Alcohol consumption and electrocardiographic left ventricular hypertrophy and mediation by elevated blood pressure in older Chinese men: the Guangzhou Biobank Cohort Study

Associations of Alcohol Consumption With Left Atrial Morphology and Function in a Population at High Cardiovascular Risk

BACKGROUND

Excessive alcohol consumption has been associated with increased risk of atrial fibrillation, although the underlying mechanisms remain unclear. An enlarged left atrium and impaired left atrial function may lead to atrial fibrillation. The association of alcohol consumption with structural and functional left atrial measures, however, has received limited attention.

METHODS AND RESULTS

We studied 503 participants from the PREDIMED-Plus (Prevención con Dieta Mediterránea) trial, a randomized trial testing intensive weight loss intervention with an energy-reduced Mediterranean diet and physical activity promotion in preventing cardiovascular disease in adults with metabolic syndrome. Participants underwent transthoracic echocardiography at baseline, year 3, and year 5 of the study. Outcomes of interest included volume index and reservoir, conduit, and contractile strains of the left atrium. Alcohol consumption was calculated through food frequency questionnaires and presented as drinks consumed per day. Multiple linear regression and mixed models estimated the association of alcohol consumption with left atrial measurements at baseline and through follow-up. Cross-sectionally, higher alcohol consumption (per 1 drink/day increases) was associated with larger left atrial volume (0.65 mL/m2 [95% CI, 0.18-1.11]) and lower left atrial reservoir and contractile strain (-0.44% [95% CI, -0.87 to -0.01]; and -0.44% [95% CI, -0.75 to -0.14]). Baseline alcohol consumption was not associated with changes in left atrial measurements, but increases in alcohol consumption (per 1 drink/day increase) during follow-up were associated with left atrial enlargement (0.71 mL/m2 [95% CI, 0.17-1.26]).

CONCLUSIONS

In a population at high cardiovascular risk, increased alcohol consumption was associated with left atrial enlargement and worsening atrial function.

REGISTRATION

URL: http://www.controlled-trials.com; Unique identifier: ISRCTN89898870.

Association of insulin resistance and glycemic measures with major abnormal electrocardiogram in older Chinese: Cross-sectional analysis based on the Guangzhou Biobank Cohort study

AIMS

To examine whether insulin resistance (IR) and glycemic measures were associated with major abnormal electrocardiogram (MA-ECG) and its specific abnormalities in the general population.

METHODS

Twelve-lead ECG measurements were performed on 21,720 participants without cardiovascular disease (5,918 men) from the Guangzhou Biobank Cohort Study. The participants were aged 50 years or above (mean age 61.6, standard deviation 7.1 years). Logistic regression was used to assess the associations of IR and glycemic measures with MA-ECG and specific abnormalities.

RESULTS

Ln-fasting insulin was significantly associated with MA-ECG and ST-T abnormalities (adjusted odds ratio = 1.52, 95 % confidence interval = 1.15-2.02 and 1.83, 1.37-2.45, respectively, for per standard deviation), which were stronger than those of TyG index with MA-ECG (1.08, 1.04-1.13) and ST-T abnormalities (1.16, 1.11-1.22). Ln-fasting insulin had association with Q wave abnormalities (3.19, 1.52-6.67). The association of TyG index with prolonged QTc varied by sex and obesity (P for interaction ≤ 0.01). Participants with diabetes had stronger associations of ln-fasting plasma glucose with ECG abnormalities than those without.

CONCLUSIONS

IR and glycemic measures were associated with MA-ECG, ischemia and prolonged QTc in older Chinese, especially in women, those with obesity, and those with diabetes. These findings underscore the importance of regular evaluations for these groups.

Association of sleep duration and napping with stroke mortality in older Chinese: A 14-year prospective cohort study of the Guangzhou Biobank Cohort study

STUDY OBJECTIVE

Evidence regarding the association of short sleep duration and napping with stroke remains limited and controversial. We examined the association of sleep duration and napping with risk of stroke mortality in an older Chinese cohort.

METHODS

Sleep duration and daytime napping were assessed by face-to-face interview during 2003-2008. Information of causes of death until April 30, 2021 was collected via record linkage with the Death Registry. Cox regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI).

