Alcohol consumption and blood pressure in the adult US population: assessment of gender-related effects

Risk of diabetes and hypertension in a population with alcohol use disorders

BACKGROUND

A population-based follow-up study assessing the risk of developing hypertension and diabetes associated with alcohol use disorder (AUD) is crucial. We investigated this relationship by using insurance claims data from Taiwan.

METHODS

From the claims data, an AUD cohort (N = 60,590) diagnosed between 2000 and 2006 and a non-AUD comparison cohort (N = 60,590) without the diagnosis of hypertension or diabetes at baseline were established and matched by propensity scores estimated by baseline demographic status and the Charlson comorbidity index (CCI). We assessed the incidence rates of hypertension and/or diabetes at the end of 2016 and used Cox's method to estimate the related hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Relative to the comparison cohort, the AUD cohort had an approximately 1.70-fold higher incidence of hypertension (35.1 vs. 20.7 per 1,000 person-years), with an adjusted HR (aHR) of 1.72 (95% CI: 1.68-1.76), 2.16-fold higher incidence of diabetes (20.2 vs. 9.36 per 1,000 person-years), with an aHR of 2.18 (95% CI: 2.11-2.24), and 1.91-fold higher incidence of both diabetes and hypertension (10.3 vs. 5.38 per 1,000 person-years) with an aHR of 2.02 (95% CI: 1.94-2.10). The incidence rates of all outcomes were greater in men than in women, whereas the HRs were greater for AUD in women than for AUD in men relative to the respective comparison patients. The risk increased further for subjects with CCI ≥ 1, which was higher in the AUD cohort.

CONCLUSIONS

The increased risk of developing diabetes and hypertension in patients with AUD, especially the differences noted according to gender, indicates that clinicians should address potential comorbidities in these patients.

Assessment of interstitial lung disease among black rheumatoid arthritis patients

BACKGROUND

Conflicting reports exist regarding the racial and the gender distribution of rheumatoid arthritis-related interstitial lung disease (RA-ILD). In a major population study of predominately Whites, RA-ILD was reported mainly among smoker middle-aged men. However, recent data suggest that the disease is that of elderly women. Our study aimed to assess the prevalence and identify the gender differences and clinical characteristics of RA-ILD in a predominantly Black population.

METHODS

Cross-sectional analysis of data obtained from the records of 1142 patients with RA diagnosis by ICD codes of which 503 cases met the inclusion criteria for the study. Eighty-six patients had chronic respiratory symptoms of cough and dyspnea and were further assessed by our multidisciplinary group of investigators. Thirty-two subjects with an established diagnosis of rheumatoid arthritis met the diagnostic criteria for interstitial lung disease.

RESULTS

Of the 32 patients with RA-ILD, mean age was 62.6 ± 2.2 (± SEM), 93.7% were females, and 89% Blacks with a BMI = 29.2 (Kg/m²). Usual interstitial pneumonia (UIP) was found in 24/32 (75%) of the cases. Seventy-two percent of the RA-ILD patient had seropositive RA. Smoking history was reported in 31.3% of the cohort, gastroesophageal reflux disease (GERD) in 32.3%, and cardiovascular disease (CVD) risk factors in 65.6%.

CONCLUSION

Our study indicates RA-ILD among Blacks is predominantly a disease of elderly females with higher rates of GERD and CVD risk factors. Further studies are needed to identify the pathogenetic differences accounting for the gender distribution of RA-ILD among Black and White populations.Key Points• First study to assess ILD among predominantly Black RA patients.• The prevalence of RA-associated ILD was 6.36%, affecting mostly women in their sixth decade with seropositive disease.• COPD was the most common airway disease among non-RA-ILD Black population.• GERD was found in approximately one-third of patients with RA-associated ILD versus one-fifth of those RA patients without any lung disease.

