Chronic heavy drinking and ischaemic heart disease: a systematic review and meta-analysis

Trends in binge drinking in the United States by LGBTQ+ identity, gender, and age, 2014-2022

BACKGROUND

People who identify as lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ+) have higher rates of risky drinking than their cisgender, heterosexual peers. It is unknown to what extent recent age and gender trends in binge drinking vary by LGBTQ+ identity.

METHODS

We used nationally representative, serial, cross-sectional surveys from men and women in the 2014-2022 Behavioral Risk Factor Surveillance System (N = 2,099,959) to examine trends in past-month binge drinking by LGBTQ+ identity, gender, and age (18-29, 30-44, 45 and older). We estimated stratum-specific prevalence ratios for an average 1-year increase in prevalence of past-month binge drinking using survey-weighted log-binomial models, controlling for education, race/ethnicity, marriage, and parenthood status.

RESULTS

In the beginning of the study period, LGBTQ+ women endorsed binge drinking at higher prevalences than their cisgender, heterosexual peers (i.e., 2014 predicted probability for women ages 30-44: 0.22 for LGBTQ+, 0.15 for cisgender, heterosexual). LGBTQ+ disparities in women's drinking attenuated over the study period among women in midlife (30-44 age group) due to increases in binge drinking among cisgender, heterosexual women (Prevalence Ratio [PR]: 1.025, 95% CI 1.018-1.033). Among men, we saw no evidence of LGBTQ+ disparities in binge drinking probabilities or in binge drinking trends across all age groups.

CONCLUSIONS

Disparities in mid-life binge drinking between LGBTQ+ and cisgender women have begun to diminish. These disparities are closing not because LGBTQ+ women are binge drinking less, but because cisgender, heterosexual women in midlife are binge drinking more.

Physical exercise and hypertension: A retrospective study in southern Sichuan

This study aimed to scrutinize the relationship between physical exercise and hypertension, taking into account multiple variables such as age, body mass index (BMI), family history, smoking, and alcohol consumption in the Southern Sichuan population, China, using a retrospective approach based on hospital record data. This retrospective study analyzed data from 946 participants obtained from a hospital electronic medical record system. The data included information regarding participants' lifestyle factors, family history, and a clinical diagnosis of hypertension. Univariate and multivariate logistic regression models were employed to identify the association between lifestyle factors and hypertension. The study found a hypertension prevalence of 38.5% in the analyzed population. Multivariate analyses identified significant factors associated with hypertension as age (odds ratio [OR]: 1.045, 95% confidence interval [CI]: 1.036-1.054), BMI (OR: 1.107, 95% CI: 1.084-1.132), smoking (OR: 2.299, 95% CI: 1.674-3.157), alcohol consumption (OR: 0.644, 95% CI: 0.478-0.867), and physical exercise (OR: 0.682, 95% CI: 0.506-0.920). Findings from this hospital record-based retrospective study reinforce the multifactorial nature of hypertension. They highlight the significance of physical exercise, along with maintaining optimal BMI and encouraging healthy habits like nonsmoking and moderate alcohol consumption in hypertension prevention. Our findings also underscore the need for future prospective studies to establish causality and explore the generalizability of these results beyond the Southern Sichuan population.

Alcohol - a scoping review for Nordic Nutrition Recommendations 2023

The objective of this scoping review is to evaluate the updated evidence on the consumption of alcohol and health outcomes regarded as relevant for the Nordic and Baltic countries, including cardiovascular disease, cancer, and all-cause mortality. It is based on the previous Nordic Nutrition Recommendations of 2012 and relevant papers published until 31 May 2021. Current evidence from mainly observational epidemiological studies suggests that regular, moderate alcohol consumption may confer protective effects against myocardial infarction (MI) and type 2 diabetes. Mendelian randomization analyses do not fully support these findings, possibly because these analyses may fail to identify low alcohol intake. For several cancers, it is not possible to set any safe limit. All-cause mortality is not increased with light to moderate alcohol intake in middle-aged and older adults who do not engage in binge drinking. Total abstinence is associated with the lowest risk of mortality in young adults. Observational studies on alcohol consumption are hampered by a number of inherent methodological issues such as ascertainment of alcohol intake, selection of appropriate exposure groups, and insufficient control of confounding variables, colliders, and mediators. It should also be emphasized that there is a socio-economic contribution to the alcohol-health axis with a stronger detrimental effect of alcohol in the lower social classes. The above issues contribute to the complexity of unravelling the causal web between alcohol, mediators, confounders, and health outcome.

Moderate-to-Heavy Alcohol Consumption May Cause a Significant Decrease in Serum High-Density Lipoprotein Cholesterol in Middle-Aged Women: A Cohort Study of the National Database Study in the Kanto 7 Prefectures-4

Aims Little is known about the association between habitual alcohol consumption and serum high-density lipoprotein cholesterol (HDL-C) in women. We aimed to investigate this association in middle-aged Japanese women in a community-based cohort study using conventional statistical analyses and explainable artificial intelligence (AI) analysis. Methods We retrospectively investigated the association between alcohol consumption and HDL-C after 10 years in 90,053 women aged 40-64 years whose drinking habits were generally consistent for 10 years. Results After 10 years, 11.3% and 17.9% of subjects had serum HDL-C decreased by ≥10 mg/dL and ≥10%, respectively. In unadjusted analysis, moderate-to-heavy alcohol consumption may both increase and decrease serum HDL-C levels after 10 years. After adjustment for potential confounding factors, moderate (23-45 g/day) and heavy (≥46 g/day) alcohol consumption were each significantly associated with decreases in HDL-C (OR (95% CI): 1.18 and 1.36 (1.11-1.26 and 1.21-1.53) for ≥10 mg/dL, 1.11 and 1.29 (1.05-1.17 and 1.17-1.43) for ≥10%), but not associated with an increase in HDL-C (0.96 and 0.98 (0.91-1.01 and 0.89-1.08) for ≥10 mg/dL, 0.97 and 0.96 (0.93-1.01 and 0.88-1.05) for ≥10%). Further analysis after adjustment for baseline serum HDL-C showed the same results. AI analysis showed that alcohol consumption was the 8th positive contributor to the decrease in HDL-C, following baseline high HDL-C (≥77 mg/dL), high low-density lipoprotein cholesterol (≥133 mg/dL), high body mass index (≥23.1 kg/m2), pharmacotherapy for dyslipidemia, high triglycerides (≥70 mg/dL), age 44-64 years, and smoking. Heavy alcohol consumption was a more positive contributor to decreased HDL-C than were other alcohol consumption levels. Conclusions Habitual moderate-to-heavy alcohol consumption may cause a significant decrease in serum HDL-C in middle-aged women, which may be modified by concomitant factors.

Pathways Linking Post-Traumatic Stress Disorder to Incident Ischemic Heart Disease in Women: Call to Action

Background

Post-traumatic stress disorder (PTSD) is associated with increased rates of incident ischemic heart disease (IHD) in women.

Objectives

The purpose of this study was to determine mechanisms of the PTSD-IHD association in women.

Methods

In this retrospective longitudinal cohort study, data were obtained from electronic health records of all U.S. women veterans who were enrolled in Veterans Health Administration care from January 1, 2000 to December 31, 2017. Propensity score matching was used to match women with PTSD to women without PTSD on age, number of prior Veterans Health Administration visits, and presence of various traditional and nontraditional cardiovascular risk factors at index visit. Cox regression was used to model time until incident IHD diagnosis (ie, coronary artery disease, angina, or myocardial infarction) as a function of PTSD and potential mediating risk factors. Diagnoses of IHD, PTSD, and risk factors were defined by International Classification of Diseases-9th or -10th Revision, and/or Current Procedural Terminology codes.

Results

PTSD was associated with elevated rates of developing each risk factor. Traditional risk factors (hypertension, hyperlipidemia, smoking, diabetes) accounted for 24.2% of the PTSD-IHD association, psychiatric risk factors (eg, depression, anxiety, substance use disorders) accounted for 33.8% of the association, and all 13 risk factors accounted for 48.5% of the association.

Conclusions

Traditional IHD risk factors explained a quarter of the PTSD-IHD association in women veterans, and over half of the risk of IHD associated with PTSD remained unexplained even when adjusting for a wide range of risk factors. To be actionable, factors underlying the remaining PTSD-IHD association warrant timely investigation.

Association Between Alcohol Consumption and Blood Pressure Levels Among HIV Sero-Positive and Sero-Negative Cohorts: A Secondary Analysis of the Vukuzazzi Study

BACKGROUND

The effect of hypertension is aggravated by lifestyle factors such as alcohol consumption. This study sought to determine the association between alcohol consumption and the level of blood pressures among HIV seronegative and seropositive cohorts.

METHODS

This secondary analysis was performed on a cross-sectional survey data of 17 922 participants during the period between 2018 and 2020. A questionnaire was used to obtain participants' alcohol consumption history, which was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy alcohol consumers. A linear regression model was used to establish relationships among participants with raised blood pressure (BP ≥ 140/90 mmHg).

