Lipoproteins and blood pressure as biological pathways for effect of moderate alcohol consumption on coronary heart disease

What Causes Premature Coronary Artery Disease?

PURPOSE OF REVIEW

This review provides an overview of genetic and non-genetic causes of premature coronary artery disease (pCAD).

RECENT FINDINGS

pCAD refers to coronary artery disease (CAD) occurring before the age of 65 years in women and 55 years in men. Both genetic and non-genetic risk factors may contribute to the onset of pCAD. Recent advances in the genetic epidemiology of pCAD have revealed the importance of both monogenic and polygenic contributions to pCAD. Familial hypercholesterolemia (FH) is the most common monogenic disorder associated with atherosclerotic pCAD. However, clinical overreliance on monogenic genes can result in overlooked genetic causes of pCAD, especially polygenic contributions. Non-genetic factors, notably smoking and drug use, are also important contributors to pCAD. Cigarette smoking has been observed in 25.5% of pCAD patients relative to 12.2% of non-pCAD patients. Finally, myocardial infarction (MI) associated with spontaneous coronary artery dissection (SCAD) may result in similar clinical presentations as atherosclerotic pCAD. Recognizing the genetic and non-genetic causes underlying pCAD is important for appropriate prevention and treatment. Despite recent progress, pCAD remains incompletely understood, highlighting the need for both awareness and research.

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

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

Additive Effects of Drinking Habits and a Susceptible Genetic Polymorphism on Cholesterol Efflux Capacity

AIMS

High levels of high-density lipoprotein cholesterol (HDL-C) are not necessarily effective in preventing atherosclerotic cardiovascular disease, and cholesterol efflux capacity (CEC) has attracted attention regarding HDL functionality. We aimed to elucidate whether drinking habits are associated with CEC levels, while also paying careful attention to confounding factors including serum HDL-C levels, other life style factors, and rs671 (^＊2), a genetic polymorphism of the aldehyde dehydrogenase 2 (ALDH2) gene determining alcohol consumption habit.

METHODS

A cross-sectional study was performed in 505 Japanese male subjects who were recruited from a health screening program. Associations of HDL-C and CEC levels with drinking habits and ALDH2 genotypes were examined.

RESULTS

The genotype frequencies of ALDH2 ^＊1/^＊1 (homozygous wild-type genotype), ^＊1/^＊2 and ^＊2/^＊2 (homozygous mutant genotype) were 55%, 37% and 8%, respectively. Both HDL-C and CEC levels were higher in ALDH2 ^＊1/^＊1 genotype carriers than in ^＊2 allele carriers. Although HDL-C levels were higher in subjects who had a drinking habit than in non-drinkers, CEC levels tended to be lower in subjects with ≥ 46 g/day of alcohol consumption than in non-drinkers. Furthermore, CEC levels tended to be lower in ALDH2 ^＊1/^＊1 genotype carriers with a drinking habit of ≥ 46 g/day than non-drinkers, while for ^＊2 allele carriers, CEC levels tended to be lower with a drinking habit of 23-45.9 g/day compared to no drinking habit.

CONCLUSIONS

Our results suggest that heavy drinking habits may tend to decrease CEC levels, and in the ALDH2 ^＊2 allele carriers, even moderate drinking habits may tend to decrease CEC levels.

Genetic evidence for a causal relationship between type 2 diabetes and peripheral artery disease in both Europeans and East Asians

BACKGROUND

Observational studies have revealed that type 2 diabetes (T2D) is associated with an increased risk of peripheral artery disease (PAD). However, whether the two diseases share a genetic basis and whether the relationship is causal remain unclear. It is also unclear as to whether these relationships differ between ethnic groups.

METHODS

By leveraging large-scale genome-wide association study (GWAS) summary statistics of T2D (European-based: N_case = 21,926, N_control = 342,747; East Asian-based: N_case = 36,614, N_control = 155,150) and PAD (European-based: N_case = 5673, N_control = 359,551; East Asian-based: N_case = 3593, N_control = 208,860), we explored the genetic correlation and putative causal relationship between T2D and PAD in both Europeans and East Asians using linkage disequilibrium score regression and seven Mendelian randomization (MR) models. We also performed multi-trait analysis of GWAS and two gene-based analyses to reveal candidate variants and risk genes involved in the shared genetic basis between T2D and PAD.

RESULTS

We observed a strong genetic correlation (r_g) between T2D and PAD in both Europeans (r_g = 0.51; p-value = 9.34 × 10^-15) and East Asians (r_g = 0.46; p-value = 1.67 × 10^-12). The MR analyses provided consistent evidence for a causal effect of T2D on PAD in both ethnicities (odds ratio [OR] = 1.05 to 1.28 for Europeans and 1.15 to 1.27 for East Asians) but not PAD on T2D. This putative causal effect was not influenced by total cholesterol, body mass index, systolic blood pressure, or smoking initiation according to multivariable MR analysis, and the genetic overlap between T2D and PAD was further explored employing an independent European sample through polygenic risk score regression. Multi-trait analysis of GWAS revealed two novel European-specific single nucleotide polymorphisms (rs927742 and rs1734409) associated with the shared genetic basis of T2D and PAD. Gene-based analyses consistently identified one gene ANKFY1 and gene-gene interactions (e.g., STARD10 [European-specific] to AP3S2 [East Asian-specific]; KCNJ11 [European-specific] to KCNQ1 [East Asian-specific]) associated with the trans-ethnic genetic overlap between T2D and PAD, reflecting a common genetic basis for the co-occurrence of T2D and PAD in both Europeans and East Asians.

CONCLUSIONS

Our study provides the first evidence for a genetically causal effect of T2D on PAD in both Europeans and East Asians. Several candidate variants and risk genes were identified as being associated with this genetic overlap. Our findings emphasize the importance of monitoring PAD status in T2D patients and suggest new genetic biomarkers for screening PAD risk among patients with T2D.

