Separate and combined effects of smoking and alcohol abuse in middle-aged men

Both Moderate and Heavy Alcohol Use Amplify the Adverse Cardiovascular Effects of Smoking in Young Patients with Hypertension

AIM

To evaluate the association of alcohol and smoking combined with cardiovascular and renal events and investigate whether moderate and heavy alcohol consumption have a different impact on this association.

METHODS

The study was conducted in 1208 young-to-middle-age stage 1 hypertensive patients. Subjects were classified into three categories of cigarette smoking and alcohol use, and the risk of adverse outcomes was assessed over a 17.4-year follow-up.

RESULTS

In multivariable Cox models, smoking showed a different prognostic impact on alcohol drinkers and abstainers. In the former, an increase in the risk of cardiovascular and renal events was observed compared to nonsmokers (hazard ratio, 2.6, 95% CI, 1.5-4.3, p < 0.001), whereas in the latter, the risk did not achieve the level of statistical significance (p = 0.27) with a significant interaction between smoking and alcohol use (p < 0.001). Among the heavy smokers who also drank alcoholic beverages, the hazard ratio from the fully adjusted model was 4.3 (95% CI, 2.3-8.0, p < 0.0001). In the subjects with moderate alcohol consumption, the risk of smoking and alcohol combined was similar to that found in the whole population (hazard ratio, 2.7; 95% CI, 1.5-3.9, p < 0.001). Among the subjects with heavy alcohol consumption, the hazard ratio was 3.4 (95% CI, 1.3-8.6, p = 0.011).

CONCLUSION

These findings indicate that the detrimental cardiovascular effects of smoking can be worsened by concomitant alcohol use. This synergistic effect occurs not only for heavy alcohol consumption but also for moderate use. Smokers should be aware of the increased risk associated with concomitant alcohol consumption.

An overview of alcohol and tobacco/nicotine interactions in the human laboratory

BACKGROUND

Alcohol use disorders and tobacco use contribute significant risk to the global burden of disease, and each are major public health concerns. Together, alcohol and tobacco use are highly comorbid and have multiplicative health risks when used concurrently, underscoring the importance of examining alcohol-tobacco interactions in the human laboratory.

OBJECTIVE

The aims of this review were to summarize the state of research examining alcohol-tobacco interactions in the human laboratory.

METHODS

We reviewed human laboratory evidence for alcohol and tobacco/nicotine interactions, including 1) craving in drinkers and smokers exposed to smoking or drinking cues, 2) fixed-dosing of alcohol or nicotine in smokers and drinkers, and 3) smoking and alcohol influences on self-administration behaviors. The interactive effects of tobacco/nicotine with other drugs of abuse are also briefly discussed.

RESULTS

Overall, results identified that alcohol and tobacco have reciprocal influences on potentiating craving, subjective responses to fixed-dose alcohol or nicotine administration, and self-administration. The literature identified that alcohol increases craving to smoke, decreases time to initiate smoking, and increases smoking self-administration. Similarly, tobacco and nicotine increase alcohol craving, decrease subjective effects of alcohol, and increase alcohol consumption.

CONCLUSION

Future studies should continue to focus on alcohol and tobacco/nicotine interactions in individuals with a wide scope of drinking and smoking histories, different states of alcohol and nicotine deprivation, and influences of either drug on craving, subjective responses, and consumption over the course of the blood alcohol curve. This work could have important implications for the impact of alcohol-tobacco interactions on guiding clinical practice, as well as in the changing landscape of addiction.

Symptoms of alcohol dependence and smoking initiation and persistence: a longitudinal study among US adults

BACKGROUND

A large number of adults report symptoms of, but do not meet diagnostic criteria for, an alcohol use disorder. Yet, little is known about the relationship between symptoms of alcohol use disorders and the initiation and persistence of smoking. This study prospectively examines the relationship between having 1-2 symptoms of alcohol dependence (without abuse) and smoking initiation and persistence as well as nicotine dependence over a 3-year period among adults in the United States.

METHODS

Data were drawn from Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Relationships between Wave 1 symptoms of alcohol dependence, alcohol abuse, and alcohol dependence and initiation and persistence of cigarette smoking and nicotine dependence at Wave 2 were examined using logistic regression analyses. Analyses were adjusted for demographics, mood and anxiety disorders.

RESULTS

Symptoms of alcohol dependence were associated with smoking initiation at Wave 2. There was no association between symptoms of alcohol dependence and smoking persistence. Symptoms of alcohol dependence predicted incident and persistent nicotine dependence. Findings persisted after adjusting for demographic characteristics and mood/anxiety disorders.

CONCLUSIONS

Even 1-2 symptoms of alcohol dependence are associated with increased vulnerability to smoking initiation and onset and persistence of nicotine dependence at a similar strength as alcohol use disorders. Efforts at smoking cessation must address problematic alcohol use, even at the subclinical level, in order to improve efficacy.

Chronic alcohol consumption, type 2 diabetes mellitus, insulin-like growth factor-I (IGF-I), and growth hormone (GH) in ethanol-treated diabetic rats

AIMS

Alcohol has deleterious influences on glucose metabolism which may contribute to the development of type 2 diabetes mellitus (T2DM). Insulin-like growth factor I (IGF-I) and growth hormone (GH), which interact with insulin to modulate metabolic control, have been shown to be related to impaired glucose tolerance. This study was conducted to assess the possibility that altered circulating IGF-I and GH levels contribute to the exacerbation of T2DM by alcohol use in type 2 diabetic Otsuka Long-Evans Tokushima Fatty (OLETF) rats and non-diabetic Long-Evans Tokushima Otsuka (LETO) rats.

MAIN METHOD

OLETF rats were pair-fed a Lieber-DeCarli Regular Ethanol diet and LETO rats were pair-fed a control diet for 6 weeks. At 6 weeks, an Intraperitoneal Glucose Tolerance Test (IP-GTT) was performed and IGF-I and GH levels were evaluated.

KEY FINDINGS

Prior to an IP-GTT, OLETF-Ethanol (O-E) group had significantly a decrease in the mean glucose levels compared to OLETF-Control (O-C) group. At 120 min post IP-GTT, the O-E group had significantly an increase in the mean glucose levels compared to O-C group. The serum IGF-I levels were significantly lower and the serum GH levels were significantly higher in the O-E group than in L-C group.

SIGNIFICANCE

These results suggest that IGF-I and GH are prominent in defining the risk and development of T2DM, and may be adversely affected by heavy alcohol use, possibly mediating its diabetogenic effects. Thus, the overall glucose intolerance in the setting of alcoholism may be attributable to inappropriate alteration of IGF-I and GH levels.