Randomized Controlled Intervention of the Effects of Alcohol on Blood Pressure in Premenopausal Women

Alcohol has been consistently demonstrated to elevate blood pressure (BP) in intervention studies in men. There are uncertainties, however, as to the nature of the relationship in women. We, therefore, determined in healthy premenopausal women the dose-dependent effects of alcohol on ambulatory BP. Twenty-four participants aged 25 to 49 years, with a mean alcohol intake of 202±94 g alcohol/wk and mean 24-hour systolic and diastolic BP of 110.2±8.9/68.9±5.7 mm Hg, were randomized to a 3-period cross-over study. Each evening they consumed higher volume red wine (lower level drinkers, 146 g alcohol/wk; higher level drinkers, 218 g alcohol/wk), lower volume red wine (lower level drinkers, 42 g alcohol/wk; higher level drinkers, 73 g alcohol/wk), or dealcoholized red wine, each for a period of 4 weeks. Higher volume red wine significantly increased 24 hours systolic and diastolic BP relative to dealcoholized red wine (by 2.0±0.6/1.2±0.4 mm Hg; P =0.001 and P =0.028, respectively). There were similar changes for higher volume red wine relative to lower volume red wine (by 1.6±0.6/1.4±0.4 mm Hg; P =0.014 and P =0.005, respectively). These effects were predominantly on awake rather than asleep BP. There was no significant difference in BP between lower volume red wine and dealcoholized red wine. We conclude that in healthy premenopausal women regular consumption of alcohol as 200 to 300 mL red wine/d (146–218 g alcohol/wk) elevates 24 hours systolic and diastolic BP. The magnitude of the increase in BP is similar to that previously reported in intervention studies in men.

Long-term alcohol consumption is an independent risk factor of hypertension development in northern China: evidence from Kailuan study

OBJECTIVE

The purpose of the present study was to determine the impact of alcohol consumption on the incidence of hypertension.

METHODS

A total of 32,389 male coal mine workers from Kailuan Coal Group in northern China (Kailuan study), free of hypertension, myocardial infarction, stroke, transient ischemia attack and cancer, were followed up every 2 years for 4 years. The average alcohol intake during the past year was reported as baseline.

RESULTS

During 4 years of follow-up, 9151 out of 32,389 workers developed hypertension categorically. At the end of the follow-up, the cumulative incidence of hypertension in relation to daily alcoholic intake of none, 1-24, 25-49, 50-99, 100-149 and at least 150 g was 25.03, 28.82, 30.10, 37.07, 40.14 and 42.49%, respectively. After adjusting for age, we found that the relative risk of hypertension in those who were never exposed to alcohol was the lowest, with the group 25-49 g/day being the next. This trend was unchanged after adjustment for age, exercise, smoking status, job type and salt intake. After further adjustment for BMI, history of high cholesterol and diabetes mellitus, a positive, linear association between alcohol consumption and the risk of hypertension was found. Models stratified by baseline SBP (<120 and 120-139 mmHg) or DBP (<80 and 80-89 mmHg) did not alter the trend.

CONCLUSION

The Kailuan study demonstrates that long-term alcohol intake is an independent risk factor of incident hypertension in a large cohort of coal mine workers. Even light-to-moderate alcohol consumption increases the risk of incident hypertension.

Adiponectin negatively correlates with alcoholic and non-alcoholic liver dysfunction: Health check-up study of Japanese men

AIM

  Central obesity, insulin resistance and alcohol consumption are thought to be major risk factors for fatty liver formation. Adiponectin (APN) prevents fatty liver formation, and its serum levels are lower in subjects with central obesity and/or insulin resistance. The aim of this study was to explore the association among serum APN levels, central obesity, insulin resistance and liver dysfunction with or without fatty liver classified by alcohol consumption in healthy subjects.

METHODS

  A total of 5588 Japanese male subjects who underwent a health check-up were classified into three groups according to alcohol consumption: non- or light drinkers (15 g/day ≥ ethanol); mild drinkers (15 g/day < ethanol ≤ 30 g/day); and moderate- or heavy drinkers (30 g/day < ethanol). Central obesity and insulin resistance were assessed by waist circumference (WC) and Homeostasis Model of Assessment - Insulin Resistance (HOMA-IR), respectively.