RESULTS

Of 27,254 participants aged average 62.0 (standard deviation = 7.1) years, 818 stroke deaths occurred within 388,798 person-years (mean = 14.3 years) of follow-up. A U-shaped relation between sleep duration and risk of stroke mortality was observed. Participants with short (≤5 h/day) or long sleep duration (≥9 h/day) showed higher risks of total stroke mortality, with adjusted HRs (95% CIs) being 1.27 (1.01-1.59) and 1.37 (1.07-1.75), respectively. However, non-significant association of short or long sleep duration with hemorrhagic or ischemic stroke mortality was found. The associations of short and long sleep duration with total stroke mortality were more pronounced in those with hypertension (P for interaction with hypertension = 0.01), with HRs (95% CIs) being 1.37 (1.04-1.82) and 1.77 (1.33-2.36), respectively. No association between napping and risk of stroke mortality was found.

CONCLUSIONS

Both short and long sleep duration, but not daytime napping, were associated with higher risk of stroke mortality. Public health messages to encourage good sleep hygiene may be important, especially for people with hypertension.

Changes in Alcohol Consumption and Risk of Heart Failure: A Nationwide Population-Based Study in Korea

Background: The association between alcohol intake and newly developed heart failure remains unclear. We aimed to measure the change in alcohol intake between two timepoints to evaluate the association of alcohol consumption with incident heart failure using a population-based study in Korea. Methods: Using the Korean National Health Insurance database, participants who underwent two subsequent national health examinations in 2009 and 2011 were included. Participants were classified into four groups according to total alcohol intake (none: 0 g alcohol/day; light: <15 g alcohol/day; moderate: 15−30 g alcohol/day; and heavy: ≥30 g alcohol/day), and changes in alcohol consumption between the two health exams were grouped into the following five categories: abstainers, sustainers (those who maintained their first examination drinking level), increasers, reducers, and quitters. After adjustment for age, sex, smoking status, regular exercise, socioeconomic information, and comorbidities, the Charlson Comorbidity Index, systolic blood pressure, and laboratory results, a Cox proportional hazards model was used to find the risk of newly diagnosed heart failure (according to ICD-10 code I50 from claims for the first hospitalization) as the primary endpoint. A subgroup analysis among those with a third examination was conducted to reflect further changes in alcohol consumption. Results: Among 3,842,850 subjects, 106,611 (3.0%) were diagnosed with heart failure during the mean follow-up period of 6.3 years. Increasers to a light level of drinking had a lower HF risk compared with abstainers (aHR = 0.91, 95% CI: 0.89−0.94). Those who increased their alcohol intake to a heavy level had a higher HF risk (from light to heavy (aHR = 1.19, 95% CI: 1.12−1.26) and from a moderate to heavy level (aHR = 1.13, 95% CI: 1.07−1.19). Reducing alcohol from a heavy to moderate level was associated with lower HF risk (aHR = 0.90, 95% CI: 0.86−0.95). Conclusion: This study found that light and moderate sustainers had lower incident heart failure risk compared with abstainers. Increased alcohol consumption from light to moderate to heavy was associated with a higher incident heart failure risk.

Changes in blood pressure and cardiovascular disease in middle-aged to older Chinese: the Guangzhou Biobank Cohort Study

BACKGROUND

Most studies on the associations of blood pressure (BP) with cardiovascular disease (CVD) risk were based on single or average BP levels. Knowledge on the association between BP trajectories and CVD in middle-aged individuals who are not on antihypertensive medication may inform the care of individuals in this group whose BPs are not controlled.

METHODS

Eight thousand nine hundred and sixty-nine participants aged 50-70 years, without CVD at baseline and not taking antihypertensive medication throughout the study, were included. Four time-points data from the Guangzhou Biobank Cohort Study were used to identify BP trajectories using latent class mixed model. Cox regression was used to investigate the association of BP trajectories with fatal and nonfatal CVD till April 2021.