Associations of Smoking and Drinking with New Lipid-Related Indices in Women with Hyperglycemia

Background: Lipid-related indices are useful for early detection of the risk of cardiovascular disease. The relationships of smoking and alcohol drinking with lipid-related indices in women with diabetes remain to be clarified. Methods: In female participants with hyperglycemia, four lipid-related indices, ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C ratio), atherogenic index of plasma (AIP), lipid accumulation product (LAP), and cardiometabolic index (CMI), were compared in smokers and nonsmokers and in occasional drinkers, regular drinkers, and nondrinkers. Analysis of covariance and logistic regression analysis were used for comparison with adjustment for age, hemoglobin A1c, history of regular exercise, and history of alcohol drinking or smoking. Results: Mean levels of LDL-C/HDL-C ratio, AIP, and CMI were significantly higher in smokers than in nonsmokers, and the odds ratios in smokers versus nonsmokers for high LDL-C/HDL-C ratio, high AIP, and high CMI were significantly higher than the reference level. These differences in mean levels and odds ratios were not found in analysis of LAP. Mean levels of LDL-C/HDL-C ratio, LAP, AIP, and CMI were significantly lower in regular drinkers than in nondrinkers. The odds ratios versus nondrinkers for high LDL-C/HDL-C ratio, high AIP, high LAP, and high CMI in regular drinkers were significantly lower than the reference level. The odds ratios versus nondrinkers for high LDL-C/HDL-C ratio, high LAP, and high CMI in occasional drinkers were also significantly lower than the reference level. Conclusions: In women with hyperglycemia, smoking was positively associated with LDL-C/HDL-C ratio, AIP, and CMI, and habitual alcohol drinking was inversely associated with LDL-C/HDL-C ratio, AIP, LAP, and CMI. Thus, LDL-C/HDL-C ratio, AIP, and CMI are thought to be affected by both smoking and alcohol drinking, which accelerates and suppresses atherosclerotic progression, respectively.

Therapeutic potential of Chinese prescription Kangen-karyu for patient with lifestyle-induced metabolic syndrome

We report a case of a 65-year-old patient with hypertension, dyslipidemia, type 2 diabetes, chronic kidney disease, and hyperuricemia, who showed an improvement in lifestyle-induced metabolic syndrome on the administration of 7.5 g of Kangen-karyu extract per day for 6 months. The levels of serum total cholesterol, low-density lipoprotein-cholesterol, and triglycerides were decreased. The systolic/diastolic blood pressure was decreased following administration. Other parameters such as estimated glomerular filtration rate, creatinine, uric acid, aspartate transaminase, alanine aminotransferase, γ-glutamyl transpeptidase, and creatine phosphokinase were improved by the administration of Kangen-karyu extract. At that time, the physical and subjective symptoms had partially disappeared. We present evidence supporting the use of Kangen-karyu extract against metabolic syndrome.

γ-Glutamyltransferase Variability and the Risk of Mortality, Myocardial Infarction, and Stroke: A Nationwide Population-Based Cohort Study

Although it has been suggested that the γ-glutamyltransferase (GGT) level is an indicator of cardiometabolic disorders, there is no previous study to evaluate the implication of GGT variability on the development of myocardial infarction (MI), stroke, all-cause mortality, and cardiovascular disease (CVD)-related mortality. GGT variability was measured as the coefficient variance (GGT-CV), standard deviation (GGT-SD), and variability independent of the mean (GGT-VIM). Using the population-based Korean National Health Insurance Service-Health Screening Cohort, we followed 158,736 Korean adults over a median duration of 8.4 years. In multivariable Cox proportional hazard analysis, the risk of mortality, MI, and stroke showed a stepwise increase according to the quartiles of GGT-CV, GGT-SD or GGT-VIM. In the highest quartile of GGT-CV compared to the lowest quartile after adjusting for confounding variables including mean GGT, the hazard ratios (HRs) for incident MI, stroke, mortality, and CVD-related mortality were 1.19 (95% confidence interval (CI), 1.06–1.34; p < 0.001), 1.20 (95% CI, 1.10–1.32; p < 0.001), 1.41 (95% CI, 1.33–1.51; p < 0.001), and 1.52 (95% CI, 1.30–1.78; p < 0.001), respectively, which were similar or even higher compared with those associated with total cholesterol variability. This is the first study to demonstrate that high GGT variability is associated with increased risk of MI, stroke, all-cause mortality, and CVD-related mortality in the general population.

Proneness to high blood lipid-related indices in female smokers

BACKGROUND

Smoking is a major risk factor for dyslipidemia. However, it remains to be clarified whether light smoking in Asian women affects lipid profiles and lipid-related indices. The aim of this study was to determine the relationships between lipid-related indices and smoking in Japanese women. Alcohol drinking influences blood lipid levels and is a potent confounder for the relationship between smoking and blood lipids. Thus, analysis for the relationships between smoking and blood lipid-related indices was also performed after stratification of drinking status.

METHODS

The participants were 18,793 Japanese women aged 35-70 years. A cross-sectional study was performed using a local population-based database. The relationships of smoking with each index were investigated by using analysis of covariance and logistic regression analysis with adjustment for age and other lifestyle factors such as alcohol drinking and regular exercise.

RESULTS

In multivariate logistic regression analysis, odds ratios of smokers vs. nonsmokers for high ratio of LDL cholesterol to HDL cholesterol (LDL-C/HDL-C), high ratio of triglycerides to HDL cholesterol (TG/HDL-C), high lipid accumulation product (LAP) and high cardio metabolic index (CMI) were significantly higher than the reference level of 1.00 in overall participants (2.17 [1.78-2.66], 1.70 [1.47-1.97], 1.17 [1.08-1.27] and 1.41 [1.30-1.53], respectively), nondrinking participants (2.29 [1.80-2.91], 1.68 [1.39-2.02], 1.21 [1.08-1.36] and 1.46 [1.30-1.63], respectively), and drinking participants (1.96 [1.35-2.85], 1.76 [1.39-2.21], 1.13 [1.01-1.27] and 1.38 [1.22-1.55], respectively). In overall participants, nondrinking participants, and drinking participants, LDL-C/HDL-C, TG/HDL-C, LAP and CMI were significantly higher in smokers than in nonsmokers. In nondrinking participants, triglycerides and LDL cholesterol were significantly higher in smokers than in nonsmokers, while the ratio of waist circumference to height and HDL cholesterol were significantly lower in smokers than in nonsmokers.

CONCLUSION

In women, all of the four lipid-related indices tested were higher in smokers than in nonsmokers, and these associations were independent of alcohol drinking. The high levels of the lipid-related indices in smokers result from the detrimental effects of smoking on levels of blood lipids such as triglycerides, HDL cholesterol and LDL cholesterol.

Cholesterol: Can't Live With It, Can't Live Without It

Given its role in many biochemical processes essential to life, cholesterol remains a topic of intense research. Of all the plasma lipids, cholesterol is distinctive because it is a precursor to steroidogenic molecules, some of which regulate metabolism, and its blood concentration in the form of low- and high-density lipoprotein cholesterol (HDL-C) are positive and negative risk factors for atherosclerotic cardiovascular disease (ASCVD). New research, however, has challenged the widely held belief that high HDL-C levels are atheroprotective and is showing that both low and high plasma HDL-C levels confer an increased risk of ASCVD. Furthermore, it is disputing the widely cited mechanism involved in reverse cholesterol transport. This review explores the evolution of cholesterol research starting with the Gofman and Framingham studies, the development of traditional and emerging lipid-lowering therapies, and the role of reverse cholesterol transport in HDL cardioprotection.