RESULTS

Out of the total participants, 3553 (19.82%) were hypertensives. Almost 13% of the hypertensives (n = 458; 12.89%) were undiagnosed, and 12.44 % (442) had uncontrolled hypertension. About 14.52% of the hypertensives (3553) were not on any antihypertensive medication. Male non-consumers of alcohol had the highest systolic and diastolic BP; uncontrolled systolic BP (165.53 ± 20.87 mmHg), uncontrolled diastolic BP (102.28 ± 19.21mmHg). Adjusted for covariates, moderate alcohol consumption was associated with HTN among participants who were HIV seropositive [unadjusted (RR = 1.772, P = .006, 95% CI (1.178-2.665)], [RR = 1.772, P = .005, 95% CI (1.187-2.64)]. [unadjusted RR = 1.876, P = .036, 95% CI (1.043-3.378)], adjusted RR = 1.876, P = .041, 95% CI (1.024-3.437). Both moderate and heavy alcohol consumption were significantly related to hypertension among HIV sero-negative [unadjusted model, moderate consumption RR = 1.534 P = .003, 95% CI (1.152-2.044)], [adjusted model, moderate alcohol consumption RR = 1.535, P = .006, 95% CI (1.132-2.080)], [unadjusted model, heavy alcohol consumption, RR = 2.480, P = .030, 95% CI (1.091-5.638)], [adjusted model RR = 2.480, P = .034, 95% CI (1.072-5.738)].

CONCLUSION

Alcohol consumption is significantly related to increase BP regardless of HIV infection.

Quality of life assessment in the first episode of acute coronary syndrome

Background

Assessment of health-related quality of life (HRQoL) is an important measure of a patient's recovery after an illness. However, HRQoL among acute coronary syndrome (ACS) survivors has not been extensively studied following cardiac management.

Aim

The purpose of this study was to assess the quality of life (QoL) among ACS patients who have undergone percutaneous coronary intervention (PCI).

Methods

This cohort study included 145 consecutive male ACS patients between March 2021 and May 2022. Of these patients, 138 (mean age 54.3 ± 10.7 years) completed the QoL assessment using the short form-12 (SF-12) health survey questionnaire. Seventy (51%) of them presented with ST-segment elevation myocardial infarction (STEMI), 18 (13%) had non-STEMI, 39 (28%) had evolved MI, and 11 (8%) had unstable angina. Recruited patients' QoL data were assessed at various time points post-PCI.

Results

At the end of the 12 months of follow-up, major clinical events (MCE) defined as death, sudden death, or re-acute myocardial infarction occurred in 54.9% of patients. Out of 7 MCE, four deaths and three re-AMIs had occurred. SF-12 physical component score was found to be significantly improved when compared to the mental component score, which seems to improve without reaching statistical significance over time. Among event-free ACS patients, we found a significant positive correlation between left ventricular ejection fraction and HRQoL.

Conclusion

Improvement in HRQoL (physical component) was seen among ACS patients post-PCI.

Relevance for Patients

QoL assessment outcomes should be considered in clinical settings, practice guidelines, and treatment modality post-PCI to improve QoL in post-ACS survivors.

Psychological and biological mechanisms linking trauma with cardiovascular disease risk

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide, and experiences of psychological trauma have been associated with subsequent CVD onset. Identifying key pathways connecting trauma with CVD has the potential to inform more targeted screening and intervention efforts to offset elevated cardiovascular risk. In this narrative review, we summarize the evidence for key psychological and biological mechanisms linking experiences of trauma with CVD risk. Additionally, we describe various methodologies for measuring these mechanisms in an effort to inform future research related to potential pathways. With regard to mechanisms involving posttraumatic psychopathology, the vast majority of research on psychological distress after trauma and CVD has focused on posttraumatic stress disorder (PTSD), even though posttraumatic psychopathology can manifest in other ways as well. Substantial evidence suggests that PTSD predicts the onset of a range of cardiovascular outcomes in trauma-exposed men and women, yet more research is needed to better understand posttraumatic psychopathology more comprehensively and how it may relate to CVD. Further, dysregulation of numerous biological systems may occur after trauma and in the presence of posttraumatic psychopathology; these processes of immune system dysregulation and elevated inflammation, oxidative stress, mitochondrial dysfunction, renin-angiotensin system dysregulation, and accelerated biological aging may all contribute to subsequent cardiovascular risk, although more research on these pathways in the context of traumatic stress is needed. Given that many of these mechanisms are closely intertwined, future research using a systems biology approach may prove fruitful for elucidating how processes unfold to contribute to CVD after trauma.

Bidirectional brain-gut axis effects influence mood and prognosis in IBD: a systematic review and meta-analysis

OBJECTIVE

The role of the brain-gut axis is of increasing interest in IBD, as the link between common mental disorders and GI inflammation may be bidirectional. We performed a systematic review examining these issues.

DESIGN

We searched EMBASE Classic and EMBASE, Medline, and APA PsychInfo (to 11 July 2021) for longitudinal follow-up studies examining effect of symptoms of anxiety or depression on subsequent adverse outcomes in IBD, or effect of active IBD on subsequent development of symptoms of anxiety or depression. We pooled relative risks (RRs) and HRs with 95% CIs for adverse outcomes (flare, escalation of therapy, hospitalisation, emergency department attendance, surgery or a composite of any of these) according to presence of symptoms of anxiety or depression at baseline, or RRs and HRs with 95% CIs for new onset of symptoms of anxiety or depression according to presence of active IBD at baseline.

RESULTS

We included 12 separate studies, recruiting 9192 patients. All 12 studies examined brain-to-gut effects. Anxiety at baseline was associated with significantly higher risks of escalation of therapy (RR=1.68; 95% CI 1.18 to 2.40), hospitalisation (RR=1.72; 95% CI 1.01 to 2.95), emergency department attendance (RR=1.30; 95% CI 1.21 to 1.39), or a composite of any adverse outcome. Depression at baseline was associated with higher risks of flare (RR=1.60; 95% CI 1.21 to 2.12), escalation of therapy (RR=1.41; 95% CI 1.08 to 1.84), hospitalisation (RR=1.35; 95% CI 1.17 to 1.57), emergency department attendance (RR=1.38; 95% CI 1.22 to 1.56), surgery (RR=1.63; 95% CI 1.19 to 2.22) or a composite of any of these. Three studies examined gut-to-brain effects. Active disease at baseline was associated with future development of anxiety or depression (RR=2.24; 95% CI 1.25 to 4.01 and RR=1.49; 95% CI 1.11 to 1.98, respectively).

CONCLUSION

Bidirectional effects of the brain-gut axis are present in IBD and may influence both the natural history of the disease and psychological health.

Beta-adrenergic drugs and risk of Parkinson's disease: A systematic review and meta-analysis

BACKGROUND

Parkinson's Disease (PD) is a neurodegenerative disorder manifested by rest tremor, rigidity, bradykinesia, and postural instability. Recent pharmaco-epidemiological studies evaluating beta-adrenergic drug use and risk of PD have reported conflicting findings.

OBJECTIVES

This systematic review and meta-analyses evaluate the association between beta-adrenergic (agonists and antagonists) drugs' use and PD.

METHODS

An electronic literature search of eight databases was performed from inception to July 2021 to identify pharmaco-epidemiological studies (case-control and cohort) reporting the risk of PD in beta-adrenergic users compared to non-users. We used the generic inverse variance method and RevMan (5.3.5) to estimate pooled adjusted risk ratios (aRRs) of PD using a random-effects model.

RESULTS

Of 3168 records, 15 studies (10 case-control; five cohort) with 6,508,877 participants, including 87,011 PD cases, were included. In the pooled analysis (n=10) including any beta-antagonist users, compared with non-users, the aRR for PD was 1.19 (CI: 1.05,1.35); for any beta-agonist users (n=8) aRR for PD was 0.87 (CI: 0.78,0.97). Propranolol users had a significantly increased risk of PD (aRR:1.91; CI:1.20,3.06), whereas salbutamol use was associated with reduced risk of PD (aRR:0.95; CI:0.92,0.99). Significant heterogeneity (I²>87%) was observed, but the majority (n=13) of the studies were of high quality, based on the JBI tool.

CONCLUSIONS

Beta-antagonist use was associated with a modestly increased risk of PD, whereas beta-agonist use was associated with a modest decreased risk of PD. Future epidemiological studies should address the issues of protopathic bias and indirect association using appropriate epidemiological methods.

Alcohol Use Disorder: Neurobiology and Therapeutics

Alcohol use disorder (AUD) encompasses the dysregulation of multiple brain circuits involved in executive function leading to excessive consumption of alcohol, despite negative health and social consequences and feelings of withdrawal when access to alcohol is prevented. Ethanol exerts its toxicity through changes to multiple neurotransmitter systems, including serotonin, dopamine, gamma-aminobutyric acid, glutamate, acetylcholine, and opioid systems. These neurotransmitter imbalances result in dysregulation of brain circuits responsible for reward, motivation, decision making, affect, and the stress response. Despite serious health and psychosocial consequences, this disorder still remains one of the leading causes of death globally. Treatment options include both psychological and pharmacological interventions, which are aimed at reducing alcohol consumption and/or promoting abstinence while also addressing dysfunctional behaviours and impaired functioning. However, stigma and social barriers to accessing care continue to impact many individuals. AUD treatment should focus not only on restoring the physiological and neurological impairment directly caused by alcohol toxicity but also on addressing psychosocial factors associated with AUD that often prevent access to treatment. This review summarizes the impact of alcohol toxicity on brain neurocircuitry in the context of AUD and discusses pharmacological and non-pharmacological therapies currently available to treat this addiction disorder.