Smoke-free policies in drinking venues predict transitions in alcohol use disorders in a longitudinal U.S. sample

BACKGROUND

Smoke-free legislation prohibiting smoking in indoor public venues, including bars and restaurants, is an effective means of reducing tobacco use and tobacco-related disease. Given the high comorbidity between heavy drinking and smoking, it is possible that the public health benefits of smoke-free policies extend to drinking behaviors. However, no prior study has examined whether tobacco legislation impacts the likelihood of alcohol use disorders (AUDs) over time. The current study addresses this gap in the literature using a large, prospective U.S. sample.

METHOD

Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we utilized logistic regression to examine whether the implementation of state-wide smoke-free legislation in bars and restaurants between Waves I (2001-2002) and II (2004-2005) predicted changes in DSM-IV AUD status (remission, onset, recurrence) in current drinkers at Wave I (n=19,763) and participants who drank in public ≥once per month (n=5913).

RESULTS

Individuals in states that implemented smoke-free legislation in drinking venues had a higher likelihood of AUD remission compared to participants in states without such legislation. Among public drinkers, smoke-free legislation was associated with a greater likelihood of AUD remission and a lower likelihood of AUD onset. These findings were especially pronounced among smokers, men, and younger age groups.

DISCUSSION

These results demonstrated the protective effects of smoke-free bar and restaurant policies on the likelihood of AUDs; furthermore, these findings call attention to an innovative legislative approach to decrease the morbidity and mortality associated with AUDs.

Longitudinal associations between smoking cessation medications and alcohol consumption among smokers in the International Tobacco Control Four Country survey

BACKGROUND

Available evidence suggests that quitting smoking does not alter alcohol consumption. However, smoking cessation medications may have a direct impact on alcohol consumption independent of any effects on smoking cessation. Using an international longitudinal epidemiological sample of smokers, we evaluated whether smoking cessation medications altered alcohol consumption independent of quitting smoking.

METHODS

Longitudinal data were analyzed from the International Tobacco Control Four Country (ITC-4) Survey between 2007 and 2008, a telephone survey of nationally representative samples of smokers from the United Kingdom, Australia, Canada, and the United States (n = 4,995). Quantity and frequency of alcohol consumption, use of smoking cessation medications (varenicline, nicotine replacement [NRT], and no medications), and smoking behavior were assessed across 2 yearly waves. Controlling for baseline drinking and changes in smoking status, we evaluated whether smoking cessation medications were associated with reduced alcohol consumption.

RESULTS

Varenicline was associated with a reduced likelihood of any drinking compared with nicotine replacement (OR = 0.56; 95% CI = 0.34 to 0.94), and consuming alcohol once a month or more compared to nicotine replacement (OR = 0.43; 95% CI = 0.27 to 0.69) or no medication (OR = 0.63; 95% CI = 0.41 to 0.99). Nicotine replacement was associated with an increased likelihood of consuming alcohol once a month or more compared to no medication (OR = 1.14; 95% CI = 1.03 to 1.25). Smoking cessation medications were not associated with more frequent drinking (once a week or more) or typical quantity consumed per episode. Medication effects on drinking frequency were independent of smoking cessation.

CONCLUSIONS

This epidemiological investigation demonstrated that varenicline was associated with a reduced frequency of alcohol consumption. Continued work should clarify under what conditions nicotine replacement therapies may increase or decrease patterns of alcohol consumption.

How can we use our knowledge of alcohol-tobacco interactions to reduce alcohol use?

Currently, 8.5% of the US population meets criteria for alcohol use disorders, with a total cost to the US economy estimated at $234 billion per year. Alcohol and tobacco use share a high degree of comorbidity and interact across many levels of analysis. This review begins by highlighting alcohol and tobacco comorbidity and presenting evidence that tobacco increases the risk for alcohol misuse and likely has a causal role in this relationship. We then discuss how knowledge of alcohol and tobacco interactions can be used to reduce alcohol use, focusing on whether (a) smoking status can be used as a clinical indicator for alcohol misuse, (b) tobacco policies reduce alcohol use, and (c) nicotinic-based medications can be used to treat alcohol use disorders.

Smoke-free bar policies and smokers' alcohol consumption: findings from the International Tobacco Control Four Country Survey

BACKGROUND

Cigarette smoking and alcohol consumption are positively correlated, and the concurrent use of tobacco and alcohol exacerbates the health risks associated with the singular use of either product. Indoor smoke-free policies have been effective in reducing smoking, but little is known about any impact of these policies on drinking behavior. The purpose of this study was to evaluate the potential association between the implementation of smoke-free bar policies and smokers' alcohol consumption.

METHODS

A prospective, multi-country cohort survey design was utilized. Participants were nationally representative samples of smokers from the United Kingdom, Australia, Canada, and the United States, who were interviewed as part of the International Tobacco Control Four Country Survey (ITC-4) in 2005, 2007, or 2008 (N=11,914). Changes in the frequency and amount of alcohol consumption were assessed as functions of change in the presence of smoke-free bar policies over time.

RESULTS

Overall, changes in alcohol consumption were statistically indistinguishable between those whose bars became smoke-free and those whose bars continued to allow smoking. However, implementation of smoke-free policies was associated with small reductions in the amount of alcohol typically consumed by those who were classified as hazardous drinkers, along with small reductions in the frequency of alcohol consumption among heavy smokers.

CONCLUSIONS

Smoking bans in public places, which protect millions of non-smokers from the harmful effects of second-hand smoke, do not appear to be associated with sizable reductions in smokers' alcohol consumption in general, but may be associated with small consumption reductions among subgroups.

Perception of the combined effects of smoking and alcohol on cancer risks in never smokers and heavy smokers

The issue addressed in the study is: How do people perceive the combined effect of alcohol consumption and tobacco consumption on risks of cancer? The method used was an application of Information Integration Theory. Sixty-four participants of both sexes were asked to estimate the risk of cancer associated with a number of situations described by a tobacco-consumption level associated with an alcohol-consumption level. Participants were subsequently presented with a questionnaire concerning the way alcohol and tobacco consumption can cause cancer. Results showed that French adults apparently considered that indulging in only one of these two behaviours represents a maximum health risk. The two effects were seen to combine disjunctively which runs counter to current medical data. However, there was total contradiction between the participants' answers to the questionnaire concerning their knowledge and the information integration task.