Alcohol Consumption Can Reduce the Risk of Gallstone Disease: A Systematic Review with a Dose-Response Meta-Analysis of Case-Control and Cohort Studies

Background/Aims

Gallstone disease (GSD) is a common gastrointestinal disorder. Clinical epidemiological studies revealed that alcohol consumption has a preventive effect on the development of GSD. This study aimed to evaluate the relative risks of drinking for GSD development and investigate the dose-response relationships.

Methods

A systematic search of the MEDLINE, EMBASE, and Cochrane Library databases for studies published up to 2018 was performed. All studies that satisfied the following eligibility criteria were included: patients with GSD with or without cholecystitis; and cohort or case-control studies investigating the association between alcohol consumption and GSD development.

Results

Sixteen case-control studies including 24,401 gallstone cases and 76,185 controls, and eight cohort studies with 14,693 GSD cases among 2,432,471 person-years were enrolled. Alcohol consumption presented a decreased overall risk of GSD (pooled relative ratio [RR], 0.84; 95% confidence interval [CI], 0.79 to 0.89; p=0.02). Subgroup analyses according to drinking levels indicated a gradual risk reduction for GSD compared to nondrinkers (light: RR, 0.96; 95% CI, 0.94 to 0.99; p=0.75; moderate: RR, 0.80; 95% CI, 0.75 to 0.85; p=0.27; high: RR, 0.66; 95% CI, 0.56 to 0.79; p<0.01). A nonlinear risk reduction was observed in a dose-response meta-analysis of all the studies (n=14, p<0.01 for nonlinearity).

Conclusions

In this systematic review with meta-analysis, alcohol consumption could decrease the risk of GSD, and the dose-response analysis revealed a dose-dependent linear risk reduction and a weakened linear trend between alcohol consumption levels less than and greater than 28 g/day.

Serum level of gamma-glutamyl transferase as a biomarker for predicting stenosis severity in patients with coronary artery disease

BACKGROUND

Gamma glutamyl transferase (GGT) is associated with pathogenesis of various diseases such as coronary artery disease (CAD). GGT activity displays an essential role in the catabolism of glutathione which is reported as a major antioxidant. The aim of this study was to explore the association of GGT activity with obstruction severity of artery in 500 CAD patients.

RESULTS

Our finding showed a significant association between serum GGT activity and CAD patients. In particular, the level of GGT in patients who had ≥50% obstruction was higher, compared to healthy and patients with less than 50% obstruction in their coronary arteries (the level of GGT in patients with at least one (1 SVD), two (2VD), three (3VD) coronary artery obstruction were 55.6±9.7, 71.7±12.7 and 84.7±13.4, while these values in patients with negative angio or control group were 28±10 and 17±4.6). Furthermore, the activity of this marker was associated with increased the risk of CAD (Odd ratio of GGT in 3VD group: 2, 95%CI: 1.8-2.3), which was also related with HDL-C. Of note, the level of GGT was enhanced progressively with increasing the obstruction severity of arteries.

CONCLUSION

We demonstrate the prognostic value of serum level of GGT as a biomarker for predicting obstruction severity in patients with CAD.

Prevalence and Associated Factors of Hypertension among Adults in Rural Uttarakhand: A Community Based Cross Sectional Study

India is in a state of transition epidemiological, economic, and demographic and nutrition transition. And all these transitions are leading to non communicable diseases like obesity, hypertension and insulin resistance. The study was aimed to estimate the Prevalence of hypertension and its associated risk factors among adults of rural Uttrakhand. It is a cross sectional community based study. Survey was conducted in rural areas of Uttrakhand, to make a sample size of 300 adults (18-45yr), using WHO STEPS questionnaire. Waist Circumference, Blood pressure, Body Mass Index of the participants was calculated. P value < 0.05 was considered significant. In the sample population based on systolic BP, 61.3% were non-hypertensive, 29.7% were pre-hypertensive and 9% were hypertensive. Based on diastolic BP, 43.3% were non-hypertensive, 32.7% were pre-hypertensive and 24% were hypertensive. Subjects with hypertension and pre-hypertension have higher BMI and waist circumference. A high prevalence rate of pre-hypertension and hypertension was depicted in rural areas of Uttrakhand region.4.8% of the female participants had systolic high blood pressure compared to the 11.9% of the male participants. On the other hand, 21.8% of the female participants had diastolic high blood pressure compared to the over 25% of the male participants.

Longitudinal study of alcohol consumption and HDL concentrations: a community-based study

Background: In cross-sectional studies and short-term clinical trials, it has been suggested that there is a positive dose-response relation between alcohol consumption and HDL concentrations. However, prospective data have been limited.Objective: We sought to determine the association between total alcohol intake, the type of alcohol-containing beverage, and the 6-y (2006-2012) longitudinal change in HDL-cholesterol concentrations in a community-based cohort.Design: A total of 71,379 Chinese adults (mean age: 50 y) who were free of cardiovascular diseases and cancer and did not use cholesterol-lowering agents during follow-up were included in the study. Alcohol intake was assessed via a questionnaire in 2006 (baseline), and participants were classified into the following categories of alcohol consumption: never, past, light (women: 0-0.4 servings/d; men: 0-0.9 servings/d), moderate (women: 0.5-1.0 servings/d; men: 1-2 servings/d), and heavy (women: >1.0 servings/d; men: >2 servings/d). HDL-cholesterol concentrations were measured in 2006, 2008, 2010, and 2012. We used generalized estimating equation models to examine the associations between baseline alcohol intake and the change in HDL-cholesterol concentrations with adjustment for age, sex, smoking, physical activity, obesity, hypertension, diabetes, liver function, and C-reactive protein concentrations.Results: An umbrella-shaped association was observed between total alcohol consumption and changes in HDL-cholesterol concentrations. Compared with never drinkers, past, light, moderate, and heavy drinkers experienced slower decreases in HDL cholesterol of 0.012 mmol · L^-1 · y^-1 (95% CI: 0.008, 0.016 mmol · L^-1 · y^-1), 0.013 mmol · L^-1 · y^-1 (95% CI: 0.010, 0.016 mmol · L^-1 · y^-1), 0.017 mmol · L^-1 · y^-1 (95% CI: 0.009, 0.025 mmol · L^-1 · y^-1), and 0.008 mmol · L^-1 · y^-1 (95% CI: 0.005, 0.011 mmol · L^-1 · y^-1), respectively (P < 0.0001 for all), after adjustment for potential confounders. Moderate alcohol consumption was associated with the slowest increase in total-cholesterol:HDL-cholesterol and triglyceride:HDL-cholesterol ratios. We observed a similar association between hard-liquor consumption and the HDL-cholesterol change. In contrast, greater beer consumption was associated with slower HDL-cholesterol decreases in a dose-response manner.Conclusion: Moderate alcohol consumption was associated with slower HDL-cholesterol decreases; however, the type of alcoholic beverage had differential effects on the change in the HDL-cholesterol concentration.

