Alcohol and ischemic heart disease: a review

Alcohol, cardiovascular diseases and all causes of death: a review of the epidemiological evidence

This paper reviews the epidemiological evidence on the association of alcohol consumption with the major cardiovascular diseases (hypertension, stroke and coronary heart disease), and all causes of death. The focus is on light and moderate consumption and several important methodological issues are apparent with the epidemiological evidence on alcohol and mortality. The epidemiological data justify the following recommendations on alcohol consumption. The evidence does not support the unqualified claim that light and moderate drinking confers overall health benefits. However, in persons over 35 years of age, there is no consistent evidence that daily consumption of up to 2-3 drinks in men or up to 1-2 drinks in women increases the risk of dying. Non-drinkers should not be encouraged to change their drinking status. The consumption of more than 2-3 drinks per day in men and more than 1-2 drinks per day in women should be actively discouraged. Further research on the effects of light and moderate alcohol consumption on cardiovascular disease and all causes of death are required, particularly in young people, women and the elderly.

CARDIOVASCULAR RISK FACTOR CLUSTERING AND CORONARY ARTERY DISEASE : A 4-YEAR FOLLOW UP STUDY OF 257 SERVICE PERSONNEL

Two hundred and fifty seven service personnel with established diagnosis of (a) silent ischaemia (40.47%) (b) Q-infarction (25.68%) and (c) non-Q-infarction (33.85%) along with 50 age-matched controls were subjected to stress tests before and after identification and control of risk factors. Lack of exercise (63.0%), dietetic indiscretion (47.4%) and cigarette smoking (40.4%) were the main risk factors. Hypercholesterolaemia (22.1%), alcohol over-indulgence (17.1%), positive family history (16.3%), diabetes mellitus (9.7%) and hypertension (6.2%) were other contributing factors. Clustering or multiplicity of risk factors was seen in 61.1% cases. All patients were advised for control of risk factors along with necessary specific therapy wherever indicated. Initial stress test was positive in 83.3% of the total and on repetition, after 4 years, the positivity dropped to 45.9% with a rate of improvement of 44.9%. Patients with silent ischaemia showed the maximum improvement (57.8%) following the risk factor intervention. Only 4 cases (1.56%) showed deterioration with reinfarction during the 4-year follow up.

Effect of moderate dose of alcohol with evening meal on fibrinolytic factors

OBJECTIVES

To evaluate the effects of moderate consumption of alcoholic beverages on the fibrinolytic system and to assess whether these effects could help explain the relation between moderate alcohol consumption and reduced coronary heart disease.

DESIGN

Four treatments were allocated in a randomised controlled order on four days over a period of 11 days.

SETTING

Metabolic ward of research institute.

SUBJECTS

Eight white healthy middle aged men.

INTERVENTIONS

Subjects were provided with food for the 11 days. On the four study days mineral water or 40 g of alcohol in the form of beer, wine, or spirits was consumed at dinner early in the evening.

MAIN OUTCOME MEASURES

Plasminogen activator inhibitor activity, tissue type plasminogen activator antigen, and tissue type plasminogen activator activity one hour before and one, three, five, nine, and 13 hours after dinner with mineral water or alcoholic beverages.

RESULTS

After dinner with alcohol plasminogen activator inhibitor activity rose from 53 (SD 19)% to a maximum of 667 (283%) five hours after dinner (P < 0.001). Tissue type plasminogen activator antigen levels rose from 5.3 (2.2) micrograms/l to a maximum of 10.8 (3.8) micrograms/l nine hours after dinner with alcohol (P < 0.001). Plasminogen activator activity was reduced in the postprandial period (from 1387 (483) IU/l to 323 (288) IU/l five hours after eating; P < 0.001) but was higher than normal early the next morning (1516 (809) IU/l after alcohol, 779 (516) IU/l after water; P = 0.04).

CONCLUSION

Moderate alcohol consumption with dinner affects plasminogen activator inhibitor activity, plasminogen activator antigen level, and tissue type plasminogen activator activity temporarily. The effects observed in the early morning are consistent with a decrease in risk of coronary heart disease in moderate drinkers.

Alcohol and the heart. How it helps, how it harms

Does regular consumption of alcohol protect against coronary artery disease but not against sudden death? In this article, Dr Sheehy examines several theories that have been proposed to explain the cardioprotective effect of ethanol and also reviews the factors related to sudden death in alcoholics.

Moderate alcohol consumption and platelet aggregation in healthy middle-aged men

Changes in platelet aggregation have often been proposed as an explanation for the protective effect of moderate alcohol consumption on the development of coronary heart disease, observed in epidemiological studies. To test the tenability of this assumption, the acute effect of moderate alcohol consumption on platelet aggregation was studied in eight healthy middle-aged men in a controlled study. The intake of alcohol consisted of two glasses of red wine at dinner and two glasses of distilled liquor (Hollands gin), combined with a snack, before bedtime. No acute effects of moderate alcohol consumption on platelet aggregation were observed.

Cardiovascular effects of ethanol in anaesthetized, conscious and pithed rats

The influence of ethanol (2.0 g/kg p.o.) on heart rate and blood pressure in anaesthetized, conscious and pithed rats was studied. In anaesthetized rats we observed an increase in heart rate and a marked and very sudden decrease in blood pressure. In pithed rats blood pressure decreased more slowly than in anaesthetized and conscious animals and there were no changes in heart rate. These results show that the central nervous system may be responsible for the increase in heart rate and early phase of hypotension caused by acute ethanol administration. The slower decrease (up to 1 h) in blood pressure may be caused by central and different indirect peripheral mechanisms.

Effect of ethanol on heart rate and blood pressure in nonstressed and stressed rats

The effect of ethanol on the cardiovascular system (ECG, heart rate, blood pressure) was studied in anesthetized, nonstressed or stressed rats. In anesthetized rats, ethanol showed no effect on heart rate or ECG. In nonstressed rats, ethanol sedated the animals but increased heart rate significantly. This ethanol induced tachycardia seemed the result of a direct stimulation of the sympathetic nerves to the heart. Blood pressure was not significantly affected by ethanol in these nonstressed rats. In stressed rats, marked behavioral excitation and significant increases in heart rate and blood pressure were noted. Ethanol pretreatment calmed the animals considerably during restraint. Ethanol did reduce slightly the stress-induced tachycardia but markedly reduced or antagonized stress-induced blood pressure increases. No major changes in the ECG were noted during these studies with the exception of a few individual animals which showed pathologic ECG responses to ethanol. These data show that ethanol affects cardiovascular functions differently in anesthetized, nonstressed or stressed rats, and that ethanol can significantly reduce or antagonize stress-induced behavioral excitation, tachycardia and hypertension.

An analysis of aboriginal mortality in NSW country regions, 1980-1981

The total number of Aboriginal deaths occurring in selected country regions of New South Wales in 1980 and 1981 has been estimated, based on the deaths reported by Aboriginal health workers and those identified on the newly modified Form of Notification of Death. Aboriginal mortality was more than four times that of the total NSW population, with young and middle-aged adults having death rates up to 12 times higher. The Aboriginal expectation of life at birth was estimated at 48 years for men and 57 years for women. The principal causes of death were diseases of the circulatory system and injuries. The effect of alcohol appeared to be substantial, particularly in the 35-44 year age group.