Cardiovascular Consequences of Binge Drinking: An Integrative Review with Implications for Advocacy, Policy, and Research

Positive association of large alcohol intake per occasion with vision-threatening severe diabetic retinopathy or diabetic macular edema in Japanese men with type 2 diabetes

OBJECTIVE

Differing from the overall consumption of alcohol, whether consuming large quantities of alcohol per drinking occasion is associated with higher risk of developing severe diabetic retinopathy remains unknown.

METHODS

We examined whether the quantity per drinking occasion (QPO), including a large QPO, and the combinations of the frequency of alcohol consumption (FAC) and QPO were associated with higher risk of developing severe diabetic retinopathy or diabetic macular edema (DME) using adjusted Cox models. Severe diabetic retinopathy or DME was designated as a vision-threatening treatment-required diabetic eye disease (TRDED). For each man with type 2 diabetes who participated in this longitudinal retrospective cohort study, the date of the earliest health check-up during the inclusion period (April 2008 to August 2016) was set as the start date of follow-up.

RESULTS

A TRDED was observed in 425 of 21,392 Japanese men aged 22-74 years with type 2 diabetes during a mean follow-up of 4.3 years (4.6/1000 person-years). Multivariable Cox analysis showed that a large QPO, defined as drinking three drinks or more per occasion, in low- (hazard ratio [HR], 4.76; 95 % CI, 2.06-10.97), intermediate- (HR, 1.58; 95 %CI, 1.001-2.50), and high-frequency categories (HR, 2.01; 95 % CI, 1.20-3.36) was significantly associated with elevated risks of TRDED.

CONCLUSIONS

In addition to the total amount of ethanol, these findings imply the necessity of avoiding the consumption of large amounts of alcohol on a single occasion to prevent severe diabetic retinopathy or DME.

Cardiovascular Disease Risk Factors in the Native American Population

Native Americans are disproportionately affected by cardiovascular disease in comparison with other racial and ethnic groups in the United States. Previous research has analyzed risk factors, quantified prevalence rates, and examined outcomes of cardiovascular disease in Native Americans, yet few studies have considered the role of societal and psychological factors on the increased burden of cardiovascular disease in Native Americans. Modifiable risk factors for cardiovascular disease, including poor nutrition, reduced physical activity, obesity, and increased substance use, are exacerbated in Native American communities due to cultural and historical factors. Further, Native Americans have endured historical trauma and continue to experience additional financial and healthcare stressors, resulting in increased levels of chronic stress. Chronic activation of stress responses through the hypothalamic-pituitary-adrenal and autonomic nervous system increases inflammation and cardiovascular dysfunction resulting in an increased risk for cardiovascular disease. Therefore, it is critical to examine the connection between these stressors and the cardiovascular health disparities in Native American communities to create effective strategies to improve health outcomes.

Joint Effects of Lifestyle Habits and Heavy Metals Exposure on Chronic Stress Among U.S. Adults: Insights from NHANES 2017-2018

BACKGROUND

Chronic stress, characterized by sustained activation of physiological stress response systems, is a key risk factor for numerous health conditions. Allostatic load (AL), a biomarker of cumulative physiological stress, offers a quantitative measure of this burden. Lifestyle habits such as alcohol consumption and smoking, alongside environmental exposures to toxic metals like lead, cadmium, and mercury, were individually implicated in increasing AL. However, the combined impact of these lifestyle habits and environmental factors remains underexplored, particularly in populations facing co-occurring exposures. This study aims to investigate the joint effects of lifestyle habits and environmental factors on AL, using data from the NHANES 2017-2018 cycle. By employing linear regression and Bayesian Kernel Machine Regression (BKMR), we identify key predictors and explore interaction effects, providing new insights into how cumulative exposures contribute to chronic stress. Results from BKMR analysis underscore the importance of addressing combined exposures, particularly the synergistic effects of cadmium and alcohol consumption, in managing physiological stress.

METHODS

Descriptive statistics were calculated to summarize the dataset, and multivariate linear regression was performed to assess associations between exposures and AL. BKMR was employed to estimate exposure-response functions and posterior inclusion probabilities (PIPs), focusing on identifying key predictors of AL.

RESULTS

Descriptive analysis indicated that the mean levels of lead, cadmium, and mercury were 1.23 µg/dL, 0.49 µg/dL, and 1.37 µg/L, respectively. The mean allostatic load was 3.57. Linear regression indicated that alcohol consumption was significantly associated with increased AL (β = 0.0933; 95% CI [0.0369, 0.1497]; p = 0.001). Other exposures, including lead (β = -0.1056; 95% CI [-0.2518 to 0.0408]; p = 0.157), cadmium (β = -0.0001, 95% CI [-0.2037 to 0.2036], p = 0.999), mercury (β = -0.0149; 95% CI [-0.1175 to 0.0877]; p = 0.773), and smoking (β = 0.0129; 95% CI [-0.0086 to 0.0345]; p = 0.508), were not significant. BKMR analysis confirmed alcohol's strong importance for AL, with a PIP of 0.9996, and highlighted a non-linear effect of cadmium (PIP = 0.7526). The interaction between alcohol and cadmium showed a stronger effect on AL at higher exposure levels. In contrast, lead, mercury, and smoking demonstrated minimal effects on AL.

CONCLUSIONS

Alcohol consumption and cadmium exposure were identified as key contributors to increased allostatic load, while other exposures showed no significant associations. These findings emphasize the importance of addressing lifestyle habits and environmental factors in managing physiological stress.

The potential cardioprotective bioactive compounds in fermented alcoholic beverages: Mechanisms, challenges, and opportunities in beer and wine

Excessive alcohol consumption is detrimental to human health, and it is implicated in the development of heart disease, stroke, and cancer. However, the last few decades have given rise to epidemiological evidence suggesting that low-to-moderate consumption of red wine and beer may reduce the risk of cardiovascular diseases. Studies have shown that moderate consumption of wine and beer protects against ischemic stroke, increases HDL plasma concentrations, and reduces platelet aggregation and insulin resistance. This cardioprotective effect has previously been attributed to phytochemicals in these beverages. This narrative review explores these potential cardioprotective phytochemicals and the underlying mechanisms responsible. Data from trials investigating the effect of alcoholic beverage consumption and in vitro analyses of the bioactive phytochemical compounds are reviewed. The potential of dealcoholized beverages is also explored. The literature shows that the cardioprotective effects observed with moderate alcohol consumption are mainly owing to the presence of anti-inflammatory polyphenolic and bioactive substances including lipophilic molecules present in low but biologically significant quantities. These phytochemicals are obtained from the raw materials and generated during the brewing processes. Studies indicate that dealcoholized variants of beer and wine also possess beneficial health effects, indicating that these effects are not alcohol dependent. There is also growing interest in dealcoholized beverages that are fortified or enhanced with cardioprotective properties. The development of such beverages is an important avenue of future research so that there are options for consumers who wish to enjoy wine and beer safely.

Cross-sectional analysis of e-cigarettes, combustible tobacco and their dual use with binge drinking among college students in the USA

Background

Tobacco use is a long-standing epidemic that has caused millions of premature deaths. Electronic cigarette use is rising among young adults, yet few studies have included combustible tobacco, e-cigarettes and their dual use in an analysis of binge drinking among college students. This study aims to calculate the associations between these three forms of tobacco use and binge drinking among college students.

Methods

This cross-sectional study used data from 332 721 college students from the American College Health Association-National College Health Assessment survey. Tobacco use was organised into four groups: no tobacco use, e-cigarette use only, combustible tobacco use only and dual use of e-cigarettes and combustible tobacco. Binge drinking was a binary indication of whether students had engaged in binge drinking in the last 2 weeks. Multiple logistic regression was employed to examine the relationship between tobacco use and binge drinking, adjusting for demographic factors and constructs of the integrated behavioural model.