High-Density Lipoprotein Processing and Premature Cardiovascular Disease

High plasma concentrations of low-density lipoprotein-cholesterol (LDL-C) are a well-accepted risk factor for cardiovascular disease (CVD), and the statin class of hypolipidemic drugs has emerged as an effective means of lowering LDL-C and reducing CVD risk. In contrast, the role of plasma high-density lipoproteins (HDL) in protection against atherosclerotic vascular disease is the subject of considerable controversy. Although the inverse correlation between plasma HDL-C and CVD is widely acknowledged, reduction of CVD risk by interventions that increase HDL-C have not been uniformly successful. Several studies of large populations have shown that the first step in reverse cholesterol transport (RCT), the transfer of cholesterol from the subendothelial space of the arterial wall via the plasma compartment to the liver for disposal, is impaired in patients with CVD. Here we review HDL function, the mechanisms by which HDL supports RCT, and the role of RCT in preventing CVD.

Effects of chronic alcohol consumption on lipid levels, inflammatory and haemostatic factors in the general population: the ‘ATTICA’ Study

BACKGROUND

Epidemiological studies suggest an unclear effect of alcohol consumption on cardiovascular risk. This ambiguity is likely related to the quantity of alcohol consumed in populations studied. The aim of this work was to evaluate the association between chronic alcohol consumption and several clinical and biochemical parameters related to coronary risk, in cardiovascular disease free men and women.

METHODS

The 'ATTICA' study is a population-based cohort, which randomly enrolled 750 men and 883 women (18-88 years old) from area around Athens, during 2001-2002. We investigated the association between alcohol consumption and arterial blood pressure, fibrinogen levels, glucose concentration, total cholesterol, HDL and LDL, apolipoprotein A1 and B, Lp(a), uric acid, leucocyte count, triglycerides, C-reactive protein and homocysteine levels.

RESULTS

Multivariate analysis, after controlling for several potential confounders, revealed a J-shaped association between alcohol intake (none, 1-2, 3-4, 5+ wine glasses/day) and uric acid, C-reactive protein, homocysteine, fibrinogen, triglycerides, apolipoproteins A1 and B, HDL and total cholesterols, blood glucose levels, leucocyte count and arterial blood pressure levels (only in males). The most beneficial values of all these biochemical and clinical parameters were found in alcohol intake of 100-200 ml (12% alcohol), even after adjustment for various potential confounders.

CONCLUSIONS

The controversial association between alcohol intake and cardiovascular disease seems to be partially explained by the J-shaped relation of several biochemical parameters related to atherosclerosis and the amount of alcoholic beverages consumed.

A U-shaped relationship between alcohol consumption and cardiometabolic index in middle-aged men

BACKGROUND

Cardiometabolic index (CMI) is a new index for discriminating diabetes. The purpose of this study was to determine whether CMI is affected by habitual alcohol drinking.

METHODS

The subjects were 21572 men (35-60 years) receiving annual health checkups. They were divided by average daily ethanol consumption into non-, light (< 22 g), moderate (≥ 22 and < 44 g), heavy (≥ 44 and < 66 g) and very heavy (≥ 66 g) drinkers. Relationship between alcohol intake and CMI was investigated with adjustment for age and histories of smoking and regular exercise.

RESULTS

Log-transformed CMI was significantly lower in light, moderate and heavy drinkers than in nondrinkers and was lowest in light drinkers, while there was no significant difference in log-transformed CMI of nondrinkers and very heavy drinkers. Odds ratio vs. nondrinkers for high CMI was significantly lower than the reference level of 1.00 in light, moderate and heavy drinkers and was lowest in light drinkers but was not significantly different from the reference level in very heavy drinkers. Odds ratio of subjects with vs. those without high CMI for hyperglycemia was significantly higher than the reference level in all of the alcohol groups and was significantly lower in moderate drinkers but was not significantly different in the other drinker groups when compared with the nondrinker group.

CONCLUSION

There is a U-shaped relationship between alcohol consumption and CMI, and moderate drinking but not excessive drinking attenuates the association between CMI and hyperglycemia.

New Insights into the High-Density Lipoprotein Dilemma

Although high-density lipoprotein-cholesterol (HDL-C) concentration is a negative risk factor for atherosclerotic cardiovascular disease (CVD), efforts to reduce CVD risk by raising HDL-C have not been uniformly successful. Many studies have shown that alcohol consumption, that increases plasma HDL-C concentration, reduces CVD incidence. However, recent genetic studies in large populations have not only removed HDL-C from the causal link between plasma HDL-C concentration and reduced CVD risk, but also suggest that the association is weak. We propose here that the cardioprotective effects of alcohol are mediated by the interaction of its terminal metabolite, acetate, with the adipocyte free fatty acid receptor 2 (FFAR2), which elicits a profound antilipolytic effect that may increase insulin sensitivity without necessarily raising plasma HDL-C concentration.

Alcohol intake and associated risk of major cardiovascular outcomes in women compared with men: a systematic review and meta-analysis of prospective observational studies

BACKGROUND

The prevalence of alcohol intake is increasing among women in some populations. Alcohol consumption plays an important role in the risk of major cardiovascular outcomes and total mortality. Here, we conducted a meta-analysis to estimate the association between alcohol intake and major cardiovascular outcomes or total mortality in women compared with men.

METHODS

We searched the PubMed, Embase, and the Cochrane Library databases for relevant articles published prior to June 2014. Among these potential included prospective studies, the different dose categories of alcohol intake were compared with the lowest alcohol intake or non-drinkers between women and men for the outcomes of major cardiovascular or total mortality.

RESULTS

We included 23 prospective studies (18 cohorts) reporting data on 489,696 individuals. The summary relative risk ratio (RRR; female to male) for total mortality was significantly increased with moderate alcohol intake compared with the lowest alcohol intake (RRR, 1.10; 95 % confidence interval [CI]: 1.00-1.21; P = 0.047); no such significance was observed with other levels of alcohol intake (low intake: RRR, 1.07; 95 % CI: 0.98-1.17; P = 0.143; heavy intake: RRR, 1.09; 95 % CI: 0.99-1.21; P = 0.084). There was no evidence of a sex difference in the relative risk for coronary disease, cardiac death, stroke, or ischemic stroke between participants with low to heavy alcohol intake compared with those who never consumed alcohol or had the lowest alcohol intake.

CONCLUSIONS

Women with moderate to heavy alcohol intake had a significantly increased risk of total mortality compared with men in multiple subpopulations. Control of alcohol intake should be considered for women, particularly for young women who may be susceptible to binge drinking.