Structural sexism and Women's alcohol use in the United States, 1988-2016

BACKGROUND

Women's alcohol consumption and binge drinking have increased concurrent with socio-economic gains and may be related to structural sexism.

METHODS

We examined associations between structural sexism (state-level sex inequality in political/economic status), and alcohol outcomes among women in Monitoring the Future (N = 20,859) from 1988 to 2016 (ages 27-45 in 2016). We controlled for state and individual confounders and tested three mediators: depressive symptoms, restrictive alcohol norms, and college completion.

RESULTS

Increased structural sexism was associated with decreased alcohol consumption frequency (RR: 0.974, 95% CI: 0.971, 0.976) and binge drinking probability (OR: 0.917, 95% CI: 0.909, 0.926). Norms and education but not depressive symptoms partially mediated these relationships.

CONCLUSION

Among women in the midlife in recent years, lower levels of state structural sexism were associated with greater alcohol consumption and binge drinking. These findings suggest that as states become more gender-equal-which confer numerous benefits for women's rights and health-additional resources and messaging may be required to prevent harmful alcohol use among women.

Variability in Coronary Artery Disease Testing for Patients With New-Onset Heart Failure

BACKGROUND

Coronary artery disease (CAD) is the most common cause of new-onset heart failure (HF). Although guidelines recommend ischemic evaluation in this population, testing has historically been underutilized.

OBJECTIVES

This study aimed to identify contemporary trends in CAD testing for patients with new-onset HF, particularly after publication of the STICHES (Surgical Treatment for Ischemic Heart Failure Extension Study), and to characterize geographic and clinician-level variability in testing patterns.

METHODS

We determined the proportion of patients with incident HF who received CAD testing from 2004 to 2019 using an administrative claims database covering commercial insurance and Medicare. We identified demographic and clinical predictors of CAD testing during the 90 days before and after initial diagnosis. Patients were grouped by their county of residence to assess national variation. Patients were then linked to their primary care physician and/or cardiologist to evaluate variation across clinicians.

RESULTS

Among 558,322 patients with new-onset HF, 34.8% underwent CAD testing and 9.3% underwent revascularization. After multivariable adjustment, patients who underwent CAD testing were more likely to be younger, male, diagnosed in an acute care setting, and have systolic dysfunction or recent cardiogenic shock. Incidence of CAD testing remained flat without significant change post-STICHES. Covariate-adjusted testing rates varied from 20% to 45% across counties. The likelihood of testing was higher among patients co-managed by a cardiologist (adjusted OR: 5.12; 95% CI: 4.98-5.27) but varied substantially across cardiologists (IQR: 50.9%-62.4%).

CONCLUSIONS

Most patients with new-onset HF across inpatient and outpatient settings did not receive timely testing for CAD. Substantial variability in testing persists across regions and clinicians.

Associations of At-Risk Drinking, Current Smoking, and Their Co-Occurrence With Primary Care Service Utilization

PURPOSE

Smoking and at-risk drinking are each associated with lower primary care utilization, but the influence of their co-occurrence is not known. The current study compared associations of endorsement of one behavior vs endorsement of both with primary care utilization.

DESIGN

Cross-sectional telephone survey.

SETTING

All United States and Territories.

SUBJECTS

246 801 adults aged 18-64.

MEASURES

The outcome was endorsement of attending a past-year primary care visit. Predictor variables included drinking and smoking status examined individually and combined.

ANALYSIS

Multivariable logistic regressions, adjusted for socio-demographics and number of chronic health conditions.

RESULTS

The odds of attending a past-year primary care visit were 24% lower for persons who drank at risk levels compared to the odds of persons who did not drink and 36% lower for persons who smoked vs those who did not smoke. Among persons who endorsed at least one risk behavior, the odds of attending a past-year primary care visit were 25-35% lower for those who engaged in multiple behaviors compared to the odds of persons who engaged in one behavior.

CONCLUSION

Substance use screening and intervention services in primary care may not be reaching individuals with the greatest need for services. Proactive outreach and identification of primary care utilization barriers are needed, with special consideration of those with co-occurring substance use.

Alcohol, cardiovascular disease and industry funding: A co-authorship network analysis of systematic reviews

BACKGROUND

Alcohol's effects on heart health is the site of a major scientific controversy. We conducted a co-authorship network analysis of systematic reviews on the impacts on alcohol on cardiovascular disease (CVD) in order to investigate patterns of co-authorship in the literature, with particular attention given to industry funding.

METHODS

We used Epistemonikos to identify systematic reviews. Review characteristics, influential authors, co-authorship subnetworks, prior histories of alcohol industry funding, study outcomes and citations were investigated.

RESULTS

60 systematic reviews with 231 unique authors met our inclusion criteria. 14 systematic reviews were undertaken by authors with histories of alcohol industry funding, including 5 that were funded directly by the alcohol industry itself. All 14 such reviews identified a cardioprotective effect of alcohol. These formed distinct co-authorship subnetworks within the literature. Of reviews by authors with no prior histories of alcohol industry funding, the findings were mixed, with 54% (25/46) concluding there was evidence of health protective effects. These two groups of reviews differed in other respects. Those with industry funding were more likely to study broader outcomes such as 'cardiovascular disease' or 'coronary heart disease' as opposed to specific CVD issues such as hypertension or stroke (93% [13/14] versus 41% [19/46]) (chi-squared 12.4, p < 0.001) and have more included studies (mean of 29 versus 20). They were also more widely cited by others. Over time the proportions of systematic reviews on CVD and alcohol undertaken by authors with no prior histories of alcohol industry funding has increased.

CONCLUSIONS

Systematic reviews undertaken by authors with histories of alcohol industry funding were more likely to study broader outcomes, and be cited more widely, and exclusively reported favorable conclusions.

Alcohol's Impact on the Cardiovascular System

Alcohol consumption has been shown to have complex, and sometimes paradoxical, associations with cardiovascular diseases (CVDs). Several hundred epidemiological studies on this topic have been published in recent decades. In this narrative review, the epidemiological evidence will be examined for the associations between alcohol consumption, including average alcohol consumption, drinking patterns, and alcohol use disorders, and CVDs, including ischaemic heart disease, stroke, hypertension, atrial fibrillation, cardiomyopathy, and heart failure. Methodological shortcomings, such as exposure classification and measurement, reference groups, and confounding variables (measured or unmeasured) are discussed. Based on systematic reviews and meta-analyses, the evidence seems to indicate non-linear relationships with many CVDs. Large-scale longitudinal epidemiological studies with multiple detailed exposure and outcome measurements, and the extensive assessment of genetic and confounding variables, are necessary to elucidate these associations further. Conflicting associations depending on the exposure measurement and CVD outcome are hard to reconcile, and make clinical and public health recommendations difficult. Furthermore, the impact of alcohol on other health outcomes needs to be taken into account. For people who drink alcohol, the less alcohol consumed the better.

Тhe impact of alcohol abuse on the development of non-communicable diseases (analytical review)

The harmful use of alcohol is a risk factor for the development of non-communicable diseases (NCDs), such as cancer, cardiovascular disease, gastrointestinal diseases, diabetes and others. In addition to morbidity, alcohol abuse increases mortality, especially at young ages. An important characteristic is the frequency and amount of alcohol consumed by a person. The more often and more a person abuses alcohol, the higher the risk of developing NCDs and the mortality rate. Purpose of the study: analysis of publications of the World Health Organization and scientific publications of foreign researchers on the influence of alcohol on the development of non-communicable diseases.

Materials and research methods. Content analysis of documents of the World Health Organization and foreign studies on the assessment of the impact of alcohol In total, 48 documents of international organizations were analyzed, including the World Health Organization (WHO), the United Nations (UN), the International Agency for Research on Cancer (IARC-IARC) and the World Bank, as well as 211 scientific publications. Of these, 19 documents were selected, which included materials from WHO, UN, IARC and the World Bank on the impact of alcohol abuse on health, and 63 scientific publications on this topic. Selection criterion: the content in the documents of materials that adequately describe the impact of alcohol abuse on health as a risk factor for the development of various diseases.

Results. An analysis of the documents and publications presented revealed a large massif of evidence that the harmful use of alcohol is a causal factor in the development of a number of noncommunicable diseases, an increase in mortality and disability at earlier stages of life, and the development of a link between harmful use of alcohol and a number of mental and behavioral disorders.

Smoking, alcohol and opioids effect on coronary microcirculation: an update overview

Smoking, heavy alcohol drinking and drug abuse are detrimental lifestyle factors leading to loss of million years of healthy life annually. One of the major health complications caused by these substances is the development of cardiovascular diseases (CVD), which accounts for a significant proportion of substance-induced death. Smoking and excessive alcohol consumption are related to the higher risk of acute myocardial infarction. Similarly, opioid addiction, as one of the most commonly used substances worldwide, is associated with cardiac events such as ischemia and myocardial infarction (MI). As supported by many studies, coronary artery disease (CAD) is considered as a major cause for substance-induced cardiac events. Nonetheless, over the last three decades, a growing body of evidence indicates that a significant proportion of substance-induced cardiac ischemia or MI cases, do not manifest any signs of CAD. In the absence of CAD, the coronary microvascular dysfunction is believed to be the main underlying reason for CVD. To date, comprehensive literature reviews have been published on the clinicopathology of CAD caused by smoking and opioids, as well as macrovascular pathological features of the alcoholic cardiomyopathy. However, to the best of our knowledge there is no review article about the impact of these substances on the coronary microvascular network. Therefore, the present review will focus on the current understanding of the pathophysiological alterations in the coronary microcirculation triggered by smoking, alcohol and opioids.