Alcoholism and diabetes mellitus

Chronic use of alcohol is considered to be a potential risk factor for the incidence of type 2 diabetes mellitus (T2DM), which causes insulin resistance and pancreatic β-cell dysfunction that is a prerequisite for the development of diabetes. However, alcohol consumption in diabetes has been controversial and more detailed information on the diabetogenic impact of alcohol seems warranted. Diabetes, especially T2DM, causes dysregulation of various metabolic processes, which includes a defect in the insulin-mediated glucose function of adipocytes, and an impaired insulin action in the liver. In addition, neurobiological profiles of alcoholism are linked to the effects of a disruption of glucose homeostasis and of insulin resistance, which are affected by altered appetite that regulates the peptides and neurotrophic factors. Since conditions, which precede the onset of diabetes that are associated with alcoholism is one of the crucial public problems, researches in efforts to prevent and treat diabetes with alcohol dependence, receives special clinical interest. Therefore, the purpose of this mini-review is to provide the recent progress and current theories in the interplay between alcoholism and diabetes. Further, the purpose of this study also includes summarizing the pathophysiological mechanisms in the neurobiology of alcoholism.

Tabakentwöhnung bei stationären Patienten mit einer Alkohol- abhängigkeit – Motivationsfaktoren und Erfolgsaussichten

Einleitung: Die Raucherprävalenz ist bei alkoholkranken Personen überdurchschnittlich hoch. Die gesundheitliche Bedeutung der Tabakabstinenz, aber auch potentielle synergistische Effekte auf die Alkoholabstinenz legen nahe, während einer stationären Alkoholbehandlung auch eine Tabakentwöhnung anzubieten. Ziel: Untersucht wurden die Aufhörbereitschaft und der Abstinenzerfolg nach einer Raucherentwöhnung während einer sechswöchigen stationären Alkoholismustherapie bei alkoholkranken Personen mit zusätzlicher psychiatrischer Komorbidität. Methodik: 90 von 94 Personen eines Behandlungsjahrgangs nahmen an der Untersuchung teil. Sie durchliefen eine Psychoedukation zur Tabakabhängigkeit und hatten nachfolgend die Gelegenheit, eine Raucherentwöhnungsgruppe zu besuchen. Erfasst wurden soziodemographische Daten, Motivation sowie die Abstinenzquoten von Tabak und Alkohol am Ende und drei Monate nach der Therapie. Ergebnisse: Wichtige Motivationsgründe für eine Tabakabstinenz sind die Vorteile des Nichtrauchens. 40 % (n = 28) der rauchenden Patienten (n = 69) ließen sich zu einer Tabakentwöhnung motivieren, 25 % (n = 7) schlossen die Behandlung abstinent ab. Auch wenn keiner der Patienten über drei Monate tabakabstinent blieb, so war doch der Anteil alkoholrückfälliger Patienten in der Raucherentwöhnungsgruppe niedriger (21,4 %; n = 6/28) als bei den übrigen Patienten (29,3 %; n = 12/41)). Diskussion: Die Tabakentwöhnung im Rahmen einer stationären Alkoholismusbehandlung scheint nicht von Nachteil für die Patienten zu sein. Bei der Einführung eines Therapieangebotes sollten motivationale Faktoren, Bewältigungsfertigkeiten für rückfallgefährliche Situationen sowie Begleitsymptome komorbider Störungen stärker im Vordergrund stehen als bei anderen Rauchern.

Longitudinal evaluation of smoke-free Scotland on pub and home drinking behavior: findings from the International Tobacco Control Policy Evaluation Project

INTRODUCTION

On 26 March 2006, Scotland implemented a smoke-free policy prohibiting smoking in indoor public venues, including bars and pubs. Drinking and smoking are highly associated behaviors, so we evaluated whether the regulations would decrease drinking behavior among smokers in public venues. We further assessed whether this effect would be more pronounced in heavier drinkers and whether decreases in drinking behavior in pubs would be offset by increased drinking in the home.

METHODS

Participants (N = 1,059) were adult smokers and nonsmokers from Scotland and from the rest of the United Kingdom, which did not have comprehensive smoke-free policies during the study period. Data were collected using a random-digit-dialed telephone survey from February to March 2006, just prior to the policy implementation in Scotland. Follow-up surveys were conducted in March 2007. Using baseline data, we categorized participants as abstainers, moderate drinkers, or heavy drinkers.

RESULTS

Overall, results demonstrated that drinking behavior did not change significantly in Scotland compared with the rest of the United Kingdom following implementation of the smoke-free policy in Scotland. However, planned comparisons examining mean changes in drinks consumed in pubs or bars following the legislation demonstrated that the smoke-free legislation was associated with reduced drinking behavior in pubs and bars among moderate- and heavy-drinking smokers in Scotland. These moderate- and heavy-drinking Scottish smokers also reduced their pub attendance following policy implementation.

DISCUSSION

The smoke-free Scottish law did not increase drinking in the home. These findings suggest that smoke-free policies may have additional public health benefits for those at greater risk for alcohol-related health problems.

Effect of transdermal nicotine replacement on alcohol responses and alcohol self-administration

RATIONALE

Nicotine replacement is commonly used to treat tobacco use in heavy-drinking smokers. However, few studies have examined the effect of nicotine replacement on subjective and physiological responses to alcohol and alcohol drinking behavior.

OBJECTIVE

The primary aim of this within-subject, double-blind study was to examine whether transdermal nicotine replacement (0 mg vs 21 mg/day) altered response to a low-dose priming drink and subsequent ad libitum drinking behavior.

MATERIALS AND METHODS

Subjects (n=19) were non-treatment-seeking, non-dependent heavy drinkers who were daily smokers. Six hours after transdermal patch application, subjective and physiological responses to a priming drink [designed to raise blood alcohol levels (BALs) to 0.03 g/dl] were assessed. This was followed by a 2-h self-administration period where subjects could choose to consume up to eight additional drinks (each designed to raise BALs by 0.015 g/dl) or to receive monetary reinforcement for drinks not consumed.

RESULTS

We found that 6 h after patch application, tobacco craving associated with withdrawal relief was decreased, and systolic blood pressure and heart rate were increased in the active patch condition compared to the placebo patch condition. Subjective intoxication in response to the priming drink was attenuated in the active nicotine patch condition compared to 6 h of nicotine deprivation (i.e., placebo patch). During the self-administration period, subjects had longer latencies to start drinking and consequently appeared to consume fewer drinks when administered the active patch compared to the placebo patch.