Results

Each tobacco use group had significantly higher odds of binge drinking compared with students who did not use tobacco. Students who engaged in dual tobacco use had significantly higher odds of binge drinking compared with exclusive combustible tobacco use (adjusted OR, aOR=2.41, 95% CI: 2.29, 2.53) and exclusive e-cigarette use (aOR=1.79, 95% CI: 1.71, 1.86).

Conclusion

The strong relationship between dual tobacco use and binge drinking among college students warrants further investigation into the aetiology and clinical manifestations of this emerging coupled substance use behaviour among the next generation of adults.

Type 2 Diabetes Health Care Outcomes for Patients with Alcohol Use Disorder Starting Addiction Treatment

BACKGROUND

Alcohol use disorder (AUD) is common and may complicate type 2 diabetes (T2DM) management. Little research has examined diabetes outcomes for people with T2DM and AUD, including during the window when patients start specialty addiction treatment.

OBJECTIVE

To examine diabetes-related health monitoring, clinical outcomes, and acute health care use among patients with T2DM and AUD newly accessing specialty addiction treatment.

DESIGN

This retrospective cohort study included electronic health record data from a large, integrated health care delivery system.

PATIENTS

Adults with T2DM and an index outpatient health care visit during 2016-2021 were included. Patients whose index visit was an initial AUD-related visit in specialty addiction treatment were in the AUD group. The comparison group had no AUD or addiction medicine visits.

MAIN MEASURES

Outcomes were diabetes-related health monitoring, achievement of treatment targets, complications, and acute health care use during the 12 months post-index visit.

KEY RESULTS

The study included 222,334 adults with T2DM, 1,998 with AUD. Relative to the comparison group, participants with AUD had elevated risk for hypoglycemia (adjusted risk ratio [aRR] = 2.14; 95% confidence interval [CI] = 1.49, 3.08), cardiovascular complications (aRR = 1.43; 95% CI = 1.34, 1.53), and neuropathy (aRR = 1.26; 95% CI = 1.14, 1.41), and were less likely to be non-smokers (aRR = 0.88; 95% CI = 0.86, 0.90), after adjusting for confounding factors. In adjusted models, the AUD versus comparison group had similar or higher rates of diabetes monitoring (e.g., any glycemic test, aRR = 1.19; 95% CI = 1.17, 1.22) and metabolic control (e.g., hemoglobin A1c < 8.0%, aRR = 1.14; 95% CI = 1.11, 1.18).

CONCLUSIONS

Patients with co-occurring T2DM and AUD in an integrated health care delivery system are vulnerable to diabetes complications that could be addressed during the early phase of specialty addiction treatment.

Alcohol Consumption and Cardiovascular Disease: A Narrative Review of Evolving Perspectives and Long-Term Implications

Cardiovascular illnesses remain the primary cause of death, accounting for at least 17.9 million fatalities per year and posing a significant public health problem because of its extensive predominance and effect on healthcare systems. The etiology of cardiovascular disease is complex and involves several environmental and lifestyle factors. Alcohol use is a highly important determinant because of its dual-edged effect on cardiovascular health. Multiple studies indicate that moderate alcohol consumption may have certain advantages, such as slight enhancements in lipid profiles. Conversely, excessive alcohol intake is associated with serious negative consequences, including cardiomyopathy, hypertension, arrhythmias, and even mortality. The aim of this study is to provide a comprehensive analysis of the several effects of alcohol on cardiovascular health and their understanding within the medical field over time. It uses an interpretative narrative review methodology and analyzes studies that focus on genetic risk factors, gender differences, and shifts in paradigms in recent years. This article highlights the need for obtaining a thorough understanding of the effects of alcohol on cardiovascular health to support public health guidelines and clinical practice, and it underscores the significance of including alcohol consumption into the broader context of cardiovascular risk management and identifies important subjects for further study.

Alcoholic cardiomyopathy: an update

Alcohol-induced cardiomyopathy (AC) is an acquired form of dilated cardiomyopathy (DCM) caused by prolonged and heavy alcohol intake in the absence of other causes. The amount of alcohol required to produce AC is generally considered as >80 g/day over 5 years, but there is still some controversy regarding this definition. This review on AC focuses on pathogenesis, which involves different mechanisms. Firstly, the direct toxic effect of ethanol promotes oxidative stress in the myocardium and activation of the renin-angiotensin system. Moreover, acetaldehyde, the best-studied metabolite of alcohol, can contribute to myocardial damage impairing actin-myosin interaction and producing mitochondrial dysfunction. Genetic factors are also involved in the pathogenesis of AC, with DCM-causing genetic variants in patients with AC, especially titin-truncating variants. These findings support a double-hit hypothesis in AC, combining genetics and environmental factors. The synergistic effect of alcohol with concomitant conditions such as hypertension or liver cirrhosis can be another contributing factor leading to AC. There are no specific cardiac signs and symptoms in AC as compared with other forms of DCM. However, natural history of AC differs from DCM and relies directly on alcohol withdrawal, as left ventricular ejection fraction recovery in abstainers is associated with an excellent prognosis. Thus, abstinence from alcohol is the most crucial step in treating AC, and specific therapies are available for this purpose. Otherwise, AC should be treated according to current guidelines of heart failure with reduced ejection fraction. Targeted therapies based on AC pathogenesis are currently being developed and could potentially improve AC treatment in the future.

Prevalence and Correlates of Heavy Alcohol use among People Living with HIV who use Unregulated Drugs in Vancouver, Canada

Among people living with HIV (PLWH), heavy alcohol use is associated with many negative health consequences. However, the impacts of heavy alcohol use are not well described for PLWH who use drugs. Thus, we investigated the prevalence and correlates of heavy alcohol use among a cohort of people who use drugs (PWUD) living with HIV in Vancouver, Canada. We accessed data from an ongoing community-recruited prospective cohort of PLWH who use drugs with linked comprehensive HIV clinical monitoring data. We used generalized linear mixed-effects modeling to identify factors longitudinally associated with periods of heavy alcohol use between December 2005 and December 2019. Of the 896 participants included, 291 (32.5%) reported at least one period with heavy alcohol use. Periods of recent incarceration (Adjusted Odds Ratio [AOR] = 1.48, 95% Confidence Interval [CI]: 1.01-2.17), encounters with police (AOR = 1.87, 95% CI: 1.37-2.56), and older age (AOR = 1.05, 95% CI: 1.02-1.07) were positively associated with heavy alcohol use. Engagement in drug or alcohol treatment (AOR = 0.54, 95% CI: 0.42-0.70) and male gender (AOR = 0.46; 95% CI: 0.27-0.78) were negatively associated with heavy alcohol use. We observed that heavy alcohol use was clearly linked to involvement with the criminal justice system. These findings, together with the protective effects of substance use treatment, suggest the need to expand access for drug and alcohol treatment programs overall, and in particular through the criminal justice system to reduce alcohol-related harms among PLWH who use drugs.

Drinking patterns of alcohol and risk of major adverse cardiovascular events after an acute coronary syndrome

AIMS

To evaluate the risk of alcohol consumption after acute coronary syndromes (ACS).

METHODS AND RESULTS

A total of 6557 patients hospitalized for ACS at four Swiss centres were followed over 12 months. Weekly alcohol consumption was collected at baseline and 12 months. Binge drinking was defined as consumption of ≥6 units of alcohol on one occasion. Major adverse cardiovascular events (MACE) were defined as a composite of cardiac death, myocardial infarction, stroke, or clinically indicated target vessel coronary revascularization. Cox regression analysis was performed to assess the risk of MACE in patients with heavy (>14 standard units/week), moderate (7-14 standard units per week), light consumption (<1 standard unit/week), or abstinence, and with binge drinking episodes, adjusted for baseline differences. At baseline, 817 (13.4%) patients reported heavy weekly alcohol consumption. At 1-year follow-up, 695/1667 (41.6%) patients reported having at least one or more episodes of binge drinking per month. The risk for MACE was not significantly higher in those with heavy weekly consumption compared to abstinence [8.6% vs. 10.2%, hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.69-1.36] or light consumption (8.6% vs. 8.5%, HR 1.41, 95% CI 0.97-2.06). Compared to patients with no binge drinking, the risk of MACE was dose-dependently higher in those with binge drinking with less than one episode per month (9.2% vs. 7.8%, HR 1.61, 95% CI 1.23-2.11) or one or more episodes per month (13.6% vs. 7.8%, HR 2.17, 95% CI 1.66-2.83).

