Prevalence and Correlates of Physical Comorbidities in Alcohol Use Disorder (AUD): a Pilot Study in Treatment-Seeking Population

This study aimed to understand the prevalence of physical comorbidities, undiagnosed and inadequately controlled chronic physical conditions and correlates of high cholesterol, hypertension and liver enzyme abnormalities in those with alcohol use disorder (AUD). Participants (n = 101) with AUD were recruited from a tertiary care centre through convenient sampling. The prevalence of physical and psychiatric comorbidities in the sample was 83.17% and 51.49%, respectively. Around 53.47% had two or more chronic physical conditions (multimorbidity). Hypertension (44.55%), asthma (23.76%), high cholesterol (22.77%) and liver enzyme abnormalities (21.78%) were the top four physical comorbidities. The prevalence of undiagnosed and inadequately controlled chronic physical conditions was 61.4% and 32.7%, respectively. Gender, education and body mass index (BMI) were associated with hyperlipidaemia while age and education were associated with hypertension. Higher waist-hip ratio was associated with liver enzyme abnormalities. Routine clinical care must include regular screening and follow-up of the risk groups to monitor their physical and mental health.

Birth cohort effects and gender differences in alcohol epidemiology: a review and synthesis

BACKGROUND

Alcohol consumption has demonstrated substantial temporal trends, with some evidence suggesting strong birth cohort effects. The identification of at-risk birth cohorts can inform the interpretation of alcohol trends across age, time, and demographic characteristics such as gender. The present literature review has 2 objectives. First, we conduct a cross-national review of the literature on birth cohort differences in alcohol consumption, disorder, and mortality. Second, we determine the consistency of evidence for birth cohort effects on gender differences.

METHODS

A search was conducted and key data on population characteristics, presence and direction of cohort effects, and interactions with gender compiled. Thirty-one articles were included.

RESULTS

Evidence suggests that younger birth cohorts in North America, especially those born after World War II, are more likely than older cohorts to engage in heavy episodic drinking and develop alcohol disorders, but this cohort effect is not found in Australia and western Europe. Cross-nationally, substantial evidence indicates that women in younger cohorts are at especially high risk for heavy episodic drinking and alcohol disorders.

DISCUSSION

Younger birth cohorts in North America and Europe are engaging in more episodic and problem drinking. The gender gap in alcohol problems is narrowing in many countries, suggesting shifting social norms surrounding gender and alcohol consumption. These trends suggest that public health efforts to specifically target heavy drinking in women are necessary.

Prevalence of hyperuricemia in Bangkok population

To investigate the prevalence of hyperuricemia in general Thai population and to evaluate its association with metabolic syndrome. A total of 1,945 subjects who sought for routine annual health checkup in our hospital from 1 October 2009 to 31 March 2010 were enrolled into the study. Inclusion criteria were healthy individuals, aged ≥35 years old, and lived in Bangkok for over 10 years. Data of general health status, age, gender, history of alcoholic consumption, body weight, height, and waist circumference were obtained by an interview-structured questionnaire. Fasting blood sample was collected from each subject early in the morning for uric acid, total cholesterol, high density lipoprotein cholesterol, triglycerides, and glucose levels. The prevalence of hyperuricemia in our study population was 24.4%, being significantly more common in men than women (59% vs. 11%, p < 0.001). The condition was also associated with various features of high body mass index or waist circumference, alcohol consumption, dyslipidemia, and high fasting blood glucose. Metabolic syndrome was found in 35% and 23% of men and women with hyperuricemia; direct relationship between level of uric acid and prevalence of metabolic syndrome was observed. Hyperuricemia is common among Bangkok population in our study. This disorder is frequently associated with metabolic syndrome.

The impact of a population-based multi-factorial lifestyle intervention on alcohol intake: the Inter99 study

PURPOSE

To investigate the effect of screening and five years of multi-factorial lifestyle intervention on changes in alcohol intake in a general population.