CONCLUSIONS

In heavy drinkers, transdermal nicotine replacement compared to mild nicotine deprivation attenuated subjective and physiological alcohol responses and delayed the initiation of drinking.

Modeling the effect of alcohol on smoking lapse behavior

OBJECTIVE

The primary aim of this project was to examine the role of alcohol use in smoking lapse behavior, as alcohol consumption is a known risk factor for poor smoking cessation outcomes.

MATERIALS AND METHODS

We have developed a novel human laboratory model to examine two primary aspects of alcohol-mediated tobacco relapse: (1) Does alcohol facilitate the initiation of the first cigarette? (2) Once the first cigarette is initiated, does alcohol facilitate subsequent smoking? Using a within-subject design, 16 daily smokers who were also heavy social drinkers received a priming drink (0.03 g/dl or taste-masked placebo) and then had the option of initiating a tobacco self-administration session or delaying initiation by 5-min increments for up to 50 min in exchange for monetary reinforcement. Subsequently, the tobacco self-administration session consisted of a 1-h period in which subjects could choose to smoke their preferred brand of cigarettes using a smoking topography system or receive monetary reinforcement for cigarettes not smoked. Alcohol craving, tobacco craving, subjective reactivity to alcohol, and nicotine withdrawal were assessed as secondary outcomes.

RESULTS

Results demonstrated that after consuming the alcohol beverage, subjects were less able to resist the first cigarette and initiated their smoking sessions sooner, and smoked more cigarettes compared to the placebo beverage. These findings have implications for smoking cessation in alcohol drinkers and model development to assess smoking lapse behavior.

Timing of Alcohol and Smoking Cessation (TASC)

Tobacco dependence is prevalent among alcohol dependent patients, and causes increased morbidity and mortality. Concurrent treatment for these disorders may be advantageous, but there are concerns about adverse effects on alcohol treatment outcomes. The Timing of Alcohol and Smoking Cessation (TASC) Study is a randomized controlled clinical trial to compare the effectiveness of smoking cessation treatment offered concurrently or six months following intensive rehabilitation for alcohol dependence. This paper describes the study design and baseline characteristics of the study population. Participants were current smokers in intensive alcohol dependence treatment, with willingness to consider quitting smoking. Smoking intervention offered behavioral and pharmacological treatment. One thousand nine hundred forty-three patients were screened for enrollment; 499 were eligible and participated (26%). We describe demographic characteristics, smoking behavior and attitudes among participants and nonparticipants toward smoking cessation and drinking. We conclude that there is considerable interest in smoking cessation in alcohol dependent treatment populations, and recruitment to research studies is feasible.

Effects of nicotine deprivation on urges to drink and smoke in alcoholic smokers

AIM

This study examined the effect of nicotine deprivation on alcohol and smoking urges in a sample of alcohol-dependent smokers in early recovery.

DESIGN

Using a within-subjects design, participants underwent two cue-reactivity laboratory sessions in which they rated their urges for alcohol and cigarettes during the following three trials: baseline, neutral cue and mood induction combined with alcohol beverage cue exposure. One session was completed after 34 hours of nicotine deprivation and another in a non-deprived state.

PARTICIPANTS

Forty alcohol-dependent heavy smokers recruited from a substance abuse day treatment program.

MEASUREMENTS

Self-reported urge to drink, urge to smoke and salivation.

FINDINGS

Results showed that during the non-deprived session, alcohol cue presentations were associated with significant increases in urges to drink and urges to smoke. Acute nicotine deprivation led to increased smoking urges, but was not associated with increased urges to drink alcohol.

CONCLUSIONS

Findings suggest that the acute effects of smoking cessation are unlikely to increase risk of relapse to alcohol in alcoholic patients who are undergoing treatment.

Association of alcohol consumption with white blood cell count: a study of Japanese male office workers

OBJECTIVES

To investigate the association of alcohol consumption with white blood cell (WBC) count.

DESIGN

Cross-sectional study.

SETTING

A work site in Japan.

SUBJECTS

A total of 5218 Japanese male office workers aged 23-59 years who participated in annual health examinations.

MAIN OUTCOME MEASURES

Subjects were classified as nondrinkers, or current drinkers who averaged <12, 12-22, 23-34, 35-45, 46-68 or > or = 69 g day(-1) of ethanol. The association between alcohol consumption and WBC count was examined by smoking status.

RESULTS

After controlling for age, body mass index, systolic blood pressure, and levels of total cholesterol, high-density lipoprotein (HDL) cholesterol and fasting plasma glucose, WBC count showed a negative dose-response relation with alcohol consumption in each smoking status. The WBC count increment per category of alcohol intake (x10(9) cells L(-1)) was -0.07 [95% confidence interval (CI), -0.11 to -0.04] for never smokers, -0.11 (95% CI, -0.15 to -0.06) for ex-smokers, and -0.04 (-0.08 to -0.00) for current smokers. For current smokers, additional adjustment for cigarettes smoked per day heightened the magnitude of these associations [the respective WBC count increment (x10(9) cells L(-1)), -0.07 (95% CI, -0.11 to -0.03)]. The risk for high WBC count (fifth quintile) also showed a negative linear trend related to alcohol intake in each smoking status.

CONCLUSIONS

The WBC count was inversely associated with alcohol consumption in both nonsmokers and smokers. In view of the firm association of WBC count with the increased risk of coronary heart disease, alcohol consumption seems to have a favourable impact on the link between WBC count and the risk of cardiovascular disease.

Excess alcohol consumption and health outcomes: a 6-year follow-up of men over age 50 from the health and retirement study

AIMS

This study examined the association of problem drinking history and alcohol consumption with the onset of several health conditions and death over a 6-year follow-up period.

SETTING

We analyzed two waves of longitudinal data on men over 50 who participated in the Health and Retirement Study, a nationally representative sample of people aged 51-61 and their spouses living in the United States in 1992.

MEASUREMENTS

Five types of health outcomes--mortality, general health, functional status, cognitive status, and mental health--were examined. Drinking categories were based on average drinks per day (0, <1, 1-2, 3-4, 5+), with 5 + defined as 'very heavy drinking'. Problem drinking history was identified as 2+ affirmative responses to the CAGE questionnaire. We controlled for smoking and other factors at baseline.