Alcohol is longitudinally associated with lower urinary tract symptoms partially via high-density lipoprotein

BACKGROUND

Previous studies on the association of alcohol consumption with lower urinary tract symptoms (LUTS) have been inconsistent, and none took into account the dynamic nature of LUTS, fluctuating over time. The purpose of the study was to determine the longitudinal association of alcohol consumption with LUTS.

METHODS

We used generalized estimating equations to analyze the longitudinal association of alcohol consumption with LUTS in a longitudinal study of 9,712 healthy men 30 years or older who visited our institution multiple times for routine comprehensive health evaluations, with an average follow-up period of 27.9 months.

RESULTS

Light-moderate alcohol consumption (0.1 to 29 g/d) was associated with decreased likelihood of moderate-severe LUTS, whereas heavy alcohol consumption (≥30 g/d) was associated with increased likelihood of moderate-severe LUTS in a dose-dependent manner. Compared to those with 0 g/d alcohol intake, subjects who drank 0.1 to 9.9, 10 to 19.9, 20 to 29.9, 30 to 39.9, or ≥40 g/d of alcohol were in general significantly associated with moderate-severe LUTS with adjusted odds ratio (95% confidence interval) as follows respectively: 0.94 (0.87 to 1.02), 1.00 (0.91 to 1.09), 0.85 (0.77 to 0.93), 1.08 (0.98 to 1.19), and 1.31 (1.19 to 1.44). However, the protective association of light-moderate alcohol consumption with LUTS was greatly attenuated when serum high-density lipoprotein (HDL) was added to the analysis, specifically for voiding symptoms.

CONCLUSIONS

We show strong evidence there is longitudinal association of alcohol consumption with LUTS. The protective effect of light-moderate alcohol consumption on LUTS is in part modulated by HDL as a confounder, similar to its effect on coronary heart disease.

Alcohol consumption for different periods in life, intake pattern over time and all-cause mortality

BACKGROUND

Conventionally, cohort studies have assessed the association between alcohol and all-cause mortality by using alcohol intake at enrolment.

METHODS

In the Melbourne Collaborative Cohort Study, participants were asked about usual frequency and quantity of beverage-specific alcohol intake for 10-year periods starting at age 20 from which current, past and lifetime intakes were calculated. We used Cox regression to estimate hazard ratios for mortality for 39 577 participants of the Melbourne Collaborative Cohort Study aged 40-69 at baseline.

RESULTS

After a mean follow-up of 15 years/person, we identified 4639 deaths. Associations between all-cause mortality and lifetime, current (baseline) and past intake were J shaped, with lower mortality at low intake (e.g. <40 g/day for men and 10 g/day for women using lifetime intake) and elevated mortality at higher intake. For men, consistent light-to-moderate drinking (>0-39/>0-39 g/day) from age 20 to baseline age was associated with a 16% lower mortality, while heavy drinking at both ages (≥80/≥40 and ≥40/0 g/day) was associated with higher mortality compared with stable abstinence.

CONCLUSIONS

Our findings support a reduced mortality risk associated with low-dose drinking but also highlight a higher mortality risk for consistent heavy drinking from a young age.

Smoking and lipid-related indices in patients with diabetes mellitus

AIMS

Lipid-related indices, including the ratio of LDL cholesterol to HDL cholesterol, the ratio of triglycerides to HDL cholesterol and lipid accumulation product, are known to be good discriminators for cardiovascular disease. The aim of this study was to clarify the relationships between smoking and the lipid indices in patients with diabetes.

METHODS

Subjects were those who had been diagnosed as having diabetes mellitus at annual health check-ups at their places of work (n = 2563). The subjects were divided into three groups of non-smokers, light smokers (≤ 20 cigarettes/day) and heavy smokers (> 20 cigarettes/day). The relationships between smoking and the lipid indices were investigated.

RESULTS

Both in all subjects and in the subjects without a habit of alcohol drinking, the LDL cholesterol:HDL cholesterol ratio and the log-transformed triglyerides:HDL cholesterol ratio tended to be higher with an increase in the amount of smoking, and the log-transformed lipid accumulation product was significantly higher in heavy smokers than in non-smokers. In the non-alcohol drinking subjects, the odds ratios of heavy smokers vs. non-smokers for high LDL cholesterol:HDL cholesterol ratio [2.32 (95% CI 1.40-3.84)], for high triglycerides:HDL cholesterol ratio [1.69 (95% CI 1.06-2.69)] and for high lipid accumulation product [1.65 (95% CI 1.02-2.67)] were significantly higher than a reference level of 1.00. The associations between smoking and the lipid indices were weaker in alcohol drinkers than in non-drinkers.

CONCLUSIONS

In patients with diabetes, the levels of lipid-related indices were higher in smokers than in non-smokers, and cardiometabolic disorders, reflected by high lipid indices, are thought to be involved in the proneness of smokers to develop atherosclerotic cardiovascular disease.

Frequency of heavy alcohol drinking and risk of metabolic syndrome in middle-aged men

BACKGROUND

Frequency of alcohol drinking is known to influence cardiovascular risk. However, little is known regarding the relationship between frequency of drinking and metabolic syndrome (MetS). The aim of this study was to determine how frequency of heavy drinking modifies the prevalence of MetS.

METHODS

The subjects were middle-aged male nondrinkers and occasional or regular heavy drinkers (ethanol intake: ≥66 g per drinking day). Odds ratios (ORs) for MetS and each component comprising MetS were calculated with adjustment for age and histories of smoking and regular exercise.

RESULTS

ORs versus nondrinkers for MetS defined by the criteria of the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) or the International Diabetes Federation (IDF) were significantly higher than the reference level of 1.00 in occasional heavy drinkers (NCEP-ATP III, 1.94 [confidence interval (CI): 1.54 to 2.45]; IDF, 1.97 [CI: 1.56 to 2.49]) and regular heavy drinkers (NCEP-ATP III, 1.48 [CI: 1.19 to 1.84]; IDF, 1.50 [CI: 1.20 to 1.86]). When compared with the reference level, OR versus nondrinkers for large waist circumference was significantly higher in occasional heavy drinkers (1.96 [CI: 1.63 to 2.35]), but not in regular heavy drinkers (1.12 [CI: 0.96 to 1.32]), while OR versus nondrinkers for hyperglycemia was significantly lower in regular heavy drinkers (0.66 [CI: 0.46 to 0.95]), but not in occasional heavy drinkers (0.86 [CI: 0.60 to 1.24]).

CONCLUSIONS

There is a positive association between heavy drinking and MetS, which is stronger in occasional drinkers than in regular drinkers. This difference may be explained by a positive association between occasional heavy drinking and central obesity and an inverse association between regular heavy drinking and hyperglycemia. The results suggest that heavy drinking, even if occasionally, is a cardiovascular risk factor.