CONCLUSION

Binge drinking during the year following an ACS, even less than once per month, is associated with worse clinical outcomes.

Folic acid antioxidant supplementation to binge drinking adolescent rats improves hydric-saline balance and blood pressure, but fails to increase renal NO availability and glomerular filtration rate

Binge drinking (BD) is an especially pro-oxidant pattern of alcohol consumption, particularly widespread in the adolescent population. In the kidneys, it affects the glomerular filtration rate (GFR), leading to high blood pressure. BD exposure also disrupts folic acid (FA) homeostasis and its antioxidant properties. The aim of this study is to test a FA supplementation as an effective therapy against the oxidative, nitrosative, and apoptotic damage as well as the renal function alteration occurred after BD in adolescence. Four groups of adolescent rats were used: control, BD (exposed to intraperitoneal alcohol), control FA-supplemented group and BD FA-supplemented group. Dietary FA content in control groups was 2 ppm, and 8 ppm in supplemented groups. BD provoked an oxidative imbalance in the kidneys by dysregulating antioxidant enzymes and increasing the enzyme NADPH oxidase 4 (NOX4), which led to an increase in caspase-9. BD also altered the renal nitrosative status affecting the expression of the three nitric oxide (NO) synthase (NOS) isoforms, leading to a decrease in NO levels. Functionally, BD produced a hydric-electrolytic imbalance, a low GFR and an increase in blood pressure. FA supplementation to BD adolescent rats improved the oxidative, nitrosative, and apoptotic balance, recovering the hydric-electrolytic equilibrium and blood pressure. However, neither NO levels nor GFR were recovered, showing in this study for the first time that NO availability in the kidneys plays a crucial role in GFR regulation that the antioxidant effects of FA cannot repair.

Opioid Misuse and Associated Health Risks among Adults on Probation and Parole: Prevalence and Correlates 2015-2020

BACKGROUND

As state legislatures work to reduce prison populations and increase the use of community-based alternatives, limited knowledge exists about the service needs of those under criminal justice supervision in the community. Preliminary research indicates unusually high rates of disease, disability, and death. Health risks for this population include opioid misuse, a form of substance misuse that has reached epidemic proportions in the U.S. Evidence indicates this may be one of multiple epidemics this population experiences, complicating intervention.

METHODS

Our study included 5154 individuals on probation or parole. Using 2015-2020 data from the National Survey of Drug Use and Health (NSDUH), we conducted a series of logistic regressions examining associations between opioid misuse and a range of health risks, controlling for sociodemographic variables and survey year.

RESULTS

Approximately 17% of those on probation or parole indicated past-year opioid misuse, a rate 4 times higher than in the general population. Compared to those on probation and parole who did not misuse opioids, it was associated with higher odds of other health risk behaviors and mental health problems. For example, the odds of marijuana and cocaine use were 4-6 times higher and the odds of substance use disorder were 10 times higher. Similarly, the odds of experiencing major depressive episodes and serious psychological distress were 2-3 times higher.

CONCLUSIONS

Our findings reveal a markedly high risk for opioid misuse within this population along with associated risks for behavioral and mental health problems. The complex treatment needs of this population require greater policy attention and further research.

Dietary cholesterol in alcohol-associated liver disease

There is an increasing prevalence of alcohol-associated liver disease (ALD) worldwide. In addition to excessive alcohol consumption, other nutritional factors have been shown to affect the initiation and progression of ALD. The emerging role of cholesterol in exacerbating ALD has been reported recently and the underlying mechanisms are discussed. In addition, the interplay between dietary cholesterol and alcohol on cholesterol metabolism is reviewed. Furthermore, we highlight the therapeutic potential of cholesterol-lowering drugs in managing the onset and severity of ALD. Finally, we suggest the future mechanistic investigation of the effect of cholesterol on insulin resistance and intestinal inflammation in the exacerbation of alcohol-induced cellular and systemic dysfunction.

A Dose-Dependent Association between Alcohol Consumption and Incidence of Proteinuria and Low Glomerular Filtration Rate: A Systematic Review and Meta-Analysis of Cohort Studies

Previous cohort studies have reported conflicting associations between alcohol consumption and chronic kidney disease, characterized by proteinuria and low glomerular filtration rate (GFR). This systematic review, which included 14,634,940 participants from 11 cohort studies, assessed a dose-dependent association of alcohol consumption and incidence of proteinuria and low estimated GFR (eGFR) of <60 mL/min/1.73 m2. Compared with non-drinkers, the incidence of proteinuria was lower in drinkers with alcohol consumption of ≤12.0 g/day (relative risk 0.87 [95% confidence interval 0.83, 0.92]), but higher in drinkers with alcohol consumption of 36.1–60.0 g/day (1.09 [1.03, 1.15]), suggesting a J-shaped association between alcohol consumption and the incidence of proteinuria. Incidence of low eGFR was lower in drinkers with alcohol consumption of ≤12.0 and 12.1–36.0 than in non-drinkers (≤12.0, 12.1–36.0, and 36.1–60.0 g/day: 0.93 [0.90, 0.95], 0.82 [0.78, 0.86], and 0.89 [0.77, 1.03], respectively), suggesting that drinkers were at lower risk of low eGFR. In conclusion, compared with non-drinkers, mild drinkers were at lower risk of proteinuria and low eGFR, whereas heavy drinkers had a higher risk of proteinuria but a lower risk of low eGFR. The clinical impact of high alcohol consumption should be assessed in well-designed studies.

Alcohol Binge Drinking-Induced ST-Segment-Elevation Acute Coronary Syndrome

We present the case of a 26-year-old man, without any apparent cardiovascular risk factors, who experienced an ST-segment-elevation acute coronary syndrome after binge drinking high-proof alcohol, which was successfully managed with primary percutaneous coronary intervention and comprehensive, guideline-directed medical therapy.

Alcohol and Cardiovascular Diseases—Do the Consumption Pattern and Dose Make the Difference?

Excessive consumption of alcohol is not only a social problem, but it also significantly increases the morbidity and mortality rates of many societies. A correlation has been demonstrated between alcohol consumption and increased mortality from cancer, accidents and injuries, liver cirrhosis and other causes. Alcohol abuse increases the incidence of hemorrhagic stroke and the risk of ischemic stroke, induces serious arrhythmias, adversely affects blood pressure and damages the heart muscle. The dose and way of drinking alcohol play a crucial role in assessing whether this drink allows people to maintain health or whether it is a great health and social threat. The beneficial effects of low and moderate doses of alcohol on the occurrence of cardiovascular diseases have been shown in many population studies and meta-analyses in which the effect of U-shaped or J-shaped curves relating alcohol intake to cardiovascular mortality was observed, especially in ischemic heart disease. However, due to the fact that alcohol consumption is associated with many health hazards, it is not recommended to consume it as a preventive action of cardiovascular diseases. Moreover, recent studies suggest that association of low-to-moderate alcohol consumption with the reduction in cardiovascular risk is a result of lifestyle changes and that any reduction in alcohol consumption is in fact beneficial in terms of general health.