METHODS

The study was a pre-randomized intervention study on lifestyle, Inter99 (1999-2006), Copenhagen, Denmark. Participants in the intervention group (n=6 091) had at baseline a medical health examination and a face-to-face lifestyle counselling. Individuals at high risk of ischemic heart disease were repeatedly offered both individual and group-based counselling. The control group (n=3 324) was followed by questionnaires. Alcohol intake was measured by questionnaires. Changes were analysed by multilevel analyses.

RESULTS

Binge drinking decreased both in men and women at three and five-year follow-ups (men: five-year: net-change:-0.13; p=0.03; women: five-year: net-change:-0.08; p=0.04). Furthermore, in women the ratio between wine and total alcohol was increased compared with the control group at five-year follow-up (net-change: 0.04; p<0.01). In men with a high intake of alcohol (>21 drinks per week) the effect on total alcohol intake was maintained at five-year follow-up (net-change: -3.7; p=0.01). No significant effects were found in women on total alcohol intake.

CONCLUSION

Multi-factorial lifestyle intervention, including low intensity alcohol intervention, improved long-term alcohol habits in a general population.

Obesity and hypertension: mechanisms, cardio-renal consequences, and therapeutic approaches

The increasing prevalence of obesity in the industrialized world is causing an alarming epidemic. Almost 70% of American adults are overweight or obese. The link between increasing body weight and hypertension is well established. Obesity hypertension through metabolic, endocrinic, and systemic hemodynamic alteration causes structural vascular and cardiac adaptations that trigger concentric, eccentric left ventricular hypertrophy and electrophysiological changes, which may increase the risk for congestive heart failure and sudden cardiac death as a result of arrhythmias. The increased renal blood flow in conjunction with a decreased renal vascular resistance causes renal hyperperfusion and hyperfiltration. Such changes lead to glomerulomegaly, focal segmental glomerulosclerosis, tubulointerstitial inflammation, and fibrosis that characterize the renal damage in obese hypertensive subjects. We propose that weight reduction, with the addition of other nonpharmacological approaches that included exercise and reduction in alcohol intake, should be the first choice to treat obesity hypertension. Salt restriction may be helpful only in salt-sensitive patients. The benefits of diet in obese patients include improvement of insulin sensitivity, reduction in sympathetic nervous and renin angiotensin system activities, and restoration of leptin sensitivity. As a consequence of these and other metabolic changes, the previously described systemic and renal hemodynamic alterations improved and the cardiovascular and renal morphological changes induced by obesity were lessened. After reviewing the medications available, we believe that owing to the cardiovascular and renal morbidity and mortality that characterized obesity hypertension, the ACEI or ARBs offer the best cardio-renal protection and should be the pharmacologic treatment of choice. If these alone do not control BP adequately, then a low-dose diuretic should be added as a second approach. Although we strongly believe in our proposal, more multicenter long-term clinical pharmacological trials are needed to evaluate the efficacy and safety of the antihypertensive approaches in the treatment of obesity hypertension.

Relationship between serum uric acid concentration, metabolic syndrome and carotid atherosclerosis

OBJECTIVE

Carotid intima-media thickness (IMT) is a useful surrogate marker of cardiovascular disease. Associations between hyperuricemia, metabolic syndrome and carotid IMT have been reported, but few of the studies have been conducted in a Japanese population.

METHODS

A total of 1,128 subjects (498 men aged, 68+/-14 years and 630 women aged 72+/-12 years) were divided into 4 groups according to serum uric acid (SUA) quartiles. We first investigated the association between SUA concentrations and metabolic syndrome; then, we assessed whether there is an independent association of SUA with carotid IMT in a population subdivided according to gender and metabolic syndrome status.