RESULTS

Three SBP trajectories were identified: 'low-slow-increase' characterized by SBP from 110 to 125 mmHg (86.5%); 'low-increase' from 110 to 150 mmHg (8.1%) and 'moderate-increase' from 125 to 155 mmHg (5.4%). Compared with the low-slow-increase group, the moderate-increase had the highest risk of CVD (hazard ratio = 1.76, 95% confidence interval = 1.34-2.29), ischemic heart disease (1.77, 1.01-3.09), myocardial infarction (3.52, 1.58-7.85), all strokes (1.88, 1.37-2.60), ischemic stroke (1.65, 1.10-2.49), haemorrhagic stroke (3.98, 1.30-12.12) and CVD mortality (2.41, 1.55-3.76). Higher risks of CVD (1.27, 1.01-1.61) and ischemic stroke (1.49, 1.07-2.09) in the low-increase group were also found.

CONCLUSION

Most people between 50 and 70 years of age and not taking antihypertensive medication maintained a slow increase SBP trajectory over a follow-up period of approximately 7 years. However, those whose SBPs increased from low and moderate levels were associated with higher CVD risks.

Aortic arch calcification and risk of all-cause mortality and cardiovascular disease: The Guangzhou Biobank Cohort Study

Background

There were no reports on the associations of aortic arch calcification (AAC) measured by chest X-ray with all-cause mortality and cardiovascular disease (CVD) in older general population. Moreover, previous studies of hemodialysis patients showed that AAC was correlated with left ventricular hypertrophy (LVH) and predicted CVD jointly. Whether the effects remained in the general population is unknown. We examined the associations of AAC with all-cause mortality and CVD in general population and the risk associated with the coexistence of AAC and LVH.

Methods

Presence and severity (grades 0-2) of AAC were measured by chest X-ray, and LVH was identified by 12-lead electrocardiogram in 27,166 Chinese aged 50+ years free of CVD from Guangzhou Biobank Cohort Study. Multivariate Cox regressions were used to examine associations of AAC and LVH with outcomes.

Findings

During an average follow-up of 14·3 years, 5,350 deaths and 4,012 CVD occurred. Compared to those without AAC at baseline, those with AAC had higher risks of all-cause mortality (HR 1·24, 95% CI 1·17-1·31) and CVD (HR 1·22, 95% CI 1·14-1·30), with dose-response relationship (P ≤ 0·001). Furthermore, those with coexistence of AAC and LVH had higher risks of all-cause mortality (HR 1·72, 95% CI 1·37-2·15) and CVD (HR 1·80, 95% CI 1·40-2·32) than those without AAC and LVH.

Interpretation

As chest X-ray has been performed commonly for health screening and in hospital patients when first admitted, AAC measured by chest X-ray can be further applied to assist cardiovascular risk stratification in the community and clinical settings.

Funding

The Natural Science Foundation of China (No. 81941019).

Association of Dietary Patterns Derived Using Reduced-Rank Regression With Subclinical Cardiovascular Damage According to Generation and Sex in the STANISLAS Cohort

Background

The diet impact on cardiovascular diseases has been investigated widely, but the association between dietary patterns (DPs) and subclinical cardiovascular damage remains unclear. More informative DPs could be provided by considering metabolic syndrome components as intermediate markers. This study aimed to identify DPs according to generation and sex using reduced‐rank regression (RRR) with metabolic syndrome components as intermediate markers and assess their associations with intima‐media thickness, left ventricular mass, and carotid‐femoral pulse‐wave velocity in an initially healthy population‐based family study.

Methods and Results

This study included 1527 participants from the STANISLAS (Suivi Temporaire Annuel Non‐Invasif de la Santé des Lorrains Assurés Sociaux) cohort fourth examination. DPs were derived using reduced‐rank regression according to generation (G1: age ≥50 years; G2: age <50 years) and sex. Associations between DPs and cardiovascular damage were analyzed using multivariable linear regression models. Although identified DPs were correlated between generations and sex, qualitative differences were observed: whereas only unhealthy DPs were found for both men generations, healthy DPs were identified in G2 (“fruity desserts”) and G1 (“fiber and w3 oil”) women. The “alcohol,” “fast food and alcohol,” “fried, processed, and dairy products,” and “meat, starch, sodas, and fat” DPs in G1 and G2 men and in G1 and G2 women, respectively, were associated with high left ventricular mass (β [95% CI], 0.23 [0.10–0.36], 0.76 [0.00–1.52], 1.71 [0.16–3.26], and 1.80 [0.45–3.14]). The “alcohol” DP in G1 men was positively associated with carotid‐femoral pulse‐wave velocity (0.22 [0.09–0.34]).