Review of Ethanol Intoxication Sensing Technologies and Techniques

The field of alcohol intoxication sensing is over 100 years old, spanning the fields of medicine, chemistry, and computer science, aiming to produce the most effective and accurate methods of quantifying intoxication levels. This review presents the development and the current state of alcohol intoxication quantifying devices and techniques, separated into six major categories: estimates, breath alcohol devices, bodily fluid testing, transdermal sensors, mathematical algorithms, and optical techniques. Each of these categories was researched by analyzing their respective performances and drawbacks. We found that the major developments in monitoring ethanol intoxication levels aim at noninvasive transdermal/optical methods for personal monitoring. Many of the "categories" of ethanol intoxication systems overlap with each other with to a varying extent, hence the division of categories is based only on the principal operation of the techniques described in this review. In summary, the gold-standard method for measuring blood ethanol levels is through gas chromatography. Early estimation methods based on mathematical equations are largely popular in forensic fields. Breath alcohol devices are the most common type of alcohol sensors on the market and are generally implemented in law enforcement. Transdermal sensors vary largely in their sensing methodologies, but they mostly follow the principle of electrical sensing or enzymatic reaction rate. Optical devices and methodologies perform well, with some cases outperforming breath alcohol devices in terms of the precision of measurement. Other estimation algorithms consider multimodal approaches and should not be considered alcohol sensing devices, but rather as prospective measurement of the intoxication influence. This review found 38 unique technologies and techniques for measuring alcohol intoxication, which is testament to the acute interest in the innovation of noninvasive technologies for assessing intoxication.

Patterns and predictors of high-intensity drinking and implications for intervention

Efforts to intervene with subgroups at particularly high risk for alcohol use require information on factors that differentiate drinking intensity levels. This article summarizes existing research and provides new findings on sociodemographics and risk factors that differentiate high-intensity drinking (HID) to provide context for developing and delivering interventions for the highest-risk drinkers. Cross-sectional data were obtained in 2019 from participants who reported past 30-day alcohol use in 2018 as part of the nationally representative 12th grade Monitoring the Future study. Among past 2-week drinkers in 2019 (N = 601; modal age 19; 57.0% male; 67.4% non-Hispanic White), bivariate associations between drinking intensity (moderate drinking [1-4 drinks for women/1-5 drinks for men], binge-only drinking [4-7/5-9 drinks], and HID [8+/10+ drinks]) and a range of sociodemographic characteristics, risk factors, and alcohol-related consequences were examined. Results showed binge-drinking norms, social and enhancement drinking motives, nicotine vaping, and use of limiting/stopping drinking and manner of drinking protective behavioral strategies differentiated all drinking intensity levels, lending support to HID and binge-only drinking having an overlapping risk profile. However, there were also risk factors uniquely associated with HID, including sex, college attendance, employment, HID norms, use of serious harm reduction protective behavioral strategies, family history of drinking problems, any cigarette or drug use other than marijuana, and depression symptoms. Therefore, risk factors differentiate young adult drinking intensity. These results can inform efforts to adapt interventions for young adults who report HID. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Binge drinking during the adolescence period causes oxidative damage-induced cardiometabolic disorders: A possible ameliorative approach with selenium supplementation

Binge drinking (BD) is the most common alcohol consumption model among adolescents. BD exposure during adolescence disrupts the nervous system function, being involved in the major mortality causes at this age: motor vehicle accidents, homicides and suicides. Recent studies have also shown that BD consumption during adolescence affects liver, renal and cardiovascular physiology, predisposing adolescents to future adult cardiometabolic damage. BD is a particularly pro-oxidant alcohol consumption pattern, because it leads to the production of a great source of reactive oxygen species (ROS) via the microsomal ethanol oxidizing system, also decreasing the antioxidant activity of glutathione peroxidase (GPx). Selenium (Se) is a mineral which plays a pivotal role against oxidation; it forms part of the catalytic center of different antioxidant selenoproteins such as GPxs (GPx1, GPx4, GPx3) and selenoprotein P (SelP). Specifically, GPx4 has an essential role in mitochondria, preventing their oxidation, apoptosis and NFkB-inflamative response, being this function even more relevant in heart's tissue. Se serum levels are decreased in acute and chronic alcoholic adult patients, being correlated to the severity of oxidation, liver damage and metabolic profile. Experimental studies have described that Se supplementation to alcohol exposed mice clearly decreases oxidative and liver damage. However, clinical BD effects on Se homeostasis and selenoproteins' tissue distribution related to oxidation during adolescence are not yet studied. In this narrative review we will describe the use of sodium selenite supplementation as an antioxidant therapy in adolescent BD rats in order to analyze Se homeostasis implication during BD exposure, oxidative balance, apoptosis and inflammation, mainly in liver, kidney, and heart. These biomolecular changes and the cardiovascular function will be analyzed. Se supplementation therapies could be a good strategy to prevent the oxidation, inflammation and apoptosis generated in tissues by BD during adolescence, such as liver, kidney and heart, improving cardiovascular functioning.

Role of Impulsivity and Emotion Dysregulation Dimensions on Core Characteristics of Binge Drinking among University Students

Binge drinking refers to a pattern of alcohol consumption that leads to rapid intoxication followed by withdrawal and abstinence periods. This study aimed to investigate the potential differential contributions of impulsivity and emotion regulation difficulties to core characteristics of binge drinking (consumption speed, frequency of binge drinking episodes, and the ratio of binge drinking episodes) among a sample of non-abstainers college students. One thousand and five hundred fifty-five participants (17-25 years old) completed the UPPS-P Impulsive behavior scale, the Difficulties in Emotion Regulation Scale (DERS) and measures related to alcohol consumption patterns and affects by means of an online survey. Multiple regression analyses showed that UPPS-P sensation seeking, lack of premeditation, positive, and negative urgency dimensions were significantly associated with binge drinking core characteristics. More specifically, lack of premeditation, and sensation seeking dimensions were associated with speed of drinking, frequency of binge drinking epiosodes, and the ratio of binge drinking episodes. Positive urgency was associated with speed of drinking, and the ratio of binge drinking episodes while negative urgency was negatively associated with speed of drinking. DERS impulse dimension was associated with speed of drinking, DERS awareness dimension was negatively associated with the frequency of binge drinking episodes, and DERS goals dimension was significantly associated with the ratio of binge drinking episodes. Furthermore, patterns of drinking were independently associated with sex, depression and anxiety scores. These findings may help to plan and develop interventions aimed at addressing binge drinking in young adults by targeting impulsivity and emotion dysregulation.

A systematic review of self-report measures used in epidemiological studies to assess alcohol consumption among older adults

Background

There is a lack of standardization regarding how to assess and categorize alcohol intake in older adults. The aim of this study was to systematically review methods used in epidemiological studies to define drinking patterns and measure alcohol consumption among older adults.

Methods

A systematic search was conducted in the MEDLINE, PubMed, PsycINFO, EMBASE, and CINAHL databases for studies published from January 2009 to April 2021. Studies were included if they were observational studies with a quantitative design; the mean age of the participants was ≥ 65 years; questionnaires, screening tools, or diagnostic tools were used to define alcohol consumption; and alcohol consumption was self-reported.

Results

Of 492 studies considered, 105 were included. Among the 105 studies, we detected 19 different drinking patterns, and each drinking pattern had a wide range of definitions. The drinking patterns abstaining from alcohol, current drinking, and risk drinking had seven, 12 and 21 diverse definitions, respectively. The most used questionnaire and screening tools were the quantity-frequency questionnaire, with a recall period of 12 months, and the full and short versions of the Alcohol Use Disorders Identification Test, respectively.

Conclusion

No consensus was found regarding methods used to assess, define, and measure alcohol consumption in older adults. Identical assessments and definitions must be developed to make valid comparisons of alcohol consumption in older adults. We recommend that alcohol surveys for older adults define the following drinking patterns: lifetime abstainers, former drinkers, current drinkers, risk drinking, and heavy episodic drinking. Standardized and valid definitions of risk drinking, and heavy episodic drinking should be developed. The expanded quantity-frequency questionnaire including three questions focused on drinking frequency, drinking volume, and heavy episodic drinking, with a recall period of 12 months, could be used.