RESULTS

In women, the prevalence of visceral obesity and metabolic syndrome were significantly increased with increased SUA quartiles, but not in men. After adjusting for age, smoking status, LDL-cholesterol, creatinine and history of diabetes mellitus, the odds ratios (95% CI) of sex-specific quartiles of SUA for metabolic syndrome were 1.0, 1.37 (0.79-2.37), 1.37 (0.79-2.38), and 1.80 (1.03-3.15) in men, and 1.0, 1.04 (0.56-1.94), 2.35 (1.30-4.22), and 2.20 (1.16-4.20) in women. After adjusting for various known risk factors, the prevalence of carotid atherosclerosis (IMT> or =1.0 mm) was higher in subjects in the second, third and fourth quartiles of SUA concentration with odds ratios (95% CI) of 2.41 (1.08-5.37), 3.33 (1.49-7.42), and 2.73 (1.17-6.35), respectively in men without metabolic syndrome but not in men with metabolic syndrome or in women with or without metabolic syndrome.

CONCLUSION

The prevalence of metabolic syndrome was significantly increased according to SUA values only in women. In men without metabolic syndrome, SUA was found to be an independent risk factor for incidence of carotid atherosclerosis.

Hyperuricemia as a predictor of hypertension in a screened cohort in Okinawa, Japan

Several epidemiological studies have shown a positive association between serum uric acid levels and the risk of hypertension. However, subjects in these studies were mostly men, or were incompletely examined for lifestyle-related variables. We prospectively examined the relation between hyperuricemia and the risk of developing hypertension with consideration for alcohol consumption and smoking habits in a large screened cohort of men and women. A total of 4,489 individuals (2,927 men and 1,562 women) who did not have hypertension and were not currently using antihypertensive medication were examined at the Okinawa General Health Maintenance Association in 1977. Subjects were re-examined in 2000. Hyperuricemia was defined as a serum uric acid level >or=7.0 mg/dl in men and >or=6.0 mg/dl in women. Hypertension was defined as systolic blood pressure (SBP) >or=140 mmHg, and/or diastolic blood pressure (DBP) >or=90 mmHg. A total of 289 subjects (201 men and 88 women) were hypertensive (SBP >or=140 mmHg, and/or DBP >or=90 mmHg) in 2000. Multivariate analysis was performed for development of hypertension in hyperuricemic subjects, adjusted for age, family history of hypertension, alcohol consumption, cigarette smoking, obesity, hypercholesterolemia, hypertriglyceridemia, low high-density lipoprotein cholesterol, and diabetes mellitus. The adjusted odds ratio (95% confidence interval) in men was 1.48 (1.08-2.02) and in women was 1.90 (1.03-3.51) (p <0.05, respectively). The results showed hyperuricemia to be a new predictor of hypertension development in both men and women.

The Relationship Between Shift Work and the Onset of Hypertension in Male Japanese Workers

We assessed the effect of shift work on the onset of hypertension. The design of this study was that of a cohort study from 1991-2001. In sum, 5338 workers comprised this cohort. The event was the onset of hypertension (systolic blood pressure >or=140 mm Hg and/or diastolic blood pressure >or=90 mm Hg and/or medication). Pooled logistic regression analysis was performed, including job schedule type, age, body mass index, lifestyle, and the results of blood chemistries as covariates. The odds ratio of the onset of hypertension in shift workers for daytime workers was 1.10 and significant. Our study revealed that shift work independently affected the onset of hypertension, and suggested that shift work is a risk factor for the onset of hypertension.

Biobehavioral approaches to the treatment of essential hypertension

Despite recent advances in the medical management of hypertension, chronically elevated blood pressure remains a major health problem in the United States, affecting almost 50 million Americans. It is widely recognized that lifestyle factors contribute to the development and maintenance of elevated blood pressure. This article critically reviews current approaches to the nonpharmacological treatment of high blood pressure and highlights outcome studies of exercise, weight loss and dietary modification, and stress management and relaxation therapies. Methodological issues in the assessment and treatment of hypertension are discussed, along with possible mechanisms by which lifestyle modification may reduce elevated blood pressure.