FINDINGS

Over the 6-year follow-up period, very heavy drinking at baseline quadrupled the risk of developing functional impairments (OR: 4.21 95%, CI: 1.67, 10.61). A problem drinking history increased the onset of depression (OR: 1.67 95% CI: 1.02, 2.74), psychiatric problems (OR: 2.15 95% CI: 1.47, 3.13) and memory problems (OR: 1.71 95% CI: 1.14, 2.56). Heavy drinking among mature adults was not associated with increased incidence of other adverse health events (i.e. angina, cancer, congestive heart failure, diabetes, myocardial infraction, lung disease or stroke).

CONCLUSION

Very heavy drinking and a problem drinking history greatly increased rates of onset of functional impairments, psychiatric problems and memory loss in late middle age for men who had not experienced these impairments at their initial interview.

Light-to-moderate alcohol consumption and mortality in the Physicians' Health Study enrollment cohort

OBJECTIVES

This study examined the relationship between light-to-moderate alcohol consumption and cause-specific mortality.

BACKGROUND

Previous studies suggest a J-shaped relation between alcohol and total mortality in men. A decrease in cardiovascular disease (CVD) mortality without a significant increase in other causes of mortality may explain the overall risk reduction at light-to-moderate levels.

METHODS

We conducted a prospective cohort study of 89,299 U.S. men from the Physicians' Health Study enrollment cohort who were 40 to 84 years old in 1982 and free of known myocardial infarction, stroke, cancer or liver disease at baseline. Usual alcohol consumption was estimated by a limited food frequency questionnaire.

RESULTS

There were 3,216 deaths over 5.5 years of follow-up. We observed a U-shaped relationship between alcohol consumption and total mortality. Compared with rarely/never drinkers, consumers of 1, 2 to 4 and 5 to 6 drinks per week and 1 drink per day had significant reductions in risk of death (multivariate relative risks [RRs] of 0.74, 0.77, 0.78 and 0.82, respectively) with no overall benefit or harm detected at the > or =2 drinks per day level (RR = 0.95; 95% confidence interval (CI), 0.79 to 1.14). The relationship with CVD mortality was inverse or L-shaped with apparent risk reductions even in the highest category of > or =2 drinks per day (RR = 0.76; 95% CI, 0.57 to 1.01). We found no clear harm or benefit for total or common site-specific cancers. For remaining other cancers, there was a nonsignificant 28% increased risk for those consuming > or =2 drinks per day.

CONCLUSIONS

These data support a U-shaped relation between alcohol and total mortality among light-to-moderate drinking men. The U-shaped curve may reflect an inverse association for CVD mortality, no association for common site-specific cancers and a possible positive association for less common cancers.

Tobacco cessation with patients recovering from alcohol and other substance abuse

This article focuses on the problem of tobacco cessation in the patient recovering from alcohol or other substance abuse. The authors review the epidemiology of the problem, specific health risks to this population from continued tobacco use, and recent research findings that address previous treatment concerns. Recommendations for counseling by physicians are made. These include an algorithm for determining the patient's stage of readiness for making a quit attempt, specific counseling tasks based on the patients stage, and motivational counseling strategies aimed at increasing the patients motivation to quit.

Effects of cigarette smoking on short-term variability of blood pressure in smoking and non smoking healthy volunteers

The present trial was planned to study the effects of smoking on short-term variability of blood pressure and on haemodynamic parameters after an overnight cessation and after one day of repeated smoking in healthy cigarette smoking volunteers, compared to a control group of non-smokers who were not asked to smoke. 40 healthy male volunteers, 20 smokers and 20 non-smokers, participated in an open study with two period of measurements over a single day (morning and afternoon). Blood pressure and heart rate were measured using standard and finger recordings over 6 min before and 10 min after smoking one cigarette (in smokers only). During the two periods, smokers were asked to smoke 4 cm of a cigarette containing 1 mg of nicotine in 2 min, and a blood sample was taken for a plasma nicotine assay. In the smoking group, smoking the first cigarette of the day caused a significant increase of systolic blood pressure (+7%), diastolic blood pressure (+10%) and heart rate (+25%). The blood pressure variability in the frequency range of the Mayer waves (66-129 mHz) was increased after an overnight cessation of smoking in the smoking group in comparison to the non-smokers, and decreased significantly after the first cigarette of the day (7.1 +/- 4.0 to 3.2 +/- 1.8 mmHg2; P < 0.01). The changes observed in the afternoon after continuous smoking were significantly less important (3.8 +/- 1.9 to 3.2 +/- 1.9 mmHg2; NS). In the non-smoking group, the different parameters remained stable between the different measurements. These results suggest that an overnight cessation of smoking in smoking subjects is associated with a increase in sympathetic activity to the vascular system in the morning, which is released by smoking the first cigarette. This effect of smoking is reduced in the afternoon after a continuous nicotinic impregnation.

Mortality risks in alcoholism and effects of abstinence and addiction treatment

The mortality rate from alcoholism and related comorbidities is high. Studies show multiple causes of premature death from alcoholism. Several studies showed that abstinence had a positive effective on the overall survival of alcoholics. Alcoholics who abstained from alcohol, particularly continuously, showed reduced mortality rates and increased years of longevity than alcoholics who relapsed to alcohol consumption. The sources of the findings tend to be derived from treatment populations, in which abstinence is expected to occur in higher rates than in the general population.

Ethanol and lactation: effects of milk lipids and serum constituents

To determine how chronic alcohol administration during lactation affects milk composition and the nutritional status of the dam, EtOH (3 g/kg) as a 20% solution was administered by intubation to Sprague-Dawley rats from days 2 through 15 of lactation. Control dams were pair fed to account for the reduction in food intake observed in the alcohol group, while another control group maintained ad lib food intake. Dams and their litters were weighed daily throughout the study. On day 16, dams were sacrificed and samples taken for further analysis. Blood alcohol levels as well as serum levels of calcium, cholesterol, glucose, iron, lipids, phosphorous, and triglycerides were measured. Liver lipid levels and the total composition and fatty acid profile of the phospholipids in milk were also measured. Results indicate that EtOH administration and pair feeding reduced dam body weight, but not litter growth. Serum iron levels was increased in both EtOH-exposed and pair-fed controls, whereas serum cholesterol was elevated only in EtOH-exposed dams. Finally, of the phospholipids in milk, only one, phosphatidylserine, was slightly but significantly increased by EtOH. If and how these changes impact the development of the offspring remain to be studied.