Cross-sectional and prospective associations of lifestyle risk behaviors clustering with elevated depressive symptoms among middle-aged and older adults

OBJECTIVES

To investigate the cross-sectional and prospective associations of lifestyle risk behaviors clustering with elevated depressive symptoms and to explore synergic prospective associations of different combinations of lifestyle risk behaviors with subsequent depressive symptoms.

STUDY DESIGN

Prospective cohort study. Data on 31,190 middle-aged and older adults from waves 4 (2011) and 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used.

MAIN OUTCOME MEASURES

Elevated depressive symptoms were estimated using the EURO-D 12-item scale. Lifestyle risk behaviors composing the cluster included physical inactivity, inadequate consumption of fruit and/or vegetables, binge drinking, and tobacco smoking. Gender, age group, education, place of residence, country, number of chronic diseases and body mass index were considered as confounders.

RESULTS

With the exception of binge drinking, all lifestyle risk behaviors were associated with higher odds of elevated depressive symptoms in cross-sectional and prospective analyses. The clustering of unhealthy lifestyle behaviors was cross-sectionally associated with elevated depressive symptoms and the clustering of two [odds ratio [OR]: 1.39; 95%CI: 1.28-1.51) and three or four (OR: 1.60; 95%CI: 1.38-1.85) were prospectively associated with elevated depressive symptoms. There were no interactions between the pairs of behaviors in the association with later elevated depressive symptoms.

CONCLUSIONS

Our findings support the need for interventions integrating multiple health behaviors to prevent elevated depressive symptoms among middle-aged and older adults.

Selenium, a dietary-antioxidant with cardioprotective effects, prevents the impairments in heart rate and systolic blood pressure in adolescent rats exposed to binge drinking treatment

BACKGROUND

Binge drinking (BD) during adolescence is related to cardiovascular alterations. Selenium (Se) is an essential trace element with antioxidant, anti-inflammatory and antiapoptotic properties, essential for correct heart function.

OBJECTIVES

To study the protective cardiovascular effects of selenium in adolescent rats exposed to a BD-like procedure.

METHODS

32 adolescent male rats exposed to an intraperitoneally BD-like model or not, and supplemented with 0.4ppm of selenite or not, were divided into 4 groups: control, alcohol, control-selenium and alcohol-selenium. Blood pressure and heart rate (HR) were determined after experimentation. Se deposits, oxidative balance and the expression of glutathione peroxidases (GPxs), NF-kB and caspase-3 were measured in the heart. Also, DNA instability in rat lymphocytes and serum vascular markers were determined. Statistical analysis was performed with the ANOVA model.

RESULTS

The BD-like model depleted Se heart deposits (p < .01), decreased GPx activity (p < .01) and GPx1 (p < .001) and GPx4 (p < .05) expression, increased NF-kB (p < .01), caspase-3 (p < .001) expression, and generated oxidation in myocytes. Outside the heart, the BD-like model caused double-strand breaks in lymphocyte DNA and increased all the vascular markers measured. These cardiovascular alterations were related to higher systolic (p < .001) and diastolic (p < .05) blood pressure and HR (p < .05). In the heart, Se supplementation in BD-exposed rats significantly increased Se deposits (p < .001) and improved oxidative balance and vascular damage, including increased GPxs and decreased NF-kB and caspase-3 activation, consequently decreasing systolic (p < .05) blood pressure and HR (p < .01).

CONCLUSIONS

Se supplementation presents cardioprotective effects since it reversed HR and systolic blood pressure observed in BD-exposed adolescent rats.

The limits of measuring binge drinking prevalence for epidemiological surveillance: An example from Spain

BACKGROUND

The public health impact of binge drinking depends on its population prevalence and its frequency and intensity among binge drinkers. The objective is to assess the consistency of time trends and age-sex disparities between binge-drinking prevalence and binge-drinking exposure indicators that combine such prevalence with the number of binge-drinking days among binge drinkers.

METHODS

Data come from 11 biennial national household surveys from 1997 to 2017 in young (15-34 years) and middle-aged adults (35-64 years) in Spain (n = 211,961). Binge-drinking was the intake of 5+ standard drinks (4+ in women from 2009 onwards) in approximately two hours. Three monthly indicators were analyzed: binge-drinking prevalence, population rate of binge-drinking days, and proportion of drinking days with binge drinking. Results were stratified for sex and two age groups. Annual percent changes (APCs), ratios of young to middle-aged people (age ratios) and men-to-women ratios were obtained from negative binomial regression.

RESULTS

Although the three indicators showed considerable consistency as an intense increase in binge drinking from 2009 to 2017 among middle-aged people, especially women, there were relevant inconsistencies. In 2009-2017 the APCs for prevalence and rate were +1.3 % and -1.6 %, respectively, in young women, and -0.6 % and -3.0 % in young men. Age ratios were significantly higher for prevalence and proportional ratio than rates, while men-to-women ratios were lower, especially in middle-aged people.

CONCLUSIONS

Adequate monitoring of binge drinking should incorporate indicators of absolute exposure, which better reflect its impact on public health, such as the population rate of binge-drinking days.

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.

Sex and Racial Differences in Patterns of Disordered Eating and Alcohol Use

The present study aimed to determine how young adults' use of disordered eating behaviors (DEBs) and alcohol uniquely cluster with one another, how these clusters differ by sex and race, and map onto health-related correlates. As a part of a cross-sectional study assessing college student health and experiences, female (n = 1,026), male (n = 336), White (n = 640), and Black (n = 561) young adult college students at three universities (M_age = 20.54, SD = 1.80) completed measures assessing DEBs and alcohol use, and physical and mental health. Multigroup mixture modeling was used to identify subgroups of female, male, White, and Black young adults that are characterized by different levels of DEBs (fasting, food avoidance, loss of control eating, overeating) and alcohol use (binge drinking, drinking quantity). Whether group membership relates to theoretically and clinically relevant health correlates (stress, depressive symptoms, sleep health) was examined via auxiliary analyses. Qualitative and quantitative differences were identified in the best-fitting mixture models for female (four groups), male (four groups), White (five groups), and Black (three groups) participants that suggest sex and racial variations exist in patterns of DEBs and alcohol use severity. Generally, classification in groups characterized by moderate to high probabilities of DEBs only, or the combination of moderate to high DEBs and alcohol use, was associated with worse affective concerns across sexes and races. Targeting young adults' DEBs and alcohol use via diversity-informed treatments focused on coping skill development may help promote health and well-being.

Selenite supplementation modulates the hepatic metabolic sensors AMPK and SIRT1 in binge drinking exposed adolescent rats by avoiding oxidative stress

Binge drinking (BD) is the main alcohol consumption pattern among teenagers. Recently, oxidative stress (OS) generated by BD exposure has been related to hepatic metabolic deregulation and cardiovascular dysfunction. This study analyzed if BD by generating oxidative stress modulates the alteration in hepatic energy homeostasis through two important regulators of energy metabolism: the NAD⁺-dependent sirtuin deacetylase (SIRT1) and AMP-activated protein kinase (AMPK) and if supplementation with the antioxidant selenium (Se) improves these metabolic disorders. Four groups of adolescent rats supplemented or not with Se (0.4 ppm) and exposed to intermittent i.p. BD were used. BD rats showed an increased AST/ALT ratio, total bilirubin in serum and lipid peroxidation in the liver. The BD rats also showed a higher abdominal/thoracic ratio and increased levels of TG, gluc, and chol compared to the control group, provoking an increase in mean blood pressure (MBP). This alcohol consumption pattern decreased hepatic Se deposits, cytoplasmic GPx activity, and GSH levels as well as the expressions of two metabolic sensors and the pAMPK/AMPK ratio. Se supplementation restored antioxidant parameters and decreased lipid oxidation, avoiding OS and improving the hepatic expression of pAMPK and SIRT1, contributing to the improvement of metabolic (better lipid profile and IRS-1 expression) and vascular function (lower MBP), and to the increase of hepatic functionality (lower AST/ALT ratio). All these actions decrease cardiometabolic risk factor development in the short and long term and could disrupt the relationship between BD and MS, two problems which are currently affecting adolescents.