Associations between heavy alcohol drinking and lipid-related indices in middle-aged men

The ratio of triglycerides to HDL cholesterol (TG/HDL-C ratio) and lipid accumulation product (LAP: a continuous marker of lipid over-accumulation determined by waist circumference and triglycerides) have been proposed to be good predictors of cardiovascular disease. The aim of this study was to clarify the relationships between heavy alcohol drinking and lipid-related indices including TG/HDL-C ratio, LAP, and ratio of LDL cholesterol to HDL cholesterol (LDL-C/HDL-C ratio). The subjects were middle-aged male nondrinkers and heavy drinkers (ethanol intake: ≥66 g per drinking day, which is 2-3 times or more than the generally recommended border level of daily alcohol consumption of 20-30 g). The levels of each lipid-related index after adjustment for age, smoking, and regular exercise were compared among nondrinkers, occasional heavy drinkers, and regular heavy drinkers. Log-transformed TG/HDL-C ratio was significantly higher in occasional heavy drinkers (mean ± standard error: 0.445 ± 0.014) than in nondrinkers (0.388 ± 0.004) and regular heavy drinkers (0.359 ± 0.013), and was not significantly different in nondrinkers and regular heavy drinkers. Log-transformed LAP was significantly higher in occasional heavy drinkers (1.51 ± 0.02) and regular heavy drinkers (1.44 ± 0.02) than in nondrinkers (1.34 ± 0.01), and was significantly higher in occasional heavy drinkers than in regular heavy drinkers. LDL-C/HDL-C ratio was significantly lower in occasional heavy drinkers (2.41 ± 0.04) and regular heavy drinkers (1.72 ± 0.04) than in nondrinkers (2.62 ± 0.01) and was significantly lower in regular heavy drinkers than in occasional heavy drinkers. Results of logistic regression analysis, using odds ratios for high lipid indices of occasional or regular heavy drinkers vs. nondrinkers, agreed with the above results of analysis of covariance. Occasional heavy drinkers showed more detrimental and less favorable levels of the lipid indices than did regular heavy drinkers, and thus heavy drinking, even if occasional, should be avoided to prevent cardiovascular disease.

Alcohol intake and triglycerides/high-density lipoprotein cholesterol ratio in men with hypertension

BACKGROUND

The triglycerides/high-density lipoprotein cholesterol (TG/HDL-C) ratio has been proposed to be a good predictor of cardiovascular disease. The relationship between alcohol consumption and TG/HDL-C ratio in patients with hypertension is unknown.

METHODS

Subjects were normotensive and hypertensive men aged 35-60 years who were divided by daily ethanol intake into non-, light (<22g/day), heavy (≥22 but <44g/day), and very heavy (≥44g/day) drinkers.

RESULTS

The TG/HDL-C ratio was significantly higher in the hypertensive group than in the normotensive group. Both in the normotensive and hypertensive groups, TG/HDL-C ratio was significantly lower in light, heavy, and very heavy drinkers than in nondrinkers and was lowest in light drinkers. In the hypertensive group, odds ratios (ORs) for high TG/HDL-C ratio (≥3.75) in light, heavy, and very heavy drinkers vs. nondrinkers were significantly lower (P < 0.01) than a reference level of 1.00 (light drinkers: OR = 0.49, 95% confidence interval (CI) = 0.40-0.59; heavy drinkers: OR = 0.59, 95% CI = 0.52-0.67; very heavy drinkers: OR = 0.70, 95% CI = 0.61-0.80) and were significantly lower than the corresponding ORs in the normotensive group. The ORs for hypertension in subjects with vs. subjects without high TG/HDL-C ratio were significantly higher than the reference level in all the alcohol groups and were significantly lower in light, heavy, and very heavy drinkers than in nondrinkers.

CONCLUSIONS

The results suggest that there is an inverted J-shaped relationship between alcohol and TG/HDL-C ratio in individuals with hypertension and that alcohol weakens the positive association between TG/HDL-C ratio and hypertension.

Habitual alcohol consumption is associated with lower cardiovascular stress responses--a novel explanation for the known cardiovascular benefits of alcohol?

In contrast to heavy alcohol consumption, which is harmful, light to moderate drinking has been linked to reduced cardiovascular morbidity and mortality. Effects on lipid status or clotting do not fully explain these benefits. Exaggerated cardiovascular responses to mental stress are detrimental to cardiovascular health. We hypothesized that habitual alcohol consumption might reduce these responses, with potential benefits. Advanced magnetic resonance techniques were used to accurately measure cardiovascular responses to an acute mental stressor (Montreal Imaging Stress Task) in 88 healthy adults (∼1:1 male:female). Salivary cortisol and task performance measures were used to assess endocrine and cognitive responses. Habitual alcohol consumption and confounding factors were assessed by questionnaire. Alcohol consumption was inversely related to responses of heart rate (HR) (r = -0.31, p = 0.01), cardiac output (CO) (r = -0.32, p = 0.01), vascular resistance (r = 0.25, p = 0.04) and mean blood pressure (r = -0.31, p = 0.01) provoked by stress, but not to stroke volume (SV), or arterial compliance changes. However, high alcohol consumers had greater cortisol stress responses, compared to moderate consumers (3.5 versus 0.7 nmol/L, p = 0.04). Cognitive measures did not differ. Findings were not explained by variations in age, sex, social class, ethnicity, physical activity, adrenocortical activity, adiposity, smoking, menstrual phase and chronic stress. Habitual alcohol consumption is associated with reduced cardiac responsiveness during mental stress, which has been linked to lower risk of hypertension and vascular disease. Consistent with established evidence, our findings suggest a mechanism by which moderate alcohol consumption might reduce cardiovascular disease, but not high consumption, where effects such as greater cortisol stress responses may negate any benefits.

Fatores de risco cardiovascular em alcoolistas em tratamento

OBJETIVO: Avaliar a presença de fatores de risco cardiovascular, com ênfase na hipertensão e na adiposidade corporal, em alcoolistas abstinentes ou não abstinentes em tratamento. MÉTODO: Trata-se de um estudo transversal com 65 pacientes alcoolistas em tratamento no CAP-Sad. O grau de dependência do álcool foi avaliado pelo SADD (Short Alcohol Dependence Data) e o uso de outras drogas, pelo ASSIST (Alcohol Smoking and Substance Involvement Screening Test). Foram avaliados o perfil bioquímico e o antropométrico dos usuários. RESULTADOS: Participaram do estudo 42 homens e 23 mulheres. A maioria dos participantes (67,74%) apresentou dependência alcoólica grave, com uso de álcool associado principalmente a cigarro (66,15%). A média da circunferência da cintura (CC) foi significativamente maior entre os abstinentes, em comparação aos não abstinentes (AB: 88,15 ± 15,95 x NA: 81,04 ± 9,86; p = 0,03). Pacientes abstinentes há mais tempo tiveram maior sobrepeso/obesidade e adiposidade abdominal (CC) do que os não abstinentes e abstinentes recentes, com razão de chances de 5,25. Os abstinentes apresentaram razão de chances de 3,38 para %GC acima da média, independente do tempo de abstinência. CONCLUSÃO: Pacientes alcoolistas abstinentes apresentam mais sobrepeso/ obesidade, adiposidade corporal (%GC) e abdominal (CC) do que os não abstinentes. É importante o acompanhamento multiprofissional no tratamento de alcoolistas com abordagem para fatores de risco cardiovasculares, principalmente evitando o ganho de peso.