Development of a structural equation model for causal relationships among arteriosclerosis risk factors

The purpose of this study was to clarify the dynamic causal relationships among arteriosclerotic risk factors, including age, smoking, alcoholic consumption, exercise, hypercholesterolemia, hypertriglyceridemia, and hypertension. Data were collected from the medical records of 400 male clients who visited a university hospital located in Inchon, Korea, from May 1996 to December 1996 for physical examinations. The Lineal Structural Relationships 8 program was used to verify the fitness of the hypothetical model to data. All of the fit statistics, except the Chi-square value, showed that the hypothetical model was well fitted to the data. Seven percent of obesity was explained by the variables of age, smoking, alcohol consumption, and exercise. Sixty percent of hyperlipidemia could be explained by the variables of age, smoking, exercise, and obesity. And 22% of hypertension was explained by the variables of age, smoking, alcohol consumption, exercise, and hyperlipidemia. Our results showed that these risk factors were directly and indirectly interrelated, and lifestyle variables (smoking, alcohol consumption, and exercise) influence almost all of arteriosclerotic risk factors.

Alcohol consumption and hypertension

Many observational studies have shown a relationship between three or more alcoholic drinks daily and hypertension. Reduction in alcohol intake is associated with lowering of blood pressure in randomized clinical trials: each drink per day reduction in intake lowers systolic and diastolic blood pressure by approximately 1 mm Hg. Although regular alcohol consumption seems to reduce the incidence of atherothrombotic cardiovascular events, excessive alcohol intake increases the risk of many medical and psychosocial problems. For persons with hypertension who drink excessively, average maximum alcohol intake of one drink per day in women and two drinks per day in men is a reasonable goal, if drinking is not otherwise contraindicated.

Alcohol consumption and risk for hypertension in middle-aged Japanese men

OBJECTIVE

To investigate the association of alcohol intake with development of hypertension.

DESIGN

Longitudinal study (followed from 1990 to 1999).

SETTING

Work site in Osaka, Japan.

PARTICIPANTS

Japanese male office workers (n = 1,310) hypertension-free, with systolic blood pressure (SBP) less than 140 mmHg, diastolic blood pressure (DBP) less than 90 mmHg, no medication for hypertension, and no past history of hypertension, 30 to 59 years of age at study entry.

MAIN OUTCOME MEASURE

Incidence of hypertension.

RESULTS

After controlling for potential predictors of hypertension, the relative risk for hypertension (SBP 140 mmHg or greater and/or DBP 90 mmHg or greater or receipt of antihypertensive medication) compared with non-drinkers was 1.52 [95% confidence interval (CI), 1.05 to 2.19] for persons who drank 0.1 to 22.9 g/day of ethanol, 1.81 (95% CI, 1.29 to 2.54) for those who drank 23.0 to 45.9 g/day of ethanol, 2.12 (95% CI, 1.53 to 2.94) for those who drank 46.0 to 68.9 g/day of ethanol, and 2.48 (95% CI, 1.75 to 3.52) for those who drank > or = 69.0 g/day of ethanol (for trend, P < 0.001). The relative risk for hypertension in current drinkers versus non-drinkers was stronger among men with a body mass index (BMI) less than 24.2 kg/m2 than among men with a BMI 24.2 kg/m2 or more, although the absolute risk was greater in more obese men.

CONCLUSIONS

The risk for hypertension increased in a dose-dependent manner as alcohol intake increased in middle-aged Japanese men. The increased relative risk for hypertension associated with alcohol was more pronounced in leaner men.

Favorable life-style modification and attenuation of cardiovascular risk factors

In order to develop an effective counseling system for prevention of cardiovascular diseases, the association of a favorably changed life-style with improved risk factors was examined. Participants were 7,321 office workers aged 30-69 years from in and around Nagoya city. The age-adjusted odds ratio (OR) and its 95% confidence interval (CI) were calculated to assess the likelihood of risk factor improvement by favorable life-style modifications during a 3-year period. Those who began to eat breakfast and increased their vegetable intake normalized their previously abnormal diastolic blood pressure with more than twice the likelihood (adjusted OR [95% CI] 2.89 [1.29-6.46] and 2.60 [1.18-5.75], respectively). 'Began to eat breakfast' was also significantly associated with normalized total cholesterol (TC) (1.84, [1.05-3.21]). 'Stopped eating till full' significantly normalized the body mass index (2.03; [1.25-3.28]), uric acid (1.65; [1.07-2.52]) and TC (1.43; [1.04-1.97]). Those who started regular exercise significantly normalized their high-density lipoprotein-cholesterol (HDL-C) abnormality with 1.69-times the likelihood (1.69; [1.24-2.29]) and those who began to walk briskly also improved their TC abnormality (1.85; [1.19-2.89]). HDL-C was normalized with 2.55-times the likelihood in those who quit smoking (2.55; [1.68-3.86]). Because favorable life-style modifications can attenuate abnormal cardiovascular risk factors, then proper advice on specific risk factors should be routinely given at each health check-up in order to prevent the onset of cardiovascular diseases in subsequent years.