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.

Prevalence of Cardiovascular Disease and Associated Factors Among Type 2 Diabetes Patients in Selected Hospitals of Harari Region, Eastern Ethiopia

Background: Cardiovascular disease (CVD) is the most prevalent complication and the leading cause of death among patients with diabetes mellitus (DM). Type 2 diabetes mellitus (T2DM) patients have a 2- to 4-fold increased risk of CVD. There is a scarcity of data about the magnitude of CVD among patients with diabetes in Ethiopia. This study aimed to assess the prevalence and associated factors of CVD among T2DM patients at selected hospitals of Harari regional state of Ethiopia. Methods: This hospital-based retrospective data review was conducted among T2DM patients on follow-up in the diabetes clinics of selected hospitals of Harari regional state. The records of T2DM patients who have been diagnosed between January 1, 2013, and December 31, 2017, were reviewed from March to April 2018. Data were collected by using structured checklists from all necessary documents of T2DM patients. Statistical analysis was done using STATA 14.1. Bivariate and multivariate logistic regressions were used to identify factors associated with CVD. Result: The records of 454 T2DM patients were extracted from three government hospitals in Harari regional state. Their age was ranging from 15 to 86 years with a mean age (±SD) of 45.39 (14.76). The overall prevalence of CVD among T2DM patients was 42.51%, composed of hypertensive heart diseases (38.99%), heart failure (6.83%), and stroke (2.20%). The final multivariate logistic regression model revealed that age older than 60 years [adjusted odds ratio (AOR) = 3.22; 95% CI: 1.71-6.09], being physically inactive (AOR = 1.45; 95 CI: 1.06-2.38), drinking alcohol (AOR = 2.39; 95% CI: 1.17-6.06), hypertension (AOR = 2.41; 95% CI: 1.52-3.83), body mass index >24.9 kg/m2 (AOR = 1.81; 95% CI: 1.07-3.07), and experiencing microvascular diabetic complications (AOR = 3.62; 95% CI: 2.01-6.53) were significantly associated with the odds of having CVD. Conclusion: The prevalence of CVD was high and associated with advanced age, physical inactivity, drinking alcohol, higher body mass index, hypertension, and having microvascular complications. Health care workers should educate T2DM patients about healthy lifestyles like physical activity, weight reduction, blood pressure control, and alcohol secession, which can reduce the risk of CVD.

[Binge drinking: the challenges of definition and its impact on health.]

Heavy episodic drinking, or binge drinking, is a drinking pattern characterized by the intake of large amounts of alcohol in a short period of time, which often leads to alcohol intoxication. There is no consensus on its operational definition, finding large methodological differences between studies in estimating the amount of alcohol consumed, as well as in defining the occasion of drinking and the reference time period. Keep in mind that most drinkers with this pattern have a low risk total average alcohol consumption. Therefore, actively detecting binge drinking is essential to be able to identify and classify all risk drinkers and characterize the global impact of alcohol consumption on health, society or the economy. Its negative effects affect the drinker himself (intoxication, cardiovascular diseases, dependence, neurocognitive and developmental disorders, among others), but also causes harm to others (accidents, violence, harmful effects on fetal and perinatal neuronal development). These effects can be acute or chronic, even among those who adopt binge drinking sporadically. Different thresholds or ways of characterizing this pattern of alcohol consumption could more adequately predict each of the associated acute and chronic effects, especially if we consider the intensity and frequency of the episodes. However, the absence of a safe threshold for alcohol consumption, both regularly and occasionally, is clear; Any intake with a binge drinking pattern, regardless of the threshold we establish, carries significant risks, not only for the health of the drinker, but also for the people around them.

Prevalence and correlates of multimorbidity among adults in Botswana: A cross-sectional study

BACKGROUND

Botswana is currently undergoing rapid epidemiological transition indicated by a decline in infectious diseases and an increase in chronic non-communicable diseases and their associated risk factors. The main aim of this study was to assess prevalence and correlates of multimorbidity among the adult population in Botswana.

METHODS

A cross-sectional study called Chronic Non-Communicable Diseases Study (NCDs study) was conducted in March, 2016. Using multistage cross sectional sampling design, 1178 male and female respondents aged 15 years and above were interviewed across 3 cities and towns, 15 urban villages and 15 rural villages. Participants were interviewed face-to-face using a structured questionnaire. Adjusted multinomial logistic regression analysis was used to assess covariates of multimorbidity. The statistical significant level was fixed at p <0 .05.

RESULTS

Prevalence of multimorbidity in the sampled population was estimated at 5.4%. Multivariate results indicate that the odds of multimobridty were significantly high among women (AOR = 3.34, 95% C.I. = 1.22-21.3) than men. On the other hand, the odds of multimorbidity were significantly low among young people aged below 24 years (AOR = 0.01, 95% C.I. = 0.00-0.07), currently married people (AOR = 0.24, 95% C.I. = 0.07-0.80) and individuals in the 2nd wealth quintile (AOR = 0.20, 95% C.I. = 0.05-0.75) compared to their counterparts. For behavioural risk factors, alcohol consumption (AOR = 4.80, 95% C.I. = 1.16-19.8) and overweight/obesity (AOR = 1.44, 95% CI = 1.12-2.61) were significantly associated with high multimorbidity prevalence.

CONCLUSION

Multimorbidity was found to be more prevalent among women, alcohol consumers and overweight/obese people. There is need to strengthen interventions encouraging healthy lifestyles such as non-consumption of alcohol, physical activity and healthy diets. Moreover, there is need for a holistic approach of health care services to meet the needs of those suffering from multimorbidity.

Effects of Alcohol on the Cardiovascular System in Women

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality for women. This review summarizes the relationship between alcohol consumption and common CVDs in women and highlights potential differences from men. Except for risk of hypertension, no sex-related effects of alcohol consumption on the risk for coronary heart disease and stroke have been reported, and data on the sex-related effects on risk for peripheral arterial disease are limited. For women, alcohol consumption has a J-shaped relationship with hypertension. About 1 to 2 standard drinks per day is associated with lower risk for the development of hypertension, whereas for men, the relationship is relatively linear. In the area of alcoholic cardiomyopathy, the prevalence is greater for men, but women may develop alcoholic cardiomyopathy at a lower lifetime level of alcohol consumption. Overall, data support that 1 to 2 standard drinks per day for women and men is associated with a lower risk of CVD, and higher daily amounts may increase the risk of CVD.

Associations between cannabis use and retinal vessel diameter in young adults

Cannabis appears to have vascular effects that may have implications for cerebrovascular function, but no studies have directly visualized the microvasculature in living cannabis users. The current study used retinal imaging, a tool taken from ophthalmology, to visualize the small retinal microvessels in cannabis users. We compared retinal arteriolar (small arteries) and venular (small veins) diameters in 55 frequent cannabis users and 51 comparison individuals with a mean age of 19.25 years (SD = 2.43). Results indicated that mean arteriolar diameter was statistically significantly wider for cannabis users (M = 157.98, SE = 1.42) than for comparison individuals (M = 153.56, SE = 1.46; F(1,103) = 4.67, p = .033), even after controlling for a variety of covariates and after excluding from analyses cannabis users who had used cannabis in the past 24 h. There was no statistically significant difference in retinal venular diameter between cannabis users and comparison individuals. Findings suggest that frequent cannabis use is associated with wider retinal arterioles, which might represent a residual vasodilatory effect of recent cannabis use or impaired autoregulation resulting from chronic cannabis use. Retinal imaging is a non-invasive, cost-effective tool for visualizing the microvasculature in living individuals and can be combined, in future research, with neuroimaging and other measures of retinal vascular function to better understand the acute and longer-term effects of cannabis use on the microvasculature.