Metabolic and biochemical effects of low-to-moderate alcohol consumption

BACKGROUND

Alcohol consumption has multiple biochemical consequences. Only a few of these are useful as diagnostic markers, but many reflect potentially harmful or beneficial effects of alcohol. Average consumption of 2 to 4 drinks per day is associated with lower overall or cardiovascular mortality risk than either lower or higher intake. We have analyzed the dose-response relationships between reported alcohol consumption and 17 biomarkers, with emphasis on intake of up to 3 drinks per day.

METHODS

Biochemical tests were performed on serum from 8,396 study participants (3,750 men and 4,646 women, aged 51 ± 13 years, range 18 to 93) who had provided information on alcohol consumption in the week preceding blood collection.

RESULTS

Gamma glutamyl transferase, alanine aminotransferase, aspartate aminotransferase, carbohydrate-deficient transferrin, urate, ferritin, and bilirubin showed little or no change with alcohol consumption below 2 to 3 drinks per day, but increased with higher intake. High-density lipoprotein cholesterol and albumin showed increasing results, and insulin showed decreasing results, across the entire range of alcohol use. Biphasic responses, where subjects reporting 1 to 2 drinks per day had lower results than those reporting either more or less alcohol use, occurred for triglycerides, glucose, C-reactive protein, alkaline phosphatase, and butyrylcholinesterase. Increasing alcohol use was associated with decreasing low-density lipoprotein cholesterol (LDL-C) in younger women, but higher LDL-C in older men.

CONCLUSIONS

Some markers show threshold relationships with alcohol, others show continuous ones, and a third group show biphasic or U-shaped relationships. Overall, the biochemical sequelae of low-to-moderate alcohol use are consistent with the epidemiological evidence on morbidity and mortality.

Influence of daily alcohol consumption on serum adiponectin levels in men

BACKGROUND

The risk of cardiovascular diseases is lower among moderate alcohol drinkers than among both nondrinkers and heavy drinkers. However, factors that can account for the U-shaped or J-shaped relationship between daily alcohol consumption and incident cardiovascular diseases remain obscure.

PURPOSE

The present cross-sectional study investigated the relationship between alcohol consumption and serum adiponectin levels.

METHOD

Total adiponectin was measured in 527 males participating in health check-up programs (age range 40-86 years, mean 60.5 years). Based on questionnaire responses, alcohol intake was categorized into three groups: none or occasional (A1); <50 g/day and ≥3 days/week (A2); and ≥50 g/day and ≥3 days/week (A3).

RESULTS

No significant differences in adiponectin levels were observed among the three alcohol consumption groups of subjects without the metabolic syndrome (MetS). In subjects with the MetS, the adiponectin level was significantly higher in the A2 (moderate drinker) group than in both the A1 and A3 groups. MetS subjects in group A2 had higher HDL-C levels than those in A1, but levels in group A3 were not significantly different from those in group A2.

CONCLUSION

An increased adiponectin level in moderate alcohol drinkers who have MetS may contribute to the U-shaped relationship between alcohol consumption and risk of cardiovascular events, in addition to the involvement of HDL-C.

Physical activity and blood lipids and lipoproteins in dialysis patients

The relationship between physical activity and blood lipids and lipoproteins in dialysis patients is reviewed in the context of the potentially confounding factors such as nutritional intake, cigarette smoking, obesity, alcohol intake, and physical activity levels in the general population and additional confounding factors such as mode of dialysis and diabetes in dialysis patients. The known associations in the general population of physical activity with high-density-lipoprotein cholesterol subfractions and apolipoprotein A-I are more pronounced in hemodialysis patients than in peritoneal dialysis patients even after adjusting for these confounding factors. Examining studies on the effects of physical activity on blood lipids and lipoproteins, the most consistent observation is the noted decrease in triglycerides and increase in high-density-lipoprotein cholesterol and insulin sensitivity in hemodialysis patients. The changes in lipids and lipoproteins in hemodialysis patients could be caused by changes in activity levels of lipoprotein lipase, insulin sensitivity, and/or glucose metabolism. Future research investigating the relationship between physical activity and blood lipids and lipoproteins in dialysis patients should direct research towards the underlying mechanisms for changes in blood lipids and lipoproteins.

Volunteerism and Mortality among the Community-dwelling Elderly

Older residents (N 5 1972) in California were investigated prospectively for association of volunteering service to others and all-cause mortality. Potential confounding factors were studied: demographics, health status, physical functioning, health habits, social support, religious involvement, and emotional states. Possible interaction effects of volunteering with religious involvement and social support were also explored. Results showed that 31 percent (n 5 630) of respondents volunteered, about half (n5289) for more than one organization. High volunteers ([.greaterequal]2 organizations) had 63 percent lower mortality than nonvolunteers (age and sex-adjusted) with relative hazard (RH) 5 0.37, confidence interval (CI) 5 0.24, 0.58. Multivariate adjustment moderately reduced difference to 44 percent (RH 5 0.56, CI 5 0.35, 0.89), mostly due to physical functioning, health habits, and social support. Unexpectedly, volunteering was slightly more protective for those with high religious involvement and perceived social support. After multivariate adjustment, any level of volunteering reduced mortality by 60 percent among weekly attenders at religious services (RH 5 0.40; CI 5 0.21,0.74). Lower mortality rates for community service volunteers were only partly explained by health habits, physical functioning, religious attendance, and social support.

Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury

Component and coalesced health risks of the cardiometabolic syndrome (CMS) are commonly reported in persons with spinal cord injuries (SCIs). These CMS hazards are also co-morbid with physical deconditioning and elevated pro-atherogenic inflammatory cytokines, both of which are common after SCI and worsen the prognosis for all-cause cardiovascular disease. This article describes a systematic procedure for individualized CMS risk assessment after SCI, and emphasizes evidence-based and intuition-centered countermeasures to disease. A unified approach will propose therapeutic lifestyle intervention as a routine plan for aggressive primary prevention in this risk-susceptible population. Customization of dietary and exercise plans then follow, identifying shortfalls in diet and activity patterns, and ways in which these healthy lifestyles can be more substantially embraced by both stakeholders with SCI and their health care providers. In cases where lifestyle intervention utilizing diet and exercise is unsuccessful in countering risks, available pharmacotherapies and a preferred therapeutic agent are proposed according to authoritative standards. The over-arching purpose of the monograph is to create an operational framework in which existing evidence-based approaches or heuristic modeling becomes best practice. In this way persons with SCI can lead more active and healthy lives.