Associations of smoking, alcohol and physical activity with risk factors for coronary heart disease and diabetes in the first follow-up cohort of the Heart Disease and Diabetes Risk Indicators in a Screened Cohort study (HDDRISC-1)

OBJECTIVES

To investigate the associations between risk factors for cardiovascular disease and cigarette smoking, alcohol intake, and physical activity in a group of predominantly healthy men.

DESIGN

Cohort study with baseline characterisation, clinical follow-up, and identification of predictors of coronary artery disease and diabetes.

SETTING

University hospital metabolic day ward.

SUBJECTS

Participants in a company health programme (n=742).

MAIN OUTCOME MEASURES

Routine haematology and biochemistry, cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol (on a subset of 522 subjects), and glucose and insulin levels during a 3 h oral glucose tolerance test (OGTT).

RESULTS

Independent associations with previous cigarette smoking included high uric acid and low HDL cholesterol, and with current cigarette smoking, high haemoglobin and white cell count and low OGTT insulin. Increasing alcohol intake was associated with increasing blood pressure, uric acid, HDL cholesterol and fasting glucose. The moderate range of exercise intensity in this cohort was associated with decreasing systolic blood pressure, fasting insulin and OGTT glucose and insulin. Factor analysis distinguished principal factors comprising features of the metabolic syndrome with low physical activity, and high white cell count, high haemoglobin concentration and low HDL cholesterol with increasing previous and current cigarette smoking and alcohol intake.

CONCLUSIONS

Some characteristics of the metabolic syndrome were seen with previous but not current smoking habit. Regular alcohol consumption was associated with mainly unfavourable metabolic characteristics, although there was an independent beneficial association with HDL cholesterol. The improved metabolic syndrome profile seen with increasing exercise is consistent with even moderate degrees of physical activity having beneficial effects on metabolism.

Alcohol intake and blood pressure: the importance of time elapsed since last drink

BACKGROUND

A positive association of chronic exposure to alcoholic beverages with blood pressure and the prevalence of hypertension has been described in epidemiological surveys, but the influence of time elapsed since last ingestion in this setting was not demonstrated.

DESIGN

A cross-sectional, population-based survey.

METHODS

In total 1089 adults from Porto Alegre, randomly selected from a population-based, multi-stage probability sample, were interviewed at home. The average daily alcohol intake of each subject was calculated taking into account the concentration of ethanol in the beverages (distilled or fermented beverages), and the time elapsed between the last ingestion of ethanol and the moment of blood pressure determination. Standardized sitting blood pressure and anthropometric parameters were collected. The magnitude and shape of the associations were analyzed considering blood pressure as a continuous variable and the prevalence of arbitrarily defined hypertension. Simple and multiple linear regression models, including models to identify nonlinear associations, with quadratic and cubic terms of the amount of alcohol consumed, were employed. Blood pressure means were compared by analysis of variance and analysis of covariance. The association between hypertension and exposure to ethanol was analyzed through logistic regression models, controlling for various potential confounders.

