [9.26 (1.6–54.9)] (p = 0.014) and heavy alcohol consumption [8.7 (1.1–69.8)] (p = 0.04) were significantly associated with CVD. Higher BMI was significantly associated with hypertension and dyslipidemia [2.4 (1.3–4.3)] (p = 0.003).

Conclusions

Smoking and heavy alcohol consumption were significantly associated with CVD, and increased BMI was significantly associated with hypertension and dyslipidemia among subjects with type 2 diabetes in this study population. These findings emphasize the need for early identification and modification of risk factors associated with CVD events in patients with diabetes.