Increased body mass index modifies associations between alcohol intake and blood cholesterol profile

BACKGROUND AND OBJECTIVES

Habitual alcohol drinking influences blood cholesterol profile, and dyslipidaemia often accompanies obesity. The aim of this study was to determine whether obesity modifies relationships between alcohol intake and blood cholesterol profile.

METHODS

  Japanese men aged 35-60 years (n = 23 834) were divided into two groups by body mass index (BMI) (normal BMI: ≥ 18·5 and < 25 kg/m(2) ; high BMI: ≥ 25 kg/m(2) ) and were further divided into four subgroups by alcohol intake [non-, light (< 22 g ethanol/day), heavy (≥ 22 and < 44 g ethanol/day) and very heavy (≥ 44 g ethanol/day) drinkers]. Relationships of alcohol intake with serum LDL cholesterol, HDL cholesterol and LDL/HDL ratio were investigated.

RESULTS

Both in the subject groups with normal and high BMI, alcohol intake was associated with lower risks of high LDL cholesterol, low HDL cholesterol and high LDL/HDL ratio, and these risks tended to decrease as alcohol intake increased. The odds ratios vs. nondrinkers for high LDL cholesterol, low HDL cholesterol and high LDL/HDL ratio tended to be lower in the normal BMI group than in the high BMI group. Significant interactions between alcohol drinking and BMI for high LDL cholesterol, low HDL cholesterol and high LDL/HDL ratio were found in all of the drinker subgroups except for the interaction for high LDL cholesterol in light drinkers.

CONCLUSIONS

High BMI status is suggested to attenuate the associations of alcohol intake with lower LDL cholesterol, higher HDL cholesterol and lower LDL/HDL ratio.

Impact of alcohol use on mortality in the elderly: results from the Korean Longitudinal Study on Health and Aging

BACKGROUND

To examine the effects of problematic drinking, amount of alcohol use and binge drinking on all-cause mortality in the elderly.

METHODS

We investigated 45-month all-cause mortality of 997 randomly sampled community-dwelling elderly Koreans aged 65 years or older who participated in the Korean Longitudinal Study on Health and Aging. Problematic drinking was defined as having alcohol use disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria or having 8 or higher of the Alcohol Use Disorders Identification Test. Light drinking was defined as drinking 7 alcoholic drinks or less, and heavy drinking as having 14 alcoholic drinks more per week during past 12 months. Binge drinking was defined as having 6 or more drinks on a single occasion at least monthly.

RESULTS

One hundred and thirteen participants (11.3%) died during the 45-month follow-up period. Heavy drinking (>14 alcoholic drinks per week) increased the all-cause mortality risk when in association with problematic drinking (hazard ratio [HR]=2.604, 95% confidence interval [CI]=1.221-5.553, p=0.012) or binge drinking (HR=2.823, 95% CI=1.259-6.328, p=0.013). Light drinking (≤ 7 alcoholic drinks per week) was associated with decreased all-cause mortality (HR=0.114, 95% CI=0.015-0.833, p=0.032).

CONCLUSIONS

Problematic drinking is associated with increased all-cause mortality in elderly Koreas, particularly when it is heavy and/or combined with binge drinking.

Endothelial dysfunction during acute alcohol withdrawal syndrome

BACKGROUND

Endothelial dysfunction (EF) is a central phenomenon in a variety of conditions associated with increased cardiovascular morbidity. Here, we investigated EF during acute alcohol withdrawal syndrome before and 24h after medication. We aimed to analyze microcirculation, applying the post-occlusive reactive hyperemia (PORH) test and spectral analysis of skin vasomotion as markers of EF. Additionally, we explored whether segmentation of spectral analysis data may disclose more detailed information on dynamic blood flow behavior.

METHODS

We investigated 30 unmedicated patients during acute alcohol withdrawal syndrome and matched controls. Patients were reinvestigated after 24h when half of them had been treated with clomethiazole. Capillary blood flow was assessed on the right forearm after compression of the brachial artery. Parameters of PORH such as time to peak (TP), slope and PORH indices were calculated. Spectral analysis was performed in order to study five different frequency bands. Withdrawal symptoms were quantified by means of the alcohol withdrawal scale (AW scale).

RESULTS

We observed a blunted hyperemic response in patients after occlusion of the brachial artery indicated by significantly increased TP and decreased PORH indices. In contrast, vasomotion as investigated by spectral analysis was not altered. Segmentation analysis revealed some alterations in the cardiac band at rest, and indicated differences between treated and untreated patients after 24h.

CONCLUSION

Our results suggest peripheral endothelial dysfunction in patients during acute alcohol withdrawal. No major influence of treatment was observed. Future studies need to address the relation of EF to cardiac morbidity during alcohol withdrawal.

Alcohol intake and atherosclerotic risk factors in normotensive and prehypertensive men

BACKGROUND

The purpose of this study was to determine whether relationships between alcohol intake and atherosclerotic risk factors were different in normotensive and prehypertensive persons.

METHODS

Japanese men aged 35-60 years who showed normal blood pressure (n = 4,778) or prehypertension (n = 9,728) without any drug therapy for hypertension were divided into non, light (<22 g ethanol/day), heavy (≥ 22 and < 44 g ethanol/day) and very heavy (≥ 44 g ethanol/day) drinkers.

RESULTS

In subjects with prehypertension, body mass index (BMI) and waist circumference were significantly lower and smaller, respectively, in light, heavy and very heavy drinkers than in nondrinkers. In subjects with normal blood pressure, BMI was significantly lower in light and heavy drinkers but not in very heavy drinkers than in nondrinkers, and waist circumference was not significantly different in non, light and heavy drinkers and was significantly larger in very heavy drinkers than in nondrinkers. Both in the prehypertensive and normotensive groups, compared with nondrinkers, hemoglobin A(1C) and low-density lipoprotein (LDL) cholesterol were significantly lower and high-density lipoprotein (HDL) cholesterol was significantly higher in light, heavy and very heavy drinkers, and log-converted triglycerides was significantly higher in very heavy drinkers.

CONCLUSIONS

The association of alcohol intake with a lower occurrence of obesity is stronger in prehypertensives than in normotensives, while the associations of alcohol intake with lower occurrences of hyperglycemia and abnormal cholesterol profile, such as lowered HDL cholesterol and elevated LDL cholesterol, and a higher occurrence of elevated triglycerides are similar in normotensive and prehypertensive persons.