Alcohol intake, lipids and risks of myocardial infarction

The health effects of alcohol consumption remain complex for several reasons: the risks and benefits accrue over many years, assessment of drinking is generally based on self-report, drinking habits change over time and studies estimate average daily drinking disregarding how or when the beverage was consumed. In addition, alcohol consumption is associated with lifestyle factors which may confound relationship with disease. Despite these methodological difficulties, epidemiological studies are surprisingly consistent, showing that light to moderate intake is associated with a lower risk of total mortality compared with those who drink heavily or do not drink at all. Thus there is a J-shaped association of alcohol intake with risk of total mortality whose basis is likely to be the effect of summing the cause-specific effects at the various drinking levels. Studies using a diversity of methods and populations have consistently reported an inverse relationship between coronary heart disease and light to moderate drinking, with the depth and width of the J-shaped mortality curve depending on the underlying risk of coronary heart disease for that population. The higher risk of death at heavy drinking levels is due to increased risk of cancer, liver diseases, cardiomyopathy and stroke. The precise mechanisms behind these effects of alcohol are only now beginning to be understood. The most plausible mechanism by which alcohol reduces the risk of coronary heart disease is by its effects on blood lipids, particularly increases in high density lipoprotein (HDL) cholesterol: about 50% of the risk reduction attributable to alcohol is explained by changes in total HDL. Further support for the HDL hypothesis comes from the lack of a differential effect of alcohol by beverage type. While the association of alcohol and cardiovascular disease is likely to be causal, any public health recommendations must consider the complexity of alcohol's metabolic, physiological and psychological effects.

Hypertension and long-term cancer incidence and mortality among Swedish men

OBJECTIVE

To examine incidence of cancer and cancer mortality in relation to high blood pressure.

DESIGN

A longitudinal study of middle-aged men from a random population sample.

SETTING

Göteborg, Sweden.

SUBJECTS

We studied 7396 men aged 47-55 years without diagnosed cancer at baseline (1970-1973).

MAIN OUTCOME MEASURES

Incidence of cancer and mortality from cancer.

RESULTS

By the end of December 1992, 1401 men had been diagnosed with cancer at any site and 651 had died from cancer. Of the men in the highest fifth of the systolic blood pressure distribution (above 166 mmHg) 126 per 10000 observation years were diagnosed with cancer at any site, compared with 91 per 10000 in the lowest fifth [below 130 mmHg; relative risk after adjustment for age, smoking, body mass index, treatment for hypertension and leisure time physical activity 1.41 (95% confidence interval 1.19-1.68); P for trend 0.0001]. Of men in the highest fifth, 55 per 10000 observation years died from cancer, compared with 42 in the lowest [adjusted relative risk 1.41 (1.09-1.82); P for trend 0.01]. Several types of tumour tended to be more common among men with hypertension, but only genito-urinary cancers [age-adjusted relative risk 1.39 (1.04-1.85)] and non-melanoma skin cancer [age-adjusted relative risk 1.98 (1.12-3.51)] were significantly so. Findings were similar for diastolic blood pressure and if data for the first 5 years of follow-up were excluded. There was an increase in risk of cancer also during the first 5 years [adjusted relative risk 1.80 (1.10-2.92) for systolic blood pressure and 1.77 (1.05-2.99) for diastolic blood pressure].

CONCLUSIONS

We found an excess risk of cancer and of death from cancer for men with high blood pressure. Although the increase in risk was comparatively modest, the findings are of public health importance, insofar as both hypertension and cancer are common conditions.

[Wine and heart]

Many epidemiological studies have shown that moderate alcohol intake, from 10 to 30 g of ethanol a day, decreases cardiovascular mortality from atherosclerotic ischaemic heart disease and ischaemic stroke as compared to non-drinkers. This beneficial effect outweighs the risks of alcohol consumption in subgroups of people with a higher risk of atherosclerosis: the elderly, people with coronary risk factors and patients with previous coronary events. It has not been demonstrated that alcohol intake, even in moderate amounts, is beneficial for the general population, in particular, men under the age of 40 and women under 50, because it raises mortality due to other causes, especially injury, cirrhosis of the liver and some types of cancer, thereby outweighing the benefits for coronary artery disease. Thus, alcohol consumption should not be recommended as a prophylaxis for the general population. Guidelines on alcohol drinking habits--whether to continue, to start, to modify or to stop--must be given on an individual basis, taking into account the relative risks and benefits for each patient. The benefits of moderate alcohol consumption on the cardiovascular system seem to be exerted fundamentally through its effects on plasma lipoproteins, principally by raising high density lipoprotein (HDL) cholesterol and to a lesser degree, by decreasing low density lipoprotein (LDL) cholesterol. It appears to exert additional beneficial effects on the heart by decreasing platelet aggregability and by bringing about changes in the clotting-fibrinolysis system. Although there has been some debate about the relative superiority of different types of alcoholic beverages (wine, beer or hard liquor), and to a greater extent, about different types of wine, there is no current evidence of any kind of beneficial effect from other components of the beverage besides ethanol. Thus, it does not seem appropriate to recommend any particular type of alcoholic drink, except for sociocultural reasons. The added benefits from some components of different types of wine with a high antioxidant activity on plasma lipoproteins remain only an interesting hypothesis. Meanwhile, encouraging a healthy diet, flavonoid rich and with a predominance of natural ingredients (fruit, legumes, cereals and seeds), in the general population should stop the current tendency of Southern European countries from abandoning the Mediterranean diet. Because of the multifactorial nature of coronary heart disease, it is necessary to remember that atherosclerotic risk reduction is achieved by behavior modification of multiple risk factors present in individual patients and in the general population. Therefore, guidelines regarding alcohol intake should always be linked to pertinent recommendations about other atherosclerotic risk factors.

Comorbid cigarette and alcohol addiction: epidemiology and treatment

The close association of nicotine addiction and alcoholism is well established. As many as 80% of alcoholics smoke, and 30% of smokers are alcoholics. The mortality from cigarette smoking and alcoholism individually is very high, as an estimated 400,000 deaths from tobacco and 100,000 deaths from alcoholism are reported annually. Cigarettes and alcohol interact to cause certain cancers, e.g., head and neck. Only recently has attention been focused on the role of tobacco in abstinent alcoholics. An important study found high rates of mortality from tobacco in abstinent alcoholics in recovery. However, the mortality rates from alcoholism were high and predominant. Of great importance is that studies show that abstinence from alcohol essentially eliminates the premature deaths or increased mortality rates from active alcoholism. Similar studies showing a reduction in mortality from abstinence in nicotine addiction have not been forthcoming. The importance of treating nicotine addiction, however, is clear to reduce the high mortality rates from tobacco smoking in active or abstinent alcoholics.