Conclusions

The DPs that explain the maximum variation in metabolic syndrome components had different associations with subclinical cardiovascular damage across generation and sex. Our results indicate that dietary recommendations should be tailored according to age and sex.

Clinical Trial Registration

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01391442.

The association between alcohol consumption and left ventricular diastolic function and geometry change in general Korean population

Aims

The adverse effect of heavy alcohol intake on cardiovascular disease is well established. However, there is only limited information about the risk of subclinical left ventricular (LV) abnormality according to alcohol consumption. Thus, this study was to investigate the association between alcohol consumption and LV functional and structural abnormality.

Methods and results

Study participants were 49 714 Korean adults received echocardiogram as an item of health check-up program. They were stratified into 6 groups according to alcohol consumption; non (life time never drinker), occasional (<1 g/day), light (1-15 g/day), moderate (15-30 g/day), heavy (30-60 g/day), and very heavy (>60 g/day) drinker. Multiple logistic regression analysis was used to assess the odd ratios (ORs) for LV hypertrophy (LVH), increased relative wall thickness (RWT) and impaired LV diastolic (LVD) function with a reference of non-drinker. Additionally, the adjusted mean values of echocardiographic parameters were evaluated to assess LV diastolic function and structure. In logistic regression analysis, very heavy alcohol drinker had the highest adjusted ORs for LVH, increased RWT and impaired LVD function in all participants and male subgroup (P < 0.05). The dose dependent relationship was found between alcohol consumption and impaired LVD function in all participants and gender subgroups. There was no specific pattern of relationship to suggest the favourable effect of light alcohol drinking on heart.

Conclusion

Increased alcohol intake had the adverse effect on LV function and structure. However, potential favourable effect of light alcohol intake was not observed. Prospective studies are required to investigate long-term effect of alcohol consumption on subclinical LV change.

Light-moderate alcohol consumption and left ventricular function among healthy, middle-aged adults: the HUNT study

OBJECTIVES

To investigate the association between alcohol consumption and left ventricular (LV) function in a population with low average alcohol intake.

DESIGN, SETTING AND PARTICIPANTS

A total of 1296 healthy participants, free from cardiovascular diseases, were randomly selected from the third wave of the Norwegian HUNT study (2006-2008) and underwent echocardiography. After validation of the inclusion criteria, 30 participants were excluded due to arrhythmias or myocardial or valvular pathology. Alcohol consumption, sociodemographic and major cardiovascular risk factors were assessed by questionnaires and clinical examination in the HUNT3. General linear models were used to analyse the cross-sectional associations between alcohol intake and LV indices.

PRIMARY AND SECONDARY OUTCOME MEASURES

LV functional and structural indices were measured with tissue Doppler and speckle tracking echocardiography.

RESULTS

We observed no associations between alcohol consumption and multivariable-adjusted LV functional indices. Excluding abstainers who reported regular alcohol consumption 10 years prior to the baseline did not change the results. Alcohol consumption was positively associated with LV mass indices (p<0.01 for linear trend of the means); there was no such association among participants with non-risky drinking characteristics (p=0.67 for linear trend of the means).

CONCLUSIONS

We found no clear evidence that light-moderate alcohol consumption is associated with measures of LV function, although our results indicate that consumption, especially when marked by binge drinking, is progressively associated with greater LV mass.

Detection of serum melanoma-associated antigen D4 in patients with squamous cell carcinoma of the esophagus