The relation between ADHD symptoms, perceived stress and binge drinking in college students

Binge drinking is a major public health problem associated with various negative short-term and long-term clinical and social outcomes. If there is evidence to suggest a relationship between ADHD and alcohol use in college students, no study has investigated the role of ADHD symptomatology in binge drinking. Thus, this research was designed to explore the relative contributions of inattention and hyperactivity/impulsivity symptoms to binge drinking in a sample of French college students while controlling for effects of perceived stress. Participants (N = 7011; mean age = 20.9; 74.9% of females) completed self-report surveys assessing ADHD symptoms, perceived stress, sociodemographic characteristics, and binge drinking frequency. Multinomial logistic regression revealed significant associations between higher levels of ADHD symptoms in general, but not perceived stress, and increasing frequency of binge drinking. Moreover, higher levels of inattention and hyperactivity/impulsivity symptoms were independently associated with greater frequency of binge drinking. The association was stronger between high rates of binge drinking and inattention than for hyperactivity/impulsivity. These findings, which remained statistically significant after adjusting for a range of potential confounders (including perceived stress), suggest that the presence of ADHD symptoms may be an important factor related to binge drinking.

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.

Alcohol Consumption and Aortic Root Dilatation: Insights from the Corinthia Study

Aortic diameter and progression to thoracic aortic aneurysm are influenced by several factors. In this study, we investigated the association of alcohol consumption with aortic root and ascending aorta dilatation. In the context of the Corinthia study, we examined 1751 patients with echocardiography. Several demographic and clinical characteristics were recorded. Alcohol consumption was assessed based on a questionnaire of frequency, type, and quantity. Accordingly, patients were categorized as everyday alcohol consumers (EDACs) and as social drinkers (SoD). Everyday alcohol consumers were further categorized to group 1: 0 to 1 drink/d; group 2: 1 to 2 drinks/d; and group 3: ≥3 drinks/d. From the study population, 40% were categorized as EDAC and had an increased aortic root diameter (AoRD) and an elevated AoRD index compared with SoD. Interestingly, there was a stepwise increase in aortic root and ascending aorta diameter according to daily alcohol consumption. Specifically, patients consuming ≥3 drinks of alcohol/d had increased indexed aortic by 1.4 mm/m2 compared with SoD even after adjustment for possible confounders. Daily alcohol consumption is associated with increased aortic root diameter. These findings may have important clinical implications, especially in patients with borderline or dilated aortic root, and merit further investigation.

Health behaviours reported by adults with congenital heart disease across 15 countries

Background

Health behaviours are essential to maintain optimal health and reduce the risk of cardiovascular complications in adults with congenital heart disease. This study aimed to describe health behaviours in adults with congenital heart disease in 15 countries and to identify patient characteristics associated with optimal health behaviours in the international sample.

Design

This was a cross-sectional observational study.

Methods

Adults with congenital heart disease ( n = 4028, median age = 32 years, interquartile range 25–42 years) completed self-report measures as part of the Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease - International Study (APPROACH-IS). Participants reported on seven health behaviours using the Health Behaviors Scale-Congenital Heart Disease. Demographic and medical characteristics were assessed via medical chart review and self-report. Multivariate path analyses with inverse sampling weights were used to investigate study aims.

Results

Health behaviour rates for the full sample were 10% binge drinking, 12% cigarette smoking, 6% recreational drug use, 72% annual dental visit, 69% twice daily tooth brushing, 27% daily dental flossing and 43% sport participation. Pairwise comparisons indicated that rates differed between countries. Rates of substance use behaviours were higher in younger, male participants. Optimal dental health behaviours were more common among older, female participants with higher educational attainment while sports participation was more frequent among participants who were younger, male, married, employed/students, with higher educational attainment, less complex anatomical defects and better functional status.

Conclusions

Health behaviour rates vary by country. Predictors of health behaviours may reflect larger geographic trends. Our findings have implications for the development and implementation of programmes for the assessment and promotion of optimal health behaviours in adults with congenital heart disease.

CD74 knockout attenuates alcohol intake-induced cardiac dysfunction through AMPK-Skp2-mediated regulation of autophagy

CD74, a non-polymorphic type II transmembrane glycoprotein and MHC class II chaperone, is the cell surface receptor for the inflammatory cytokine macrophage migration inhibitory factor (MIF) and participates in inflammatory signaling regulation. This study examined the potential role of CD74 in binge drinking-induced cardiac contractile dysfunction. WT and CD74 knockout mice were exposed to ethanol (3 g/kg/d, i.p., for 3 days). Echocardiography, cardiomyocyte function, histological staining and autophagy signaling including AMPK, mTOR, and AMPK downstream signals Skp2 and Sirt1 were evaluated. Our results revealed that ethanol challenge overtly compromised echocardiographic, cardiomyocyte contractile, intracellular Ca²⁺ and ultrastructural properties along with overt apoptosis, inflammation (elevated MIF, IL-1β and IL-6) and mitochondrial O₂^- production (p < 0.01), the effect of which was reconciled by CD74 ablation (p < 0.01 vs. ethanol group) with the exception of MIF expression. Ethanol challenge upregulated autophagy (p < 0.001), promoted AMPK phosphorylation and Sirt1 levels (p < 0.003) while suppressing mTOR phosphorylation and Skp2 levels (p < 0.02). These effects were reversed by CD74 ablation. In vitro studies demonstrated that short-term ethanol challenge compromised cardiomyocyte contractile function and facilitated GFP-Puncta formation, which were mitigated by CD74 knockout (p < 0.0001). Moreover, the CD74 ablation-offered beneficial effects against ethanol-induced cardiomyocyte dysfunction, and GFP-Puncta formation were nullified by the AMPK activator AICAR, the Skp2 inhibitor C1 or the Sirt1 activator SRT1720 (p < 0.0001). Taken together, our data revealed that CD74 ablation counteracts acute ethanol challenge-induced myocardial dysfunction, inflammation and apoptosis possibly through an AMPK-mTOR-Skp2-mediated regulation of autophagy.

Cardiovascular effects of alcohol: A double-edged sword / how to remain at the nadir point of the J-Curve?

BACKGROUND

In addition to its established harmful effects on the liver and other organs, heavy alcohol use confers deleterious effects on the cardiovascular (CV) system, as well. However, data have emerged that light/moderate alcohol consumption (1 drink/day for women and 1-2 drinks/day for men) may be protective against CV disease.

OBJECTIVE/METHODS

English articles regarding the CV effects of alcohol/ethanol were reviewed by search in Medline, Scopus, and Google Scholar.

RESULTS

A J-shaped curve has been proposed to illustrate a differential effect of alcohol on the CV system with the lowest point on the curve (light/moderate drinking) corresponding to optimal exposure to alcohol, which may confer cardioprotection, the rather neutral effect of non-drinking, and the highest risk of heavy and/or binge drinking reflecting the consequence of harmful exposure. However, staying at the nadir of this J-shaped curve appears difficult. Furthermore, concern and distrust have also been raised about the quality of evidence for such "cardioprotection", emphasizing the need for further randomized controlled trials. Another concern relates to the risk of moderate drinking leading to problem drinking, since alcohol is the most common addictive substance.

CONCLUSION

Optimal exposure to alcohol (light/moderate use) means that one needs to stay at the nadir of the J-shaped curve for alcohol use to avail oneself of possible cardioprotection, and this may not be an easy thing to accomplish and/or adhere to, especially if one "likes" alcohol drinking. However, the evidence of "cardioprotection" conferred by alcohol has also been refuted, due to lack of randomized controlled trials.