RESULTS

  WC was significantly increased, while HOMA-IR was significantly decreased according to the extent of alcohol consumption. Serum alanine aminotransferase levels were significantly lower and serum APN levels were significantly higher in mild drinkers than in the other two groups. Multiple linear regression analysis showed that serum APN level served as the significant and independent determinant for liver dysfunction in the subjects with fatty liver, irrespective of alcohol consumption. However, WC became a non-significant determinant of liver dysfunction as alcohol consumption increased.

CONCLUSION

  Hypoadiponectinemia is a significant determinant for steatotic dysfunction for all levels of alcohol consumption, but central obesity was not a significant determinant for alcoholic fatty liver-induced liver dysfunction.

Population blood pressure and low to moderate alcohol intake in an untreated population followed over 20years. Copenhagen City heart study

The aim of this study is to evaluate whether a changing population alcohol intake is capable of setting off a shift in the blood pressure distribution in the untreated part of a population. The focus is on subjects with an alcohol intake well below the limits of alcoholism because these subjects make out the majority of the population. The Copenhagen City Heart Study is a prospective longitudinal epidemiological study. The untreated study population was followed over 20years. Specially trained technicians using a blinded sphygmomanometer measured BP once with the subject in the sitting position. The BP measurement was fully standardised and the measurement method was unchanged throughout the observation period. A questionnaire concerning drinking habits was completed by the participants and double-checked by the technicians. The results were a decreasing population systolic BP and an increasing self-reported alcohol intake. The population increase was based on an increasing proportion of light to moderate drinkers. There was no effect of a moderately increasing alcohol intake as a covariate in a multivariate analysis of population systolic BP.

CONCLUSION

A moderately increasing population alcohol intake cannot explain the observed changes in population systolic blood pressure.

Trends and determinant factors for population blood pressure with 25 years of follow-up: results from the Copenhagen City Heart Study

OBJECTIVE

This study aimed to evaluate within-population trends in population blood pressure (BP) over 25 years and to identify important determinants for a changing population BP.

DESIGN

Copenhagen City Heart Study is a prospective longitudinal epidemiological study. The study population (15 508) did not receive antihypertensive therapy.

METHODS

The BP measurement was fully standardized and measurement method was unchanged throughout the observation period. A questionnaire concerning drinking habits, smoking, medical therapy and physical exercise was completed by the participants and double checked by the technicians.

RESULTS

After an initial increase, population systolic BP (SBP) decreased. All risk factors were tested in the longitudinal model by means of a residual likelihood ratio test. The final model included sex, age and body mass index as significant factors and covariates. Two interactions were included. The first interaction 'age×sex' showed that the sex differences diminished with age. The second interaction 'age×survey' showed that the value of SBP in the young generations decreased survey by survey. SBP in the elderly also decreased survey by survey, but to a lesser degree. Diastolic BP (DBP) increased to a peak value in survey 3 and hereafter decreased.

CONCLUSION

SBP decreased. body mass index, sex and age have an effect on population BP. A decreasing trend in SBP among new entrants is responsible for (part of) the observed decrease in population SBP. The decreasing SBP among the elderly was affected by the fact that an increasing number of the elderly population started antihypertensive medication. DBP decreased, but none of the investigated factors affected DBP.