Physical activity protects against coronary death and deaths from all causes in middle-aged men. Evidence from a 20-year follow-up of the primary prevention study in Göteborg

We set out to examine the long-term effect of work-related and leisure time physical activity on risk of death from coronary heart disease (CHD) and other causes. Data were obtained from a large prospective population study of 7142 participant men aged 47 to 55 years at baseline in 1970-1973 and without symptomatic CHD. Data on physical activity at work and at leisure were assessed by way of a questionnaire. After 20 years follow-up men with physically demanding work had a slightly higher mortality from all causes, but not from CHD. The association with all-cause mortality disappeared after controlling for smoking, occupational class, and alcohol abuse. Men who were physically active during leisure time had a lower risk of death from CHD, cancer, and all causes. After controlling for smoking, diastolic blood pressure, serum cholesterol, body mass index, diabetes alcohol abuse, and low occupational class, the most active men had a relative risk (RR) of dying from CHD of 0.72 (0.56-0.92 95% CI) and of all causes of 0.70 (0.61-0.80 95% CI). The adjusted relative risk for cancer death was of borderline significance. Noncardiovascular deaths other than cancer showed a strong relationship with low physical activity in the present study that remained after controlling for smoking, alcohol abuse, and other factors (adjusted RR 0.55 (0.42-0.73 95% CI)). The protective effect of CHD and on mortality was present after excluding the first 8 years of follow-up, and at all levels of other risk factors, such as smoking, diastolic blood pressure, serum cholesterol, and body mass index. In conclusion, this long-term study demonstrates the protective effect of leisure time physical activity on CHD death, cancer death, and on death from all causes. The effect on coronary death and on death from all causes was independent of other risk factors.

Influence of nicotine on myocardial stiffness and fibrosis during chronic ethanol use

Cardiomyopathy related to ethanol abuse is often accompanied by cigarette use. To examine if the major cardioactive component may intensify the abnormal function and composition induced by chronic ethanol, nicotine was administered orally, 2.5 mg bid, to a canine model receiving 36% of calories as ethanol for 6 months (group III). These animals were compared with group II receiving ethanol alone, group IV on nicotine alone, and controls (group I). In the intact, ventilated, anesthetized dog, left ventricular pressures and volumes were measured before and after dextran infusion and related to left ventricular collagen alterations. Basal heart rate, aortic pressure, and ejection fraction were comparable with controls. End-diastolic pressure and diastolic chamber stiffness (KPV) were significantly higher in the basal state and during dextran infusion in the three experimental groups, compared with group I. The increment was largest in the ethanol-nicotine group. Analysis of left ventricular myocardium revealed a rise of collagen concentrations in all three experimental groups, with an interstitial distribution on histochemical examination. Moreover, determination of advanced glycosylation endproducts, as a measure of alterations in collagen cross-links, revealed higher concentrations versus controls. The greater increase of diastolic stiffness in the nicotine-ethanol group occurred despite a similar concentration of fluorescent products as group II. Because the former had a larger increase of collage concentration, total cross-linked collagen content was presumably greater after the combined use of nicotine-ethanol. Thus, nicotine in relatively high dose when combined with ethanol, elicited a modest further increase in the left ventricular chamber stiffness and collagen concentration.

Diet and heart disease. The role of fat, alcohol, and antioxidants

Overwhelming evidence indicates that the Western diet plays a major role in atherogenesis. Clinicians are only now beginning to tease out the precise components of the diet that are harmful or beneficial. With respect to fat intake, it remains unclear whether it is the amount or type of fat that promotes atherosclerotic disease. There appears to be a consistent positive association of cholesterol, saturated fat, and possibly trans-fatty acid intake and atherosclerotic disease. Although there is general agreement that reducing intake of these dietary components would be beneficial, controversy remains on what should replace these harmful fats. Some researchers advocate massive reductions in total fat consumption with replacement with carbohydrates for everyone, whereas others recommend a Mediterranean-style diet, which replaces saturated animal fats with vegetable fats. Very low-fat diets have been shown to lower the chance of a heart attack among those with severe coronary artery disease, but for the majority of Americans who do not have obvious artery disease, there is no convincing evidence that a very low-fat diet is optimal. There may be other adverse health effects of this Asian diet, such as increased rates of hemorrhagic stroke. Further research is required to refine thinking on the optimal composition of fats in diet. The effects of alcohol consumption on chronic diseases are complex. The strength and consistency of the observational and experimental evidence strongly suggests a causal link between light to moderate alcoholic beverage consumption and reduced risks of CHD. These reductions in risk of CHD appear to be mediated largely by raising HDL cholesterol levels, although additional mechanisms remain possible and do not appear to be beverage specific. Maximal benefit in terms of CHD appears to be at the level of one drink per day. From a public policy standpoint, whether the benefits for CHD persist at heavy drinking levels or are attenuated is moot because clear harm of heavy drinking in terms of overall mortality outweighs any benefits in the reduction of heart disease. Although the association of alcohol and CHD is likely to be causal, any individual or public health recommendations must consider the complexity of alcohol's metabolic, physiologic, and psychological effects. With alcohol, the differences between daily intake of small to moderate and large quantities may be the difference between preventing and causing disease. A discussion of alcohol intake should be a part of routine preventive counseling. Given the complex nature of alcohol disease relationships, alcohol consumption should not be viewed as a primary preventive strategy; also, it should not necessarily be viewed as an unhealthy behavior. Based on the totality of available evidence, antioxidants represent a possible but as yet unproven means to reduce risks of cardiovascular disease. Although it remains unclear whether supplementation of diet with antioxidant vitamins will reduce risks of atherosclerotic disease, most researchers agree that consumption of fruits and vegetables is an important part of a healthy diet. The U.S. Department of Agriculture recommends two to four servings of fruit and three to five servings of vegetables per day.