RESULTS

Positive nonlinear associations of the amount of alcohol consumed with blood pressure and the prevalence of hypertension (> or = 160/95 mmHg) were found, independent of age, years of education, smoking, and use of oral contraceptive and antihypertensive drugs. The consumption of 30 g/day ethanol was associated with increases of 1.5 and 2.3 mmHg in diastolic and systolic blood pressures, respectively, for men, and 2.1 and 3.2 mmHg, respectively, for women. The prevalence of hypertension was higher among those ingesting more than 30 g/day (odds ratio = 2.9, P < 0.01). The time elapsed between the last ingestion and blood pressure measurement was independently associated with the prevalence of hypertension. Men with last consumption of alcohol 13-23 h prior to measurement had odds of being hypertensive 2.6 (confidence interval 1.3-5.0) greater than did subjects who had consumed alcoholic beverages 24 h and more before the blood pressure determination. For men, systolic and diastolic blood pressures were lower during the first 3 h after ingestion and increased afterward. Frequency of consumption and type of beverage consumed were not independently associated with level of blood pressure.

CONCLUSION

A time-dependent association between alcohol consumption and effects on blood pressure, demonstrated in experimental studies, was found for free-living individuals selected at random.

Geriatric substance use disorders

AUDs are increasingly recognized as common problems among older adults. The magnitude of this problem is likely to increase over ensuing decades as baby boomers reach retirement age with drinking habits that are significantly different from current cohorts of older adults. Barriers to detection are numerous and include nonspecificity of alcohol-related presentations, patient denial, and clinicians' unwillingness to recognize that patients can and do develop alcohol problems in later life. Despite the limitations of current screening and diagnostic instruments, the authors recommend use of the CAGE as a formal screening tool for older patients because of its brevity, demonstrated efficacy, and convenience. In patients who answer affirmatively to any CAGE question, diagnostic certainty can be increased by use of follow-up questions or referral to an alcohol treatment specialist. Referral of patients with established alcohol abuse or dependence is essential for definitive treatment, and successful outcomes can be expected and are gratifying once achieved. In patients with less severe AUDs, brief interventions with frequent follow-up are recommended. Age-specific screening and diagnostic instruments for older AUD patients, once fully developed and validated, will facilitate identification. Much less is known about other substance use disorders in older adults. Psychoactive drug use is not uncommon in this patient population and may result in adverse health outcomes. Treatment interventions proposed for AUDs are advocated for older adults found to have other substance use disorders as well and are likely to yield improved outcomes. Future investigations that better define the epidemiology, detection, and treatment of other substance use disorders in older populations are clearly warranted at this time.

The effects of recent food, alcohol, and tobacco intake and the temporal scheduling of testing on cardiovascular activity at rest and during psychological stress

Participants in cardiovascular psychophysiological studies receive various instructions regarding restraints on alcohol, food, and tobacco intake prior to testing. Further, although the hour of testing is frequently a concern, little attention is paid to month of the year. In the present study, we examined cardiovascular activity at rest and in response to a laboratory stress task in 1,272 men in terms of these variables. Alcohol consumption among alcohol users and food intake within 4 hr of testing were associated with higher baseline diastolic blood pressure (BP) but lower baseline heart rate (HR). Tobacco use in smokers within 1 hr of testing was associated with elevated baseline BP and HR. Hour of testing was related to baseline HR, whereas month of the year was associated with baseline BP. In contrast to these baseline effects, cardiovascular reactions to the laboratory stress task were largely immune to these contextual influences.

Alcohol and hypertension

Epidemiologic studies in the past two decades have firmly established a relationship between regular, heavier alcohol consumption and hypertension. This association has been demonstrated in both cross-sectional and prospective studies. It is found in both sexes and several races and is independent of the type of alcoholic beverage, adiposity, education, smoking, salt intake, and several other traits. Clinical experiments show that blood pressure falls in days to weeks with abstinence from alcohol and that it rises again within days after resuming drinking. No mechanism has been demonstrated for this alcohol/blood pressure effect. Alcohol withdrawal symptoms have not been seen in the clinical experiments; thus, this is not likely to be the major explanation. Studies of the role of alcohol in hypertension sequelae, such as coronary heart disease and stroke, have been difficult because of the effects of alcohol, independent of blood pressure, in these conditions. Overall, it is likely that this alcohol-hypertension relation is causal. Restriction of intake by heavier drinkers lowers blood pressure in some, and heavy alcohol ingestion should always be considered by clinicians as a possible hypertension risk factor.