Despite improvements in surgical techniques, perioperative management, and multidisciplinary therapy, treatment outcomes of patients with esophageal squamous cell carcinoma (ESCC) remain poor. Therefore, development of novel molecular biomarkers, which either predict patient survival or become therapeutic targets, is urgently required. In the present study, to facilitate early detection of ESCC and predict its clinical course, we investigated the relationship of the serum level of melanoma-associated antigen (MAGE)-D4 to patients' clinicopathological characteristics. Using quantitative real-time reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assays, we determined the levels of MAGE-D4 mRNA and protein in cell lysates and conditioned medium of cultures, respectively, of nine ESCC cell lines. Further, we determined MAGE-D4 levels in serum samples collected from 44 patients with ESCC who underwent radical esophagectomy without neoadjuvant therapy as well as from 40 healthy volunteers. Samples of conditioned medium and cell lysates contained comparable levels of MAGE-D4 that correlated closely with the levels of MAGE-D4 mRNA. Preoperative MAGE-D4 levels in the sera of 44 patients with ESCC, which varied from 0 to 2,354 pg/mL (314 ± 505 pg/mL, mean ± standard deviation), were significantly higher compared with those of healthy volunteers. By setting the cutoff at the highest value for healthy volunteers (50 pg/mL), the MAGE-D4-positive group of patients was more likely to have shorter disease-specific and disease-free survival compared with those of the MAGE-D4-negative group, although the differences were not statistically significant. Our results indicate that the elevation of preoperative serum MAGE-D4 levels in some patients with ESCC was possibly caused by excess production of MAGE-D4 by tumor cells followed by its release into the circulation. Clinical implications of serum MAGE-D4 levels should be validated in a large population of patients with ESCC.

Adherens junctions associated protein 1 serves as a predictor of recurrence of squamous cell carcinoma of the esophagus

Esophageal squamous cell carcinoma (ESCC), the most common esophageal cancer in East Asia, is among the six cancers with the highest fatality rates worldwide. Unfortunately, multidisciplinary treatment strategies have not achieved satisfactory outcomes. Therefore, novel insights into the molecular biology of ESCC are required to improve treatment. The gene encoding the transmembrane adherens junctions-associated protein-1 (AJAP1) expressed by epithelial cells resides in chromosome 1p36, which is frequently lost or epigenetically silenced in several malignancies. Here, we investigated the expression levels and regulatory mechanism of AJAP1 transcription. We determined the levels of AJAP1 mRNA and the genes encoding potentially interacting proteins expressed by ESCC cell lines, as well as the chromosomal copy number of AJAP1 and the methylation status of its promoter region. AJAP1 mRNA levels of 78 pairs of surgically resected specimens were determined to evaluate the association of AJAP1 expression and clinicopathological factors. Nine ESCC cell lines differentially expressed AJAP1 mRNA, and demethylation of hypermethylated AJAP1 genomic DNA reactivated AJAP1 mRNA expression. The copy number of sequences upstream or downstream of the AJAP1 transcriptional start site was not detectably altered. AJAP1 mRNA levels correlated inversely with those of ezrin (EZR) and were significantly lower in ESCC tissues compared with adjacent normal tissues. AJAP1 mRNA levels decreased gradually with increasing tumor stage. Patients with downregulated AJAP1 transcription were more likely to experience shorter overall and disease-free survival. Multivariate analysis of disease-free survival identified downregulated AJAP1 transcription as an independent prognostic factor. These results suggest that in ESCC, AJAP1 acts as a putative tumor suppressor and that AJAP1 transcription is regulated by promoter hypermethylation. These findings indicate that downregulated AJAP1 transcription may serve as a novel tumor biomarker to predict recurrence of ESCC after esophagectomy.

Evaluation of Moderate Alcohol Use With QT Interval and Heart Rate Using Mendelian Randomization Analysis Among Older Southern Chinese Men in the Guangzhou Biobank Cohort Study

Western observational studies show that moderate alcohol use is associated with lower cardiovascular disease (CVD) risk, but these associations may be confounded by the healthier attributes of moderate users in these settings. Mendelian randomization analysis may help to ascertain the causal effect of moderate alcohol use on specific factors related to CVD and thereby clarify the role of alcohol. We used Mendelian randomization analysis with the aldehyde dehydrogenase 2 gene (ALDH2) as an instrumental variable to examine the association of alcohol units (10 g of ethanol) per day with heart rate-corrected QT interval and heart rate assessed from electrocardiogram among 4,588 older southern Chinese men in the Guangzhou Biobank Cohort Study (2003-2008). The F statistic was 77 for ALDH2 on alcohol use, suggesting little weak-instrument bias. Instrumental variable analysis showed that alcohol units were not associated with the corrected QT interval, with β = 1.04 (95% confidence interval: -0.61, 2.70) milliseconds, but they were associated with increased heart rate, with β = 0.98 (95% confidence interval: 0.04, 1.92) beat per minute. This study suggests that moderate alcohol use in men is not beneficial for heart function via QT interval or heart rate but could be detrimental. Future studies using specific cardiovascular outcomes may elucidate how alcohol affects different aspects of the cardiovascular system and, hence, the overall effects of alcohol on CVD can be estimated.

