06 May 2014 In Cardiovascular System

Grain alcohol is a simple molecule (ethanol) but a complex drug. Alcohol has divergent cardiovascular effects depending on the amount consumed. In moderation, alcohol is associated with reduced risk for coronary heart disease, most likely because it increases high-density lipoprotein cholesterol. Especially in excess, alcohol impairs ventricular function, increases arrhythmias such as atrial fibrillation, and causes hypertension. The latter is an important consequence but is often overlooked by clinicians treating patients with hypertension. Although more attention has been given to the type of alcohol ingested (e.g., red vs. white wine), the pattern of drinking is far more important. In a study of 1,935 subjects after myocardial infarction, steady drinkers experienced a progressive decline in mortality with increasing consumption, whereas binge drinkers experienced no cardioprotection, even with heavy intake.

06 May 2014 In Cardiovascular System

Background Alcohol exposure is one of the major risk factors for global burden of disease, but atrial fibrillation (AF) had not yet been included in these estimates. The purpose of this contribution was to examine the dose-response relationship between alcohol consumption and AF and to explore potential causal pathways. Design and methods Systematic literature review and meta-analyses. Results Overall, a consistent dose-response relationship between the amount of alcohol consumed daily and the probability of the onset of AF was found. Women consuming 24, 60 and 120 g of alcohol daily had relative risks of 1.07 [95% confidence interval (CI): 1.04-1.10], 1.42 (95% CI: 1.23-1.64) and 2.02 (95% CI: 1.60-2.97), respectively, relative to nondrinkers. Among men, the corresponding relative risks were 1.08 (95% CI: 1.04-1.11), 1.44 (95% CI: 1.23-1.69) and 2.09 (95% CI: 1.52-2.86). Based on the categorical analyses, we could not exclude the existence of a threshold (three drinks a day for men and two drinks a day for women). Several pathogenic mechanisms for the development of AF in alcohol users were identified. Conclusion Epidemiological criteria for causality were met to conclude a causal impact of alcohol consumption on the onset of AF with a monotonic dose-response relationship. However, the impact of light drinking is not clear.

06 May 2014 In Cardiovascular System

OBJECTIVE: To assess alcohol intake as a risk factor for adverse events among patients with incident atrial fibrillation (AF). DESIGN: Prospective cohort study.

SETTING: Population based cohort study and nationwide Danish registries.

PATIENTS: The Danish Diet, Cancer and Health study included 57 053 participants (27 178 men and 29 875 women) aged between 50 and 64 years. The study population for this study included the 3107 participants (1999 men, 1108 women) who developed incident AF after inclusion.

MAIN OUTCOME MEASURES: A composite of thromboembolism or death.

RESULTS: During a median follow-up of 4.9 years 608 deaths and 211 thromboembolic events occurred. Of those who developed AF, 690 (35%) men and 233 (21%) women had a high intake of alcohol (>20 drinks/week for men and >13 drinks/week for women). After adjustment for use of oral anticoagulation and components of the CHA2DS2-VASc score, men with an intake of >27 drinks/week had a higher risk for thromboembolism or death (