Educational attainment impacts drinking behaviors and risk for alcohol dependence: results from a two-sample Mendelian randomization study with ~780,000 participants

Observational studies suggest that lower educational attainment (EA) may be associated with risky alcohol use behaviors; however, these findings may be biased by confounding and reverse causality. We performed two-sample Mendelian randomization (MR) using summary statistics from recent genome-wide association studies (GWAS) with >780,000 participants to assess the causal effects of EA on alcohol use behaviors and alcohol dependence (AD). Fifty-three independent genome-wide significant SNPs previously associated with EA were tested for association with alcohol use behaviors. We show that while genetic instruments associated with increased EA are not associated with total amount of weekly drinks, they are associated with reduced frequency of binge drinking ≥6 drinks (ßIVW = -0.198, 95% CI, -0.297 to -0.099, PIVW = 9.14 × 10-5), reduced total drinks consumed per drinking day (ßIVW = -0.207, 95% CI, -0.293 to -0.120, PIVW = 2.87 × 10-6), as well as lower weekly distilled spirits intake (ßIVW = -0.148, 95% CI, -0.188 to -0.107, PIVW = 6.24 × 10-13). Conversely, genetic instruments for increased EA were associated with increased alcohol intake frequency (ßIVW = 0.331, 95% CI, 0.267-0.396, PIVW = 4.62 × 10-24), and increased weekly white wine (ßIVW = 0.199, 95% CI, 0.159-0.238, PIVW = 7.96 × 10-23) and red wine intake (ßIVW = 0.204, 95% CI, 0.161-0.248, PIVW = 6.67 × 10-20). Genetic instruments associated with increased EA reduced AD risk: an additional 3.61 years schooling reduced the risk by ~50% (ORIVW = 0.508, 95% CI, 0.315-0.819, PIVW = 5.52 × 10-3). Consistency of results across complementary MR methods accommodating different assumptions about genetic pleiotropy strengthened causal inference. Our findings suggest EA may have important effects on alcohol consumption patterns and may provide potential mechanisms explaining reported associations between EA and adverse health outcomes.

Associations between alcohol consumption trajectory and deaths due to cancer, cardiovascular diseases and all-cause mortality: a 30-year follow-up cohort study in Thailand

OBJECTIVES

This study examined the association between alcohol consumption trajectory and deaths due to cancer, cardiovascular diseases (CVDs) and all-cause mortality in Thailand.

DESIGN

Data were obtained from a Thai prospective cohort study with more than 30 years of follow-up (n=1961).

SETTING

All participants resided in Bangkok and its vicinity.

PARTICIPANTS

Employees from the Electricity Generating Authority of Thailand aged between 35 and 54 years old were randomly selected.

MAIN OUTCOME MEASURES

Exposure was alcohol consumption trajectory over the study period from 1985 to 2012. The main outcomes were all-cause mortality, and deaths due to cancer and CVDs recorded in national vital registries between 2002 and 2015. Cox's proportional hazard regression was used to determine the associations between alcohol consumption trajectory and each outcome adjusting for sample characteristics, health behaviours and health conditions.

RESULTS

From a total of 59 312 person years, 276 deaths were observed. Compared with drinkers who drank occasionally or most occasional over their lifetime, consistent regular or mostly consistent-regular drinkers had higher rates of all-cause mortality (HR: 1.53; 95% CI 1.09 to 2.16) and cancer mortality (HR: 2.05; 95% CI 1.13 to 3.74). The study did not find a significant association between trajectory of alcohol consumption and deaths due to CVDs.

CONCLUSIONS

Regular drinking of alcohol increased risk for all-cause and cancer mortality. Effective interventions should be implemented to reduce number of regular drinkers in order to saves life of individuals.

Alcohol consumption combined with dietary low-carbohydrate/high-protein intake increased the left ventricular systolic dysfunction risk and lethal ventricular arrhythmia susceptibility in apolipoprotein E/low-density lipoprotein receptor double-knockout mice

Alcohol abuse is positively associated with cardiovascular disease. Dietary low-carbohydrate/high-protein (LCHP) intake confers a greater mortality risk. Here, the impact of ethanol consumption in combination with dietary LCHP intake on left ventricular (LV) systolic function and lethal ventricular arrhythmia susceptibility were investigated in apolipoprotein E/low-density lipoprotein receptor double-knockout (AL) mice. The underlying mechanisms, cardiac sympathovagal balance, beta-adrenergic receptor (ADRB) levels, and gap junction channel protein connexin 43 (Cx43) expression, were examined. Male AL mice fed an LCHP diet with or without ethanol were bred for 16 weeks. Age-matched male AL and wild-type mice received standard chow diet and served as controls. The following were used to assess LV systolic function, lethal ventricular arrhythmia susceptibility, cardiac sympathovagal balance, Cx43 expression, and ADRB levels: The results demonstrated that ethanol consumption in combination with dietary LCHP intake worsened LCHP-induced LV systolic dysfunction in AL mice and enhanced their susceptibility in the ventricular arrhythmia-evoked test. There were concomitant increases in LV weight, LF/HF ratio shown by HRV, TH, ADRB1, ADRB2, and Cx43 expressions by LV fluorescence immunohistochemistry, and LV Cx43 messenger ribonucleic acid expression by PCR. In AL mice, alcohol consumption combined with dietary LCHP intake may thus promote a shift in cardiac sympathovagal balance toward sympathetic predominance, the increases in beta-adrenergic receptors (ADRB1 and ADRB2), and then affect the gap junction channel protein Cx43, which in turn could contribute to increased risks of LV systolic dysfunction and susceptibility to lethal ventricular arrhythmia.

Heavy Drinking Habits Are Associated with Worse In-Hospital Outcomes in Patients with Acute Coronary Syndrome: An Insight from the AMIS Plus Registry

BACKGROUND

The association between alcohol consumption and the occurrence of coronary heart disease is well described in the literature, while data regarding the impact of regular alcohol consumption on in-hospital outcomes in the setting of acute coronary syndrome (ACS) are lacking. We aimed to evaluate the impact of self-reported alcohol consumption on in-hospital outcomes in patients with ACS.

METHODS

Data derived from patients enrolled between 2007 and 2019 in the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry were retrospectively analyzed. Patients were stratified based on alcohol drinking pattern. Primary outcome was all-cause in-hospital mortality, while secondary outcomes were set as incidence of major adverse cardiac and cerebrovascular events (MACCEs). Outcome comparisons according to quantity of daily alcohol intake were also performed.

RESULTS

Records concerning alcohol consumption were available in 25,707 patients; 5,298 of them (21%) fulfilled the criteria of regular alcohol consumption. Regular drinkers were predominantly male, younger, smokers, more comorbid and with a worse clinical presentation as compared with abstainers/occasional drinkers. Daily alcohol intake was reported in 4,059 (77%) of these patients (regular drinkers). Among them, 2,640 were light drinkers (≤2 drinks/day) and 1,419 heavy drinkers (>2 drinks/day). In-hospital mortality and MACCEs of heavy drinkers were significantly higher compared with those of light drinkers (5.4 vs. 3.3% and 7.0 vs. 4.4%, both p = 0.001). When tested together with Global Registry of Acute Coronary Events risk score parameters, heavy alcohol consumption was independently associated with in-hospital mortality (p = 0.004).

CONCLUSIONS

Our results support that heavy alcohol consumption is an independent predictor of in-hospital mortality in patients presenting with ACS.

Association Between Cognitive Function and Early Life Experiences in Patients with Alcohol Use Disorder

INTRODUCTION

Early life experiences could be potential risk factors for the development of alcohol use disorder. In similar circumstances, it might also influence cognitive impairment in later life. However, the relationship between early life experience and cognitive function in people with alcohol use disorders is unclear. The current study examined the effects of early social environments and experiences on cognitive function in patients with alcohol use disorder.

METHODS

A total of 37 adult male patients with alcohol use disorder and 30 healthy control (HC) subjects were enrolled. The MATRICS Cognitive Consensus Battery (MCCB) was used to evaluate cognitive function. The Childhood Trauma Questionnaire (CTQ) and the Revised Adult Attachment Scale (RAAS) were used to evaluate early life experiences of the participants. The RAAS was used to evaluate the attachment patterns of participants.

RESULTS

Compared with the HC group, the alcohol use disorder group reported higher levels of childhood abuse and were more likely to form an insecure attachment style. Patients with alcohol use disorder who experienced trauma performed worse in terms of discrete cognitive parameters such as social cognition, reasoning and problem solving compared to patients without trauma. Importantly, emotional neglect and social comfort were significantly associated with individual social cognitive skills.

CONCLUSIONS

Our results suggest that the cognitive function of patients with alcohol use disorder, especially social cognitive function, is affected by early life experiences.