Alcohol, coronary disease, and hypertension

Disparities in the relationships between alcohol consumption and various cardiovascular conditions are now evident, with complex interrelationships between conditions. An inverse relationship of alcohol use to coronary heart disease is supported by many population studies. Interpretation of these data as a protective effect of alcohol against coronary disease is strengthened by plausible mechanisms. Although some experimental data suggest the hypothesis that wine, in particular, has additional protective benefit, prospective studies show no consensus on this point. Strong, consistent epidemiologic data support a relationship of heavier drinking to hypertension. Intervention studies show a pressor effect of alcohol, which appears and regresses within several days, but a mechanism has not yet been established. As with most aspects of alcohol and health effects, the data do not suggest monotonic relationships of alcohol with these conditions. Thus, amount of alcohol taken is a crucial consideration. Advice to concerned persons needs to take into account individual factors in drinkers or potential drinkers.

The risk of alcohol

We have reviewed 156 papers which provided sufficient information to relate individual alcohol consumption to risk for a variety of physical damage. Overall, there was evidence for a dose-response relationship between level of alcohol consumption and risk of harm for liver cirrhosis, cancers of the oropharynx, larynx, oesophagus, rectum (beer only), liver and breast, and blood pressure and stroke. An increased risk of cardiac arrhythmias, cardiomyopathy and sudden coronary death was associated with heavy drinking. There was evidence for a protective effect of alcohol consumption against risk of coronary heart disease, which could be achieved at consumption levels of less than 10 g alcohol a day. The mortality of non-drinkers was higher than that of moderate drinkers in some studies. Level of alcohol consumption and total mortality were dose-related when non-drinkers were excluded. The finding of a dose-relationship between alcohol and harm suggested causality. It was not possible to define individual risk for all harms at a given level of alcohol consumption because of variations in methodology, but some idea of the order of magnitude of the increased risk can be obtained from calculating trends of pooled log-odds ratios. At levels of alcohol consumption of more than 20-30 g a day, all individuals are likely to accumulate risk of harm. Current guidelines on upper limits of lower risk drinking in different countries (168-280 g of alcohol a week for men and 84-140 g a week for women) reflect levels at which the risk of total mortality is not greatly increased above one.

Alcohol drinking and cigarette smoking: an exploration of the association in middle-aged men and women

The association of alcohol and cigarette consumption was explored among 13,673 black or white persons aged 40-49 years, who received check-ups from mid-1979 to 1985. Alcohol use was strongly associated with number of cigarettes smoked per day, but not with tar-yield, mentholation and presence of filters. Duration of cigarette use, frequency and depth of inhalation, proportion of cigarette smoked and greater time from arising to first cigarette were significantly related to alcohol use in some but not all race-sex groups. Among smokers who consumed alcohol, liquor drinkers smoked the most cigarettes per day and wine drinkers the least. Thus, the association between alcohol drinking and cigarette smoking is strong in middle-aged persons but there are race- and sex-related disparities when specific aspects of smoking behaviour are considered.

How much alcohol is in a 'standard drink'? An analysis of 125 studies

A group of researchers have undertaken a review of 125 international, published, epidemiological studies that relate various physical harms to different levels of alcohol consumption. For this review it was necessary to be able to compare the data from the different studies directly. The different measures of alcohol quoted in the studies were converted to the standard measure of grammes of alcohol. The present paper discusses the problems involved in doing this, and gives details of the conversion methods used.

The Canadian consensus report on non-pharmacological approaches to the management of high blood pressure

The Canadian Consensus Conference on Non-Pharmacological Approaches to the Management of High Blood Pressure reviewed in March, 1989 on its meeting in Halifax, Nova Scotia, data concerning the efficacy of eight interventional strategies used for controlling hypertension. These strategies were as follows: alcohol restriction, weight reduction, physical exercise, reduction of salt intake, relaxation/stress management, increase of potassium and calcium intake and combination of pharmacological and non-pharmacological management. The Panel of the Consensus Conference recommended as efficacious the following interventions: alcohol restriction for less than two standard drinks per day, reduction of excessive body weight, and reduction of salt intake. There is sufficient scientific evidence for recommending potassium rich diet for normotensives and hypertensive persons. The Panel also concluded that a combination of pharmacological and non-pharmacological management is an efficacious measure. The Panel at this point of time could not issue recommendations as to the value of relaxation/stress management, physical exercise and calcium intake.