The Relationship Between Regional Cerebral Blood Flow Estimates and Alcohol Problems at 5-Year Follow-Up: The Role of Level of Response

BACKGROUND

Acute alcohol consumption is associated with temporarily increased regional cerebral blood flow (CBF). The extent of this increase appears to be moderated by individual differences in the level of response (LR) to alcohol's subjective effects. The low LR phenotype is a known risk factor for the development of alcohol problems. This study investigates how the low LR phenotype relates to the relationship between alcohol-related changes in CBF and alcohol problems 5 years later.

METHODS

Young adults (ages 18 to 25) were selected based on their LR to alcohol and underwent a neuroimaging protocol including arterial spin labeling and functional scans. These participants were recontacted ~5 years later and assessed on alcohol outcomes. A final sample of 107 subjects (54 low and 53 high LR subjects) was included in the analyses. Whole-brain analysis revealed 5 clusters of significant alcohol-induced, versus placebo-induced, CBF changes that were consistent with a previous report. Peak alcohol-placebo CBF response was extracted from these regions and, along with the LR group, submitted to a hierarchical linear regression predicting alcohol problems. Analyses controlled for age, sex, and baseline alcohol problems.

RESULTS

In the regression analysis, greater alcohol-placebo CBF difference in the right middle/superior/inferior frontal gyri and bilateral anterior cingulate gyri clusters predicted greater future alcohol problems for the low LR group, whereas this relationship was not found to be significant in the high LR group.

CONCLUSIONS

This study demonstrates a clinically important relationship between CBF and future alcohol problems, particularly in individuals with a low LR phenotype. These initial results help to elucidate the neurobiological pathways involved in the development of alcohol use disorders for individuals with low LR.

Polydrug use patterns, risk behavior and unmet healthcare need in a community-based sample of women who use cocaine, heroin or methamphetamine

BACKGROUND

The use of multiple illicit drugs (polydrug use) is associated with health-related harms and elevated risk of drug overdose. Polydrug use in common among women who use 'hard' drugs, such as cocaine, heroin or methamphetamine.

METHODS

Quantitative data collection was conducted with a community-recruited sample of 624 women who used heroin, methamphetamine or cocaine in Oakland, CA during 2014-2015. We conducted latent class analysis to classify polydrug use patterns. We assessed associations between classes of polydrug use and infectious disease risk behaviors, health care utilization and unmet health care need.

RESULTS

We identified four distinct classes of drug use: (1) predominantly crack (52% of women); (2) powder cocaine & non-heroin opioids (8%); (3) moderate polydrug use (25%); (4) heavy polydrug use (15%). Odds of sexual risk, injection drug use and unmet healthcare need were twice as high in the heavy polydrug use class as the predominantly crack class (p > 0.01 for each outcome). The rate of binge drinking (as days per month) was also significantly higher in the heavy polydrug class (p = 0.01). The moderate polydrug use class had higher odds of injection drug use and drug treatment participation, compared to the mainly crack class (p < 0.001 for each outcome). There were no differences between classes in health insurance or health care utilization.

DISCUSSION

Reduction of polydrug use could be an effective harm reduction strategy to address sexual and injection risk among women. The use of both opioids and stimulants in three of the four classes suggests that multi-modal substance abuse treatment approaches may be most appropriate.

Effects of Repeated Binge Drinking on Blood Pressure Levels and Other Cardiovascular Health Metrics in Young Adults: National Health and Nutrition Examination Survey, 2011-2014

BACKGROUND

Binge drinking prevalence rates are highest in young adults; however, little is known about the effects of binge drinking on blood pressure (BP) and other cardiovascular health metrics in individuals between 18 and 45 years of age. The aim of this study was to determine the effects of regular binge drinking on BP, lipid and glucose levels and to determine if there were differences in these associations between men and women.

METHODS AND RESULTS

We analyzed data from NHANES (the US National Health and Nutrition Examination Survey) for men and women 18 to 45 years old who were non-binge drinkers, binge drank 1 to 12 times, or binge drank >12 times in the past year. After controlling for diet and physical activity, both categories of men binge drinkers compared with non-binge drinkers had higher systolic BP (121.8 and 119.0 mm Hg versus 117.5 mm Hg) and total cholesterol (215.5 and 217.9 mg/dL versus 207.8 mg/dL) values. There were no effects of binge drinking on systolic BP or total cholesterol in women. Binge drinking in men and women was associated with higher high-density lipoprotein-cholesterol values. The effects of binge drinking on glucose parameters in men and women were variable.

CONCLUSIONS

Compared with young adult women, repeated binge drinking in men was associated with an elevated systolic BP, and greater frequency of binge drinking in men was associated with a more unfavorable lipid profile. In young adults with elevated systolic BP, practitioners should consider the possible role of binge drinking and address the importance of reducing alcohol intake as an important cardiovascular risk reduction strategy.

Nonpharmacologic management of hypertension: a multidisciplinary approach

PURPOSE OF REVIEW

Nonpharmacologic lifestyle modification interventions (LMIs), such as increasing physical activity, dietary modification, weight-loss, reducing alcohol consumption and smoking cessation, are effective strategies to lower resting blood pressures (BPs) in prehypertensive or hypertensive patients. However, the limited time shared between a physician and a patient is not adequate to instill an adoption of LMI. The purpose of this review is to therefore highlight evidence-based BP lowering, LMI strategies that can feasibly be implemented in clinical practices.

RECENT FINDINGS

Interventions focusing on modifying physical activity, diet, weight-loss, drinking and smoking habits have established greater efficacy in reducing elevated BP compared with providing guideline recommendations based on national guidelines. Alone greater reductions in BP can be achieved through programmes that provide frequent contact time with exercise, nutrition and/or wellness professionals. Programmes that educate individuals to lead peer support groups can be an efficient method of ensuring compliance to LMI.

SUMMARY

Evidence of a multidisciplinary approach to LMI is an effective and attractive model in managing elevated BP. This strategy is an attractive model that provides the necessary patient attention to confer lifestyle maintenance.

Prevalence and correlates of binge drinking among older adults with multimorbidity

BACKGROUND

Binge drinking among older adults has increased in the past decade. Binge drinking is associated with unintentional injuries, medical conditions, and lower health-related quality of life. No studies have characterized multimorbidity among older binge drinkers.

METHODS

We examined past 30-day binge alcohol use and lifetime medical conditions among adults age ≥50 from the National Survey on Drug Use and Health from 2005 to 2014. Self-reported lifetime prevalence of 13 medical conditions and medical multimorbidity (≥2 diseases) among binge drinkers were compared to non-binge drinkers. Multivariable logistic regression models were used to examine correlates of binge alcohol use among older adults with medical multimorbidity.

RESULTS

Among adults aged ≥50, 14.4% reported past-month binge drinking. Estimated prevalence of medical multimorbidity was lower (21.4%) among binge drinkers than non-binge drinkers (28.3%; p < 0.01). Binge drinkers were more likely to use tobacco and illegal drugs than non-binge drinkers (ps < 0.001). In the adjusted model, among older adults with multimorbidity, higher income (AOR = 1.44, p < 0.05), past-month tobacco use (AOR = 2.55, p < 0.001) and substance use disorder for illegal drugs (AOR = 1.80, p < 0.05) was associated with increased odds of binge alcohol use.

CONCLUSION

The prevalence of multimorbidity was lower among current binge drinkers compared to non-binge drinkers, possibly because older adults in good health are apt to drink more than adults in poorer health. Current use of tobacco and substance use disorder were associated with an increased risk for binge drinking among older adults with multimorbidity. Binge drinking by older adults with multimorbidity may pose significant health risks especially with the concurrent use of other substances.