Association between Helicobacter Pylori infection and stroke: a meta-analysis of 273,135 patients

BACKGROUND

Stroke stands among the most leading causes of mortality worldwide. Although modifiable risk factors for stroke have been identified, current risk factors do not sufficiently explain the risk in young patients. Previous studies have postulated an association between infection by Helicobacter pylori (HP) and stroke.

OBJECTIVE

To investigate the association between HP infection and stroke by using a systematic review and meta-analysis approach.

METHODS

Four electronic search engines/libraries were systematically searched for relevant observational studies. Studies were screened for eligibility and data were extracted. The odds ratio (OR) and 95% confidence interval (95% CI) were combined under the random-effect model. The protocol was registered in PROSPERO (CRD42019123689).

RESULTS

Among the included studies, 25 studies were analyzed for anti-HP IgG, 9 studies were for anti-Cag A, and 6 studies were for the C-urea breath test. The results showed that positive anti-HP IgG was significantly associated with an increased risk of stroke [OR (95% CI) = 1.43 (1.25-1.46)]. Similarly, both antiCag A and C-urea breath test were significantly associated with an increased risk of stroke with [OR (95% CI) = 1.77 (1.25-2.49)], and [OR (95% CI) = 2.21 (1.33-3.66)], respectively. Furthermore, our results indicated that positive anti-HP IgG was associated with stroke caused by atherothrombosis and small artery disease.

CONCLUSIONS

This study suggests that HP infection is significantly associated with increased risk of stroke. However, more well-designed studies are required to investigate if early HP eradication might decrease the incidence of stroke.

Meeting the Global NCD Target of at Least 10% Relative Reduction in the Harmful Use of Alcohol: Is the WHO European Region on Track?

BACKGROUND

The Global Action Plan for the Prevention and Control of Noncommunicable Diseases set the target of an "at least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context". This study investigated progress in the World Health Organization (WHO) European Region towards this target based on two indicators: (a) alcohol per capita consumption (APC) and (b) the age-standardized prevalence of heavy episodic drinking (HED).

METHODS

Alcohol exposure data for the years 2010-2017 were based on country-validated data and statistical models.

RESULTS

Between 2010 and 2017, the reduction target for APC has been met with a decline by -12.4% (95% confidence interval (CI) -17.2, -7.0%) in the region. This progress differed greatly across the region with no decline for the EU-28 grouping (-2.4%; 95% CI -12.0, 7.8%) but large declines for the Eastern WHO EUR grouping (-26.2%; 95% CI -42.2, -8.1%). Little to no progress was made concerning HED, with an overall change of -1.7% (-13.7% to 10.2%) in the WHO European Region.

CONCLUSIONS

The findings indicate a divergence in alcohol consumption reduction in Europe, with substantial progress in the Eastern part of the region and very modest or no progress in EU countries.

Shift work and risk of skin cancer: A systematic review and meta-analysis

Shift work with circadian disruption has been considered as a carcinogenic risk factor for skin cancer. The few prior studies that investigated the association between shift work and skin cancer have inconclusive results. Our main objective was to evaluate the associations between shift work and the risks of different types of skin cancer. We systematically searched PubMed, Web of Science, Cochrane Library, EMBASE and Science Direct until October 2018 for studies that included a relationship between shift work and skin cancer. Our search yielded 193 articles and 9 studies met the criteria for our review. The included studies involved 3,579,147 participants and 17,308 skin cancer cases. Overall, ever shift work, was associated with increased risk of melanoma (RR = 1.10, 95% CI = 1.05–1.16) and a significant decrease in the risk of BCC (RR = 0.90, 95% CI = 0.88–0.93). No association between shift work and the risk of SCC was detected. Interestingly, our dose response analysis demonstrated that the risk of melanoma cumulatively increases by 2% for every year of shift work (RR = 1.02; 95% CI = 1.00–1.03). In conclusion, shift work is associated with increased risk of melanoma and deceased risk of BCC. Further studies are needed to confirm our findings and to elucidate the related potential biological mechanisms.

Evidence for a Direct Harmful Effect of Alcohol on Myocardial Health: A Large Cross-Sectional Study of Consumption Patterns and Cardiovascular Disease Risk Biomarkers From Northwest Russia, 2015 to 2017

Background Alcohol drinking is an increasingly recognized risk factor for cardiovascular disease. However, there are few studies of the impact of harmful and hazardous drinking on biomarkers of myocardial health. We conducted a study in Russia to investigate the impact of heavy drinking on biomarkers of cardiac damage and inflammation. Methods and Results The Know Your Heart study recruited a random sample of 2479 participants from the population of northwest Russia (general population) plus 278 patients (narcology clinic subsample) with alcohol problems. The general population sample was categorized into harmful drinkers, hazardous drinkers, nonproblem drinkers, and nondrinkers, according to self-reported level of alcohol consumption, whereas the narcology clinic sample was treated as the separate group in the analysis. Measurements were made of the following: (1) high-sensitivity cardiac troponin T, (2) NT-proBNP (N-terminal pro-B-type natriuretic peptide), and (3) hsCRP (high-sensitivity C-reactive protein). The narcology clinic subsample had the most extreme drinking pattern and the highest levels of all 3 biomarkers relative to nonproblem drinkers in the general population: high-sensitivity cardiac troponin T was elevated by 10.3% (95% CI, 3.7%-17.4%), NT-proBNP by 46.7% (95% CI, 26.8%-69.8%), and hsCRP by 69.2% (95% CI, 43%-100%). In the general population sample, NT-proBNP was 31.5% (95% CI, 3.4%-67.2%) higher among harmful drinkers compared with nonproblem drinkers. Overall, NT-proBNP and hsCRP increased with increasing intensity of alcohol exposure (test of trend P<0.001). Conclusions These results support the hypothesis that heavy alcohol drinking has an adverse effect on cardiac structure and function that may not be driven by atherosclerosis.

Aircraft Noise and the Risk of Stroke

BACKGROUND

There have been many individual studies on the question whether air- craft noise is a risk factor for stroke, but until now there has not been any summary of the current state of the evidence of adequately high methodological quality.

METHODS

In a systematic review and meta-analysis (PROSPERO registry number CRD42013006004), we evaluated the relation between address-based aircraft noise exposure and the incidence of stroke. A systematic literature search was performed in the MEDLINE, EMBASE, and BIOSIS databases including publications up to August 2017. Two of the authors, working independently of each other, screened the titles, abstracts, and full texts for eligible articles and evaluated the quality of the included studies on a three-level scale. The change of risk per 10 dB increase in the weighted mean aircraft noise level (LDEN) was calculated. LDEN is a noise level indicator with additional weighting of evening and nighttime noise.

RESULTS

Of the nine studies that met the inclusion criteria, seven were suitable for inclusion in the meta-analysis. The result of the meta-analysis indicated a relative stroke risk of 1.013 (95% confidence interval, [0.998; 1.028]) per 10 dB increase in LDEN, corresponding with an estimated 1.3% increase in the risk of stroke for each additional 10 dB of aircraft noise. The underlying studies were of poor to medium quality. The analyses of the studies included adjustments for various combinations of confounders, including age, sex, ethnicity, and socioeconomic status.

CONCLUSION

The present meta-analysis indicates that aircraft noise increases the risk of stroke, even if the overall finding just fails to reach statistical significance. The differing measures of exposure in the included studies, the lack of differentiation be- tween ischemic and hemorrhagic stroke, and the lack of consideration of maximum noise levels are all factors that may have led to a marked underestimation of the risk of stroke.

Heavy and binge alcohol drinking and parenting status in the United States from 2006 to 2018: An analysis of nationally representative cross-sectional surveys

BACKGROUND

Binge and heavy drinking are preventable causes of mortality and morbidity. Alcohol consumption by women who parent is damaging to child health, and it is concerning that women in the United States in their reproductive years have experienced increased drinking over the past decade. Although media attention has focused on the drinking status of women who are child-rearing, it remains unclear whether binge and heavy drinking vary by parenting status and sex.

METHODS AND FINDINGS

We examined national trends in binge drinking, defined as 5 or more drinks in a single day for men and 4 or more drinks for women, and heavy drinking, defined as 60 or more days with binge episodes in a year. We used survey-weighted logistic regression from the 2006-2018 waves of the cross-sectional National Health Interview Survey (NHIS, N = 239,944 eligible respondents) to study time trends in drinking outcomes by sex, age, and parenting status. Binge drinking increased for both sexes in nearly all age groups, with the largest increase among women ages 30-44 without children (from 21% reporting binge drinking in 2006 to 42% in 2018); the exception was young men (ages 18-29) with children, among whom binge drinking declined. By 2012, the prevalence of binge drinking among young men with children (38.5%) declined to below that of young women without children (39.2%) and stayed lower thereafter. Despite widespread increases in binge drinking, heavy drinking declined or remained stable for all groups except older women (ages 45-55) without children (odds ratio [OR] for heavy drinking each year = 1.06, 95% CI 1.02-1.10) and women ages 30-44, regardless of parenting status. For binge drinking outcomes only, we saw evidence of interaction in drinking trends by parenting status, but this was shown to be confounded by sex and age. Men and women with children reported consistently lower levels of drinking than those without children. Rates of abstention mirrored trends in binge outcomes for both sexes, limiting concerns about invariance. Study limitations include self-reported data and measurement invariance in binge drinking cutoffs across study years.