Beyond alcohol: beverage consumption and cardiovascular mortality

This paper reviews epidemiological investigations which have identified an inverse relationship between alcohol consumption and death from coronary heart disease: evidence from studies of mixed populations as well as of single-sex populations have, on the whole, demonstrated that this relationship is independent of sex or age. This 'cardioprotective effect' of alcohol can be explained, at least in part, by ethanol-related increases in high density lipoprotein cholesterol and reduced platelet coagulability. With certain beverages, especially red wine, phenolic compounds may provide additional protection by altering eicosanoid metabolism in favour of increased prostacyclin and decreased thromboxane synthesis, as well as antioxidant functions which prevent the peroxidation of low-density lipoprotein. Trans-resveratrol, a tri-hydroxy stilbene present in the skins of specific grape cultivars, is a constituent of certain red wines which may play a crucial role in modulating lipoprotein metabolism, eicosanoid synthesis, oxidation and coagulation. Preliminary studies using the human hepatoma cell line HepG2 are described, demonstrating that this compound has no effect upon cell viability or overall protein synthesis in these cells, and at high concentrations DNA synthesis as measured by radioactive thymidine incorporation is enhanced. Reduced intracellular concentration and secretion of apolipoprotein B have been shown to occur in response to resveratrol although a clear dose-dependency has not yet been demonstrated. The mechanisms underlying these changes as well as the effects upon the synthesis and secretion of other apolipoproteins are under active investigation in our laboratory.

Alcoholic cardiomyopathy

Clinical observations over the past two decades have pointed to the relationship between heart disease and alcohol abuse, usually without evident malnutrition or cirrhosis. While the prevalence of heart failure in the alcoholic population is now known, subclinical abnormalities of left ventricular function in noncardiac alcoholics who were normotensive have a high prevalence with or without some degree of ventricular hypertrophy by echocardiogram. This is frequently a diastolic rather than systolic abnormality. Congestive cardiomyopathy is not infrequently associated with high diastolic arterial blood pressures. Intoxication itself may contribute to blood pressure elevation. Angina pectoris in the absence of significant coronary disease is another presentation. Although the history may not be readily obtained, the major diagnostic feature in this entity is the history of ethanol ingestion in intoxicating amounts for at least 10 years, often marked by periods of spree drinking. While the course of congestive cardiomyopathy may be progressively downhill in individuals who continue to be actively alcoholic after the onset of heart failure, in one series one third of the patients became abstinent. These patients had a 4 year mortality that was persistently one-sixth of the alcoholic group. Management of heart failure is traditional in these patients. Atrial arrhythmias have been shown to occur during the early ethanol withdrawal phase in patients without other clinical evidence of heart disease. Sudden death in a segment of the alcoholic population is considered arrhythmia related and is commonly associated with cigarette use. Identification of the addicted individual is the essential element to management.

Moderate alcohol intake, increased levels of high-density lipoprotein and its subfractions, and decreased risk of myocardial infarction

BACKGROUND

Previous studies have suggested that moderate alcohol intake exerts a protective effect against coronary heart disease. Alterations in plasma lipoprotein levels represent one plausible mechanism of this apparent protective effect.

METHODS

We therefore examined the interrelation among alcohol consumption, plasma lipoprotein levels, and the risk of myocardial infarction in 340 patients who had had myocardial infarctions and an equal number of age- and sex-matched controls. The case patients were men or women less than 76 years of age with no history of coronary disease who were discharged from one of six hospitals in the Boston area with a diagnosis of a confirmed myocardial infarction. Alcohol consumption was estimated by means of a food-frequency questionnaire.

RESULTS

We observed a significant inverse association between alcohol consumption and the risk of myocardial infarction (P for trend, < 0.001 after control for known coronary risk factors). In multivariate analyses, the relative risk for the highest intake category (subjects who consumed three or more drinks per day) as compared with the lowest (those who had less than one drink a month) was 0.45 (95 percent confidence interval, 0.26 to 0.80). The levels of total high-density lipoprotein cholesterol (HDL) and its HDL2 and HDL3 subfractions were strongly associated with alcohol consumption (P for trend, < 0.001 for each). The addition of HDL or either of its subfractions to the multivariate model substantially reduced the inverse association between alcohol intake and myocardial infarction, whereas the addition of the other plasma lipid measurements did not materially alter the relation.

CONCLUSIONS

These data confirm the inverse association of moderate alcohol intake with the risk of myocardial infarction and support the view that the effect is mediated, in large part, by increases in both HDL2 and HDL3.

Treatment of smoking cessation in smokers with past alcohol/drug problems

A review of existing scientific studies suggests (1) smoking is very common among alcoholics, (2) many recovering alcoholics die from smoking-related diseases, (3) recovering alcoholics are interested in smoking cessation, (4) recovering alcoholics can stop smoking, (5) smoking cessation does not appear to increase relapse to alcohol, and (6) possible treatments for smoking cessation among alcoholics have not been empirically tested. In a prior study of ours on nicotine gum, the 38 subjects (12% of the sample) who self-reported a past but not present history of alcohol/drug problems appeared more dependent on nicotine, were less likely to stop smoking (1 year quit rates = 7 vs. 19%) but appeared to benefit more from nicotine replacement therapy (+10 vs. +1% increase in 1 year quit rates with nicotine vs. placebo gum) than subjects without this history. Although these results are preliminary, they suggest recovering alcoholics might benefit from nicotine replacement therapy.

Relationships between knowledge and belief variables and health maintenance behaviors in a Danish population over 45 years of age

The growing body of evidence regarding the importance of self-care behavior for the maintenance of health and functional capacity has stimulated research interest in identifying the factors and processes that influence health-related behavior. This article examines relationships between health knowledge and belief variables and two types of health maintenance behavior: (a) routine habits that affect health and (b) deliberately undertaken health-protective behavior. The findings suggest that generalized health beliefs may have limited influence on behavior. Health locus of control beliefs may be related to behavioral change, but were not related to either current tobacco and alcohol consumption or to conscious health maintenance behaviors. It is concluded that more attention needs to be directed toward cultural influences on health beliefs and behavior.

The high risk of death by alcohol related diseases in subjects diagnosed as diabetic and impaired glucose tolerant: the Paris Prospective Study after 15 years of follow-up

The 15 year mortality rates and causes of death are reported for the Paris Prospective Study cohort of 7180 working men, aged between 44 and 55 years who attended the first follow-up examination. All subjects were classified as normoglycaemic, impaired glucose tolerant or diabetic according to the WHO criteria, following an oral glucose tolerance test. The relative risks of death in comparison to the normoglycaemic group were 1.6 for impaired glucose tolerant and 2.3 for diabetic subjects; for death due to coronary heart disease: 1.7 and 2.3 respectively; for death due to alcohol and cirrhosis: 7.0 and 13.3 respectively. It appears that in this cohort a proportion of subjects screened as diabetic have impaired liver function and disturbed carbohydrate metabolism, due to excessive alcohol consumption. Alcohol should be investigated as a possible risk factor for diabetes, particularly in epidemiological studies where diabetes is diagnosed by the oral glucose tolerance test and the population has a high consumption of alcohol.