Alcohol intake and blood pressure in young adults: the CARDIA Study

Associations between self-reported average daily alcohol intake and blood pressure were assessed in 5031 black and white men and women ages 18-30 from the Coronary Artery Risk Development in Young Adults Study (CARDIA). In general, intake was positively but weakly related to both systolic and diastolic blood pressure. Associations with systolic pressure were generally stronger than those with diastolic pressure. With average daily alcohol intake categorized as none, 0.1-9.9 ml, 10.0-19.9 ml, 20.0-29.9 ml, and 30.0+ ml, mean systolic pressure, adjusted for age, body mass index, education, smoking, and physical activity, increased progressively with increasing intake in black and white men and in white women. Mean diastolic pressure increased progressively with increasing intake only in white men and women, but was highest for those averaging 30.0+ ml per day in black women as well as white men and women. Mean pressures were also compared for those averaging 75.0+ ml per day (men) or 50.0+ ml per day (women) vs those reporting no intake. Differences in adjusted mean pressures for white men were 3.2 mmHg (95% confidence limits (CL) -0.3, 6.8) for systolic pressure and 1.7 mmHg (-1.6, 5.0) for diastolic pressure. In black men differences were 4.4 mmHg (1.4, 7.4) and 3.4 mmHg (0.6, 6.3), respectively. Differences in white women were 1.4 mmHg (-2.5, 5.3) for systolic pressure and 0.9 mmHg (-2.7, 4.5) for diastolic pressure and for black women, -0.2 mmHg (-4.3, 3.8) and 1.9 mmHg (-1.9, 5.8). Separate analyses in smokers and nonsmokers of the associations between alcohol intake and blood pressure suggested that associations may differ by smoking status in some sex-race groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Derivation and validation of a prediction rule for identifying heavy consumers of alcohol

Using two population-based cohorts of men aged 45-59, we sought to derive and validate a prediction rule for identifying heavy consumers of alcohol. Eighty-five percent of eligible men on electoral rolls in Caerphilly, Wales (derivation set, N = 2512) and 90% of eligible men on the practice lists of 16 Speedwell, England, general practitioners participated (validation set, N = 2348). Alcohol consumption was assessed by questionnaire with heavy alcohol consumption defined as the top 10% of the Caerphilly population's alcohol usage (greater than 525 cc ethanol per week). The prediction rule, Score = (mean corpuscular volume x 1.00) + (body mass index x 0.31) + (systolic blood pressure x 0.08) + HDL-cholesterol x 9.24) + (fasting triglyceride x 2.20) was derived by multiple linear regression in the Caerphilly cohort and validated in the Speedwell cohort. Comparing the lower 20% of the Score distribution with the upper 5%, likelihood ratios increased from 0.15 to 5.29 and 0.06 to 7.42 in the Caerphilly and Speedwell cohorts, respectively. Having a score of 136.30 or greater yielded a relative risk of being a heavy drinker of 23.1 (95% Cl = 10.1-53.0) in Caerphilly and 99.3 (95% Cl = 12.8-769.5) in Speedwell. The derived prediction rule is a valid diagnostic aid to help clinicians identify heavy alcohol consumers.

Is there statistical evidence for a blood lead-blood pressure relationship?

In this paper we show that there is weak statistical evidence for a blood lead-blood pressure relationship in the second National Health and Nutrition Examination Survey data. The significance and magnitude of this relationship for 40-59 year old white males as originally reported by Pirkle, Schwartz, Landis, and Harlan does not characterize other age and sex samples and is sensitive to the use of blood pressure data of questionable quality.