CONCLUSIONS

This study demonstrated that trends in binge and heavy drinking over time were not differential by parenting status for women; rather, declines and increases over time were mainly attributable to sex and age. Women both with and without children are increasing binge and heavy drinking; men, regardless of parenting status, and women without children consumed more alcohol than women with children. Regardless of impact on child health, increased drinking rates in the past decade are concerning for adult morbidity and mortality: binge drinking has increased among both sexes, and heavy drinking has increased among older women. Men and women of all ages and parenting status should be screened for heavy alcohol use and referred to specialty care as appropriate.

Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction

Noncommunicable disease now contributes to the World Health Organization top 10 causes of death in low-, middle- and high-income countries. Particular examples include stroke, coronary heart disease, dementia and certain cancers. Research linking clinical and lifestyle risk factors to increased risk of noncommunicable disease is now well established with examples of confirmed risk factors, including smoking, physical inactivity, obesity and hypertension. However, despite a need to target our resources to achieve risk reduction, relatively little work has examined the overlap between the risk factors for these main noncommunicable diseases. Our high-level review draws together the evidence in this area. Using a systematic overview of reviews, we demonstrate the likely commonality of established risk factors having an impact on multiple noncommunicable disease outcomes. For example, systematic reviews of the evidence on physical inactivity and poor diet found each to be associated with increased risk of cancers, coronary heart disease, stroke, diabetes mellitus and dementia. We highlight the potential for targeted risk reduction to simultaneously impact multiple noncommunicable disease areas. These relationships now need to be further quantified to allow the most effective development of public health interventions in this area.

Tubal ligation and endometrial Cancer risk: a global systematic review and meta-analysis

BACKGROUND

Studies on relationship between tubal ligation and endometrial cancer have led to contradictory findings. In several studies, however, a reduced endometrial cancer risk was suggested following tubal ligation. Therefore, a systematic review and meta-analysis was conducted to examine the relationship between tubal ligation and endometrial cancer risk.

METHODS

In this systematic review and meta-analysis, PubMed/Medline, Web of Science, Scopus, Embase, and Google Scholar were searched for relevant studies published up to May 30th, 2018. We compared endometrial cancer risk in women with and without tubal ligation in retrieved studies.

RESULTS

Two hundred nine studies were initially retrieved from the data bases. After exclusion of duplicates and studies which did not meet inclusion criteria, ten cohort and case-control studies, including 6,773,066 cases, were entered into the quantitative meta-analysis. There was 0.90% agreement between two researchers who searched and retrieved the studies. The summary OR (SOR) was reported using a random effect model. Begg's test suggested that there was no publication bias, but a considerable heterogeneity was observed (I² = 95.4%, P = 0.001). We pooled the raw number of tables cells (i.e. a, b, c, and d) of eight studies. The SOR suggested that tubal ligation was significantly associated with a lower risk of endometrial cancer (SOR = 0.577, 95% CI = 0.420-0.792). Also, given the rare nature of endometrial cancer (< 5%), different effect sizes were considered as comparable measures of risk. Therefore we pooled ten studies and SOR of these studies revealed that tubal ligation was significantly associated with a lower risk of endometrial cancer (SOR = 0.696, 95% CI = 0.425-0.966). Besides that, we pooled eight studies in which adjusted effect sizes were reported and a subsequent analysis revealed that the summary estimate of adjusted odds ratio (SAOR) was significant (SAOR = 0.862, 95% CI = 0.698-1.026).

CONCLUSIONS

This study revealed a protective effect of tubal ligation on endometrial cancer risk (approximately 42% lower risk of cancer). It is recommended that studies should be designed to reveal mechanisms of this relationship.

Dynamic Features of Problematic Drinking: Alcohol Use Disorder Latent Classes Across Ages 18-64

Aims

Alcohol use disorders (AUDs) are linked with numerous severe detrimental outcomes. Evidence suggests that there is a typology of individuals with an AUD based on the symptoms they report. Scant research has identified how these groups may vary in prevalence by age, which could highlight aspects of problematic drinking behavior that are particularly salient at different ages. Our study aimed to (a) identify latent classes of drinkers with AUD that differ based on symptoms of AUD and (b) examine prevalences of latent classes by age.

Short summary

Our findings advocate for personalized treatment approaches for AUD and highlight the need for carefully considering the role of age in prevention and intervention efforts.

Methods

We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). Current drinkers aged 18-64 who met criteria for a past-year AUD were included (n = 5402).

Results

Latent class analysis (LCA) based on 11 AUD criteria revealed 5 classes: 'Alcohol-Induced Injury' (25%), 'Highly Problematic, Low Perceived Life Interference' (21%), 'Adverse Effects Only' (34%), 'Difficulty Cutting Back' (13%) and 'Highly Problematic' (7%). Using time-varying effect modeling (TVEM), each class was found to vary in prevalence across age. The Adverse Effects Only and Highly Problematic, Low Perceived Life Interference classes were particularly prevalent among younger adults, and the Difficulty Cutting Back and Alcohol-Induced Injury classes were more prevalent as age increased.

Conclusions

Findings suggest that experience of AUD is not only heterogeneous in nature but also that the prevalence of these subgroups vary across age.

Risk of Ischemic Stroke and Peripheral Arterial Disease in Heterozygous Familial Hypercholesterolemia: A Meta-Analysis

Heterozygous familial hypercholesterolemia (HeFH) is a common genetic disorder predisposing affected individuals to lifelong low-density lipoprotein cholesterol (LDL-C) elevation and coronary heart disease. However, whether HeFH increases the risk of peripheral arterial disease (PAD) and ischemic stroke is undetermined. We examined associations between HeFH and these outcomes in a comprehensive systematic review and meta-analysis. We searched MEDLINE, EMBASE, Global Health, the Cochrane Library, and PubMed (for ahead-of-print publications) for relevant English-language studies. Maximally adjusted risk estimates were pooled under random- and fixed-effects meta-analysis to derive odds ratios (ORs) and 95% confidence intervals (CIs). We included 6 studies representing 183 388 participants. Heterozygnous familial hypercholesterolemia was associated with a higher risk of PAD (OR: 3.59 [95% CI: 1.30-9.89]). This trend was nonsignificantly preserved (OR: 2.96 [95% CI: 0.68-12.88]) in sensitivity analyses of genetically defined HeFH. Genetic HeFH was not associated with increased ischemic stroke risk (OR: 0.76 [95% CI: 0.37-1.58]) although possessing an LDL-C >4.9 mmol/L (190 mg/dL) was (OR: 1.42 [95% CI: 1.06-1.89]). We found clinical and genetic diagnoses of HeFH to be associated with increased PAD risk. Genetically confirmed HeFH may not confer an increased risk of ischemic stroke. Modest associations may exist between LDL-C and ischemic stroke risk in HeFH.

Delirium Tremens: Assessment and Management

Delirium Tremens (DT) falls in the most severe spectrum of alcohol withdrawal, which could potentially result in death, unless managed promptly and adequately. The prevalence of DT in general population is <1% and nearly 2% in patients with alcohol dependence. DT presents with a combination of severe alcohol withdrawal symptoms and symptoms of delirium with agitation and sometimes hallucination. Clinical and laboratory parameters which predict DT have been discussed. Assessment of DT includes assessment of severity of alcohol withdrawal, evaluation of delirium, and screening for underlying medical co-morbidities. Liver disease as a co-morbidity is very common in patients with DT and that could complicate the clinical presentation, determine the treatment choice, and influence the outcome. Benzodiazepines are the mainstay of treatment for DT. Diazepam and lorazepam are preferred benzodiazepine, depending upon the treatment regime and clinical context. In benzodiazepine refractory cases, Phenobarbital, propofol, and dexmedetomidine could be used.

Association of longitudinal alcohol consumption trajectories with coronary heart disease: a meta-analysis of six cohort studies using individual participant data

BACKGROUND

Studies have shown that alcohol intake trajectories differ in their associations with biomarkers of cardiovascular functioning, but it remains unclear if they also differ in their relationship to actual coronary heart disease (CHD) incidence. Using multiple longitudinal cohort studies, we evaluated the association between long-term alcohol consumption trajectories and CHD.

METHODS

Data were drawn from six cohorts (five British and one French). The combined analytic sample comprised 35,132 individuals (62.1% male; individual cohorts ranging from 869 to 14,247 participants) of whom 4.9% experienced an incident (fatal or non-fatal) CHD event. Alcohol intake across three assessment periods of each cohort was used to determine participants' intake trajectories over approximately 10 years. Time to onset for (i) incident CHD and (ii) fatal CHD was established using surveys and linked medical record data. A meta-analysis of individual participant data was employed to estimate the intake trajectories' association with CHD onset, adjusting for demographic and clinical characteristics.

RESULTS

Compared to consistently moderate drinkers (males: 1-168 g ethanol/week; females: 1-112 g ethanol/week), inconsistently moderate drinkers had a significantly greater risk of incident CHD [hazard ratio (HR) = 1.18, 95% confidence interval (CI) = 1.02-1.37]. An elevated risk of incident CHD was also found for former drinkers (HR = 1.31, 95% CI = 1.13-1.52) and consistent non-drinkers (HR = 1.47, 95% CI = 1.21-1.78), although, after sex stratification, the latter effect was only evident for females. When examining fatal CHD outcomes alone, only former drinkers had a significantly elevated risk, though hazard ratios for consistent non-drinkers were near identical. No evidence of elevated CHD risk was found for consistently heavy drinkers, and a weak association with fatal CHD for inconsistently heavy drinkers was attenuated following adjustment for confounding factors.