Reduced expression of DENND2D through promoter hypermethylation is an adverse prognostic factor in squamous cell carcinoma of the esophagus

Esophageal cancer ranks sixth in cancer mortality worldwide and patients with esophageal squamous cell carcinoma (ESCC) have a poor prognosis with a 5-year survival rate of less than 10%. Elucidation of the mechanisms of carcinogenesis and tumor progression in esophageal cancer is urgently required to develop targets for therapy and prognostic biomarkers. In the present study, the expression and regulatory mechanism of the differentially expressed in normal and neoplastic cells domain containing 2D (DENND2D), which is a regulator of Rab GTPases, were investigated to explore its potential as a tumor suppressor gene for ESCC. The level of DENND2D mRNA expression in ESCC cell lines and surgical specimens was determined using a quantitative real-time reverse transcription-polymerase chain reaction assay, and the relationship between the expression levels of DENND2D mRNA and clinicopathological factors was evaluated. The expression and distribution of DENND2D were determined using immunohistochemistry. DNA methylation analysis was performed to determine the regulatory mechanism of DENND2D expression in ESCC. The level of DENND2D mRNA expression was reduced in 8/9 ESCC cell lines and in 59/65 surgical specimens, and the mean expression levels were significantly lower in cancerous tissues compared to corresponding normal tissues (p<0.001). The expression pattern of DENND2D protein and mRNA was consistent. Downregulation of DENND2D mRNA in ESCC tissues was identified as an independent prognostic factor in multivariate analysis (hazard ratio, 2.194; p=0.039). The DENND2D promoter was methylated in 5/9 ESCC cell lines, and DNA demethylation reactivated DENND2D mRNA expression. Hypermethylation of DENND2D was frequently detected in ESCC tissues (64.6%) and was significantly associated with downregulation of DENND2D mRNA expression (P=0.008). Taken together, our data suggest that DENND2D is a candidate tumor suppressor gene that was inactivated by promoter hypermethylation in patients with ESCC and may serve as a novel biomarker of ESCC.

Overexpression of melanoma-associated antigen D4 is an independent prognostic factor in squamous cell carcinoma of the esophagus

To pursue an urgently needed treatment target for esophageal cancer (EC), we investigated the function of the recently discovered melanoma-associated antigen (MAGE)-D4 in squamous cell EC. MAGE-D4 messenger RNA (mRNA) expression was analyzed in nine EC cell lines using quantitative reverse transcription polymerase chain reaction. In 65 surgical specimens of squamous cell EC with no prior neoadjuvant therapy, MAGE-D4 mRNA expression in EC tissues and corresponding normal tissues was analyzed and compared, and evaluated in terms of clinicopathological factors. In representative cases, MAGE-D4 protein distribution was analyzed immunohistochemically. The heterogeneity of MAGE-D4 mRNA expression was confirmed in EC cell lines by quantitative reverse transcription polymerase chain reaction. In surgical specimens, MAGE-D4 mRNA expression was significantly higher in EC tissues than in corresponding normal tissues (P < 0.001). Patients with the highest MAGE-D4 mRNA expression in EC tissues (top quartile, n = 17) had significantly shorter overall survival than patients with low expression (2-year survival: 44% and 73%, respectively, P = 0.006). Univariate analysis identified age (≥65 years), lymphatic involvement, and high MAGE-D4 mRNA expression as significant prognostic factors; high MAGE-D4 mRNA expression was also an independent prognostic factor in multivariable analysis (hazard ratio: 2.194; P = 0.039) and was significantly associated with Brinkman index (P = 0.008) and preoperative carcinoembryonic antigen level (P = 0.002). Immunohistochemical MAGE-D4b expression was consistent with MAGE-D4 mRNA profiling. Our results suggest that MAGE-D4 overexpression influences tumor progression, and MADE-D4 can be a prognostic marker and a potential molecular target in squamous cell EC.