Association between alcohol intake amount and prevalence of metabolic syndrome in Korean rural male population

Moderate alcohol consumption is known to be associated with a reduced risk of cardiovascular disease and mortality. However, few studies reported that long-term alcohol drinking may increase the prevalence of central obesity, and cardiovascular disease. We examined the association between metabolic syndrome, nutritional factors and alcohol intake amount in Korean male rural population. We performed a cross-sectional analysis on data from Korean Rural Genomic Cohort (KRGC) study. We used multiple logistic regression analysis to estimate the adjusted odds ratio of metabolic syndrome according to alcohol intake amount categories (never, 0-16 g/day, 16-40 g/day, and >40 g/day). The age adjusted odds ratio for the prevalence of metabolic syndrome was significantly increased in the quartile with the highest alcohol consumption compared to the non-alcohol drinking group (1.33; C.I., 1.11-1.59). These results were similar in the high energy intake group, but not in the low energy intake group. Waist circumference, blood pressure, and serum triglyceride levels were significantly higher in the quartile with the highest alcohol consumption compared to the non-alcohol drinking group. These results suggest that large alcohol consumption is associated with metabolic syndrome and may be a modifiable risk factor of metabolic syndrome especially in subjects with high calorie intake.

Associação entre marcadores antropométricos de adiposidade corporal e hipertensão arterial na população adulta de Cuiabá, Mato Grosso

OBJETIVO: Avaliar a associação entre marcadores antropométricos de adiposidade corporal (índice de massa corporal e circunferência da cintura) e hipertensão arterial. MÉTODOS: Estudo de corte transversal, de base populacional, realizado no período de 2003 a 2004, com 1.298 indivíduos de 20 a 59 anos. Foram considerados hipertensos os indivíduos com pressão arterial > 140/90 mmHg ou em uso de medicação anti-hipertensiva. As associações entre os indicadores antropométricos e a hipertensão arterial foram analisadas por regressão de Poisson, ajustada por potenciais fatores de confusão (sexo, idade, escolaridade, tabagismo, consumo de bebida alcoólica e atividade física no lazer). A curva ROC foi utilizada para determinar o melhor ponto de corte do IMC para detecção da hipertensão arterial. RESULTADOS: A prevalência de hipertensão arterial foi de 28,3%, sendo 33,5% no sexo masculino e 23,5% no feminino. Após ajuste para o IMC e potenciais fatores de confusão, a circunferência da cintura perdeu associação com o desfecho avaliado, permanecendo apenas o IMC com poder de explicação para a hipertensão arterial (RP = 1,05, p = 0,001). O melhor ponto de corte para o IMC no sexo masculino foi de 25,6 Kg/m², e no sexo feminino 25,7 Kg/m². CONCLUSÕES: A associação observada entre a circunferência da cintura e a hipertensão arterial em muitos estudos pode estar relacionada à ausência de controle de potenciais fatores de confusão nas análises, bem como à não remoção do efeito da adiposidade total. Novas investigações devem ser conduzidas na população brasileira, a fim de se verificar as verdadeiras associações entre indicadores antropométricos e vários desfechos, estudando-se também os melhores pontos de corte desses indicadores.

Influence of gender on the association of alcohol drinking with blood pressure

BACKGROUND

The purpose of this study was to determine whether gender influences the association of alcohol drinking with blood pressure.

METHODS

The subjects (43,810 healthy men and women at ages of 35-54 years) were divided into five groups by average daily ethanol intake (non-, very light (<10 g per day), light (> or =10 g and <20 g per day), moderate (> or =20 g and <30 g per day), and heavy (> or =30 g per day) drinkers). The means of each variable after adjustment for age, body weight, and history of smoking were compared among the groups.

RESULTS

Systolic blood pressure of men was significantly higher in moderate and heavy drinkers than in nondrinkers, and systolic blood pressure of women was significantly higher in heavy drinkers but not in moderate drinkers than in nondrinkers. Diastolic blood pressure of men and women was significantly higher in light, moderate and heavy drinkers than in nondrinkers. The differences in systolic and diastolic blood pressure between drinkers and nondrinkers were greater in men than in women. Both in men and women, serum HDL cholesterol was significantly higher in all four drinker groups than in the nondrinker group, and the difference between drinkers and nondrinkers was greater in women than in men. The above findings were not altered when age- and alcohol intake-matched groups of subjects were used.

CONCLUSIONS

The results suggest that blood pressure is more prone to be elevated by alcohol drinking in men than in women.