CONCLUSIONS

Using prospectively recorded alcohol data, this study has shown how instability in drinking behaviours over time is associated with risk of CHD. As well as individuals who abstain from drinking (long term or more recently), those who are inconsistently moderate in their alcohol intake have a higher risk of experiencing CHD. This finding suggests that policies and interventions specifically encouraging consistency in adherence to lower-risk drinking guidelines could have public health benefits in reducing the population burden of CHD. The absence of an effect amongst heavy drinkers should be interpreted with caution given the known wider health risks associated with such intake.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03133689 .

Reporting bias in the literature on the associations of health-related behaviors and statins with cardiovascular disease and all-cause mortality

Reporting bias in the literature occurs when there is selective revealing or suppression of results, influenced by the direction of findings. We assessed the risk of reporting bias in the epidemiological literature on health-related behavior (tobacco, alcohol, diet, physical activity, and sedentary behavior) and cardiovascular disease mortality and all-cause mortality and provided a comparative assessment of reporting bias between health-related behavior and statin (in primary prevention) meta-analyses. We searched Medline, Embase, Cochrane Methodology Register Database, and Web of Science for systematic reviews synthesizing the associations of health-related behavior and statins with cardiovascular disease mortality and all-cause mortality published between 2010 and 2016. Risk of bias in systematic reviews was assessed using the ROBIS tool. Reporting bias in the literature was evaluated via small-study effect and excess significance tests. We included 49 systematic reviews in our study. The majority of these reviews exhibited a high overall risk of bias, with a higher extent in health-related behavior reviews, relative to statins. We reperformed 111 meta-analyses conducted across these reviews, of which 65% had statistically significant results (P < 0.05). Around 22% of health-related behavior meta-analyses showed small-study effect, as compared to none of statin meta-analyses. Physical activity and the smoking research areas had more than 40% of meta-analyses with small-study effect. We found evidence of excess significance in 26% of health-related behavior meta-analyses, as compared to none of statin meta-analyses. Half of the meta-analyses from physical activity, 26% from diet, 18% from sedentary behavior, 14% for smoking, and 12% from alcohol showed evidence of excess significance bias. These biases may be distorting the body of evidence available by providing inaccurate estimates of preventive effects on cardiovascular and all-cause mortality.

Gender Differences in Binge Drinking

Just as binge drinking rates differ for men and women, the predictors and consequences of binge drinking vary by gender as well. This article examines these differences and how binge drinking definitions and research samples and methods may influence findings. It also describes the relationship between age and binge drinking among men and women, and how drinking culture and environment affect this relationship. It examines gender-specific trends in binge drinking, predictors of binge drinking for men and women, and binge drinking in the context of smoking. The article reviews current findings on gender differences in the health consequences of binge drinking, including morbidity and mortality, suicidality, cancer, cardiovascular disorders, liver disorders, and brain and neurocognitive implications. It also discusses gender differences in the behavioral and social consequences of binge drinking, including alcohol-impaired driving, sexual assault, and intimate partner violence, and includes implications for treatment and prevention.

Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

IMPORTANCE

Lack of current and comprehensive trend data derived from a uniform, reliable, and valid source on alcohol use, high-risk drinking, and DSM-IV alcohol use disorder (AUD) represents a major gap in public health information.

OBJECTIVE

To present nationally representative data on changes in the prevalences of 12-month alcohol use, 12-month high-risk drinking, 12-month DSM-IV AUD, 12-month DSM-IV AUD among 12-month alcohol users, and 12-month DSM-IV AUD among 12-month high-risk drinkers between 2001-2002 and 2012-2013.

DESIGN, SETTING, AND PARTICIPANTS

The study data were derived from face-to-face interviews conducted in 2 nationally representative surveys of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions, with data collected from April 2001 to June 2002, and the National Epidemiologic Survey on Alcohol and Related Conditions III, with data collected from April 2012 to June 2013. Data were analyzed in November and December 2016.

MAIN OUTCOMES AND MEASURES

Twelve-month alcohol use, high-risk drinking, and DSM-IV AUD.

RESULTS

The study sample included 43 093 participants in the National Epidemiologic Survey on Alcohol and Related Conditions and 36 309 participants in the National Epidemiologic Survey on Alcohol and Related Conditions III. Between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, and DSM-IV AUD increased by 11.2%, 29.9%, and 49.4%, respectively, with alcohol use increasing from 65.4% (95% CI, 64.3%-66.6%) to 72.7% (95% CI, 71.4%-73.9%), high-risk drinking increasing from 9.7% (95% CI, 9.3%-10.2%) to 12.6% (95% CI, 12.0%-13.2%), and DSM-IV AUD increasing from 8.5% (95% CI, 8.0%-8.9%) to 12.7% (95% CI, 12.1%-13.3%). With few exceptions, increases in alcohol use, high-risk drinking, and DSM-IV AUD between 2001-2002 and 2012-2013 were also statistically significant across sociodemographic subgroups. Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income. Increases were also seen for the total sample and most sociodemographic subgroups for the prevalences of 12-month DSM-IV AUD among 12-month alcohol users from 12.9% (95% CI, 12.3%-17.5%) to 17.5% (95% CI, 16.7%-18.3%) and 12-month DSM-IV AUD among 12-month high-risk drinkers from 46.5% (95% CI, 44.3%-48.7%) to 54.5% (95% CI, 52.7%-56.4%).

CONCLUSIONS AND RELEVANCE

Increases in alcohol use, high-risk drinking, and DSM-IV AUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis. Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role.

The Association Between Vasectomy and Prostate Cancer: A Systematic Review and Meta-analysis

Importance

Despite 3 decades of study, there remains ongoing debate regarding whether vasectomy is associated with prostate cancer.

Objective

To determine if vasectomy is associated with prostate cancer.

Data Sources

The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched for studies indexed from database inception to March 21, 2017, without language restriction.

Study Selection

Cohort, case-control, and cross-sectional studies reporting relative effect estimates for the association between vasectomy and prostate cancer were included.

Data Extraction and Synthesis

Two investigators performed study selection independently. Data were pooled separately by study design type using random-effects models. The Newcastle-Ottawa Scale was used to assess risk of bias.

Main Outcomes and Measures

The primary outcome was any diagnosis of prostate cancer. Secondary outcomes were high-grade, advanced, and fatal prostate cancer.

Results

Fifty-three studies (16 cohort studies including 2 563 519 participants, 33 case-control studies including 44 536 participants, and 4 cross-sectional studies including 12 098 221 participants) were included. Of these, 7 cohort studies (44%), 26 case-control studies (79%), and all 4 cross-sectional studies were deemed to have a moderate to high risk of bias. Among studies deemed to have a low risk of bias, a weak association was found among cohort studies (7 studies; adjusted rate ratio, 1.05; 95% CI, 1.02-1.09; P < .001; I2 = 9%) and a similar but nonsignificant association was found among case-control studies (6 studies; adjusted odds ratio, 1.06; 95% CI, 0.88-1.29; P = .54; I2 = 37%). Effect estimates were further from the null when studies with a moderate to high risk of bias were included. Associations between vasectomy and high-grade prostate cancer (6 studies; adjusted rate ratio, 1.03; 95% CI, 0.89-1.21; P = .67; I2 = 55%), advanced prostate cancer (6 studies; adjusted rate ratio, 1.08; 95% CI, 0.98-1.20; P = .11; I2 = 18%), and fatal prostate cancer (5 studies; adjusted rate ratio, 1.02; 95% CI, 0.92-1.14; P = .68; I2 = 26%) were not significant (all cohort studies). Based on these data, a 0.6% (95% CI, 0.3%-1.2%) absolute increase in lifetime risk of prostate cancer associated with vasectomy and a population-attributable fraction of 0.5% (95% CI, 0.2%-0.9%) were calculated.

Conclusions and Relevance

This review found no association between vasectomy and high-grade, advanced-stage, or fatal prostate cancer. There was a weak association between vasectomy and any prostate cancer that was closer to the null with increasingly robust study design. This association is unlikely to be causal and should not preclude the use of vasectomy as a long-term contraceptive option.

Alcohol dependence and risk of somatic diseases and mortality: a cohort study in 19 002 men and women attending alcohol treatment

AIMS

To (1) estimate sex-specific risks of a comprehensive spectrum of somatic diseases in alcohol-dependent individuals versus a control population, and in the same population to (2) estimate sex-specific risks of dying from the examined somatic diseases.

DESIGN

Register-based matched cohort study. Alcohol-dependent individuals were identified from the Copenhagen Alcohol Cohort. Controls were selected randomly from the Danish Civil Registration System. Information on somatic diseases was obtained from the Danish National Patient Registry and causes of death obtained from the Cause of Death Registry. Cox proportional hazards model was applied to estimate hazard ratios (HRs).

SETTING

Denmark.

PARTICIPANTS

A total of 19 002 alcohol-dependent individuals and 186 767 controls.

MEASUREMENTS

Outcome variables included 11 disease groups and 29 subgroups, defined according to the International Classification of Diseases (ICD). The main predictor variable was diagnosis of alcohol dependence according to ICD.

FINDINGS

Alcohol-dependent men and women compared with controls had statistically significantly higher risks of all disease groups and the majority of subgroups when analysed as disease events. HRs were elevated for well-established alcohol-related diseases but also for diseases such as dementia [men, HR = 2.0, 95% confidence interval (CI) = 1.6-2.3; women, HR = 2.4, 95% CI = 1.8-3.2], psoriasis (men, HR = 4.3, 95% CI = 3.5-5.2; women, HR = 5.4, 95% CI = 3.7-7.8) and breast cancer in men (HR = 3.3, 95% CI = 1.6-7.0). Similar results were found when disease groups and subgroups were analysed as causes of death.

CONCLUSIONS

Alcohol-dependent men and women have significantly higher risks of a comprehensive spectrum of somatic diseases, both as disease events and as causes of death, relative to individuals from the general population.

The relationship between different dimensions of alcohol use and the burden of disease-an update

BACKGROUND AND AIMS

Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs).

METHODS

Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others.

RESULTS

In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently.

CONCLUSIONS

Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.

Quantifying the contribution of alcohol to cardiomyopathy: A systematic review

Alcohol has a direct toxic impact on the heart, and while there is an ICD code for alcoholic cardiomyopathy, the burden of alcohol-attributable cardiomyopathy is not clear. For the usual estimation of this burden via population-attributable fractions, one would need to determine the risk relationships, i.e., average risk associated with different dimensions of alcohol exposure. The most important among these risk relationships is the dose-response relationship with different levels of average alcohol consumption. To establish risk relationships, we systematically searched for all studies on dose-response relationships, directly and indirectly, via reviews. The results did not permit computation of pooled estimates through meta-analyses. There were clear indications that heavy drinking (≥80 g per day) over several years was linked to high risk of cardiomyopathy, with greater lifetime exposure of alcohol linked to higher risks. Some studies indicated potential effects of patterns of drinking as well. As such, the global quantification of alcohol-attributable cardiomyopathy will have to rely on other methods than those used conventionally.

APOA5 Gene Polymorphisms and Cardiovascular Diseases: Metaprediction in Global Populations

BACKGROUND

Apolipoprotein A5 (APOA5) 1131 is one of the most investigated gene polymorphisms in association with cardiovascular diseases (CVD) for its roles in epigenetics pathways.

OBJECTIVES

The major objective of this metaprediction study was to comprehensively examine the association of polymorphism risk subtypes of APOA5 1131 gene and potential contributing factors of CVD risks in global populations.

METHODS

This study is a meta-analysis to determine APOA5 gene polymorphisms as risk factors for CVDs. Following the guidelines of meta-analyses, we applied big data analytics including the recursive partition tree, nonlinear association curve fit, and heat maps for data visualization-in addition to the conventional pooled analyses.

RESULTS

A total of 17,692 CVD cases and 23,566 controls from 50 study groups were included. The frequency of APOA5 1131 CC and TC polymorphisms in Asian populations (22.2%-52.6%) were higher than that in other populations, including Caucasians and Eurasians (10.0%-25.0%). The homozygous CC and heterozygous TC genotypes (both p < .0001) were associated with increased risks for CVD and were higher in many Western nations, including Canada, Spain, the Czech Republic, Hungary, Turkey, Egypt, France, and Iran. The CC genotype was associated with greater risks (RR > 2.00, p < .0001) for dyslipidemia and myocardial infarction, whereas RR > 1.00 was associated with metabolic syndrome, coronary artery disease, and stroke. Air pollution was significantly associated with APOA5 1131 CC and TC polymorphisms.

DISCUSSION

The findings of this study provided novel insight to further understand the associations among APOA5 1131 polymorphisms, air pollution, and the development of CVDs. Methylation studies are needed to examine epigenetic factors associated with APOA5 1131 polymorphisms and CVD and to suggest potential prevention strategies for CVD.

The relationship between different dimensions of alcohol use and the burden of disease-an update

BACKGROUND AND AIMS

Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs).

METHODS

Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others.

RESULTS

In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently.

CONCLUSIONS

Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.

Assessing Sex Differences in the Risk of Cardiovascular Disease and Mortality per Increment in Systolic Blood Pressure: A Systematic Review and Meta-Analysis of Follow-Up Studies in the United States

In the United States (US), cardiovascular (CV) disease accounts for nearly 20% of national health care expenses. Since costs are expected to increase with the aging population, informative research is necessary to address the growing burden of CV disease and sex-related differences in diagnosis, treatment, and outcomes. Hypertension is a major risk factor for CV disease and mortality. To evaluate whether there are sex-related differences in the effect of systolic blood pressure (SBP) on the risk of CV disease and mortality, we performed a systematic review and meta-analysis. We conducted a comprehensive search using PubMed and Google Scholar to identify US-based studies published prior to 31 December, 2015. We identified eight publications for CV disease risk, which provided 9 female and 8 male effect size (ES) observations. We also identified twelve publications for CV mortality, which provided 10 female and 18 male ES estimates. Our meta-analysis estimated that the pooled ES for increased risk of CV disease per 10 mmHg increment in SBP was 25% for women (95% Confidence Interval (CI): 1.18, 1.32) and 15% for men (95% CI: 1.11, 1.19). The pooled increase in CV mortality per 10 mm Hg SBP increment was similar for both women and men (Women: 1.16; 95% CI: 1.10, 1.23; Men: 1.17; 95% CI: 1.12, 1.22). After adjusting for age and baseline SBP, the results demonstrated that the risk of CV disease per 10 mm Hg SBP increment for women was 1.1-fold higher than men (P<0.01; 95% CI: 1.04, 1.17). Heterogeneity was moderate but significant. There was no significant sex difference in CV mortality.

Modelling the impact of alcohol consumption on cardiovascular disease mortality for comparative risk assessments: an overview

BACKGROUND

Although alcohol consumption has long been considered as a risk factor for chronic disease, the relationship to cardiovascular disease (CVD) is complex and involves at least two dimensions: average volume of alcohol consumption and patterns of drinking. The objective of this contribution was to estimate the burden of CVD mortality caused by alcohol consumption.

METHODS

Risk assessment modelling with alcohol-attributable CVD mortality as primary outcome. The mortality burden of ischaemic heart disease (IHD) and ischaemic stroke (IS) attributable to alcohol consumption was estimated using attributable-fraction methodology. Relative Risk (RR) data for IHD and IS were obtained from the most comprehensive meta-analyses (except for Russia and surrounding countries where alcohol RR data were obtained from a large cohort study). Age-group specific RRs were calculated, based on large studies. Data on mortality were obtained from the World Health Organization's Global Health Estimates and alcohol consumption data were obtained from the Global Information System on Alcohol and Health. Risk of former drinkers was modelled taking into account global differences in the prevalence of sick quitters among former drinkers. Alcohol-attributable mortality estimates for all other CVD causes except IHD and IS were obtained from the 2014 Global Status Report on Alcohol and Health.

RESULTS

An estimated 780,381 CVD deaths (441,893 and 338,490 CVD deaths among men and women respectively) were attributable to alcohol consumption globally in 2012, accounting for 1.4 % of all deaths and 26.6 % of all alcohol-attributable deaths. This is in contrast to the previously estimated 1,128,273 CVD deaths attributable to alcohol consumption globally, and represents a decrease of 30.8 % in alcohol-attributable CVD mortality and of 10.6 % in the global burden of all alcohol-attributable deaths.

CONCLUSIONS

When the most comprehensive and recent systematic reviews and meta-analyses are taken as bases, the net impact of alcohol consumption on CVD is lower than previously estimated.

Temporal changes in alcohol-related mortality and morbidity in Australia

BACKGROUND AND AIMS

Alcohol consumption is an avoidable risk factor for morbidity and mortality. Studies have examined relative risks and outcomes of alcohol-related harms in Australia at discrete times, limiting the ability to examine changes across time. This paper examined alcohol consumption and its contribution to deaths, illness and injury at two time-points, 2001 and 2010.

DESIGN

Alcohol consumption was modelled based on the 2001 and 2010 National Drug Strategy Household Survey, upshifted to reflect alcohol sales data.

SETTING

All data reported are from Australian sources.

MEASUREMENTS

Based on relative risk estimates obtained from meta-analysis, alcohol-attributable fractions were estimated for 42 disease and injury categories in 2001 and 2010 separately for conditions that were not 100% alcohol-attributable. Deaths and hospital separations attributable to alcohol were calculated in 2001 and 2010.

FINDINGS

There was a relatively stable per capita consumption of alcohol across time, with males reporting higher levels of consumption compared with females. While there were increases in the number of abstainers from alcohol across time, the proportion of heavy alcohol consumers also increased. This corresponded with an observed increase in alcohol-attributable burden. For example, alcohol-attributable deaths increased from 4957 [95% confidence interval (CI) = 2867-8770] to 5610 (95% CI = 3398-9408) during the study period.

CONCLUSION

The findings demonstrate that there has been an increase in alcohol-attributable harms between 2001 and 2010 in Australia without a corresponding increase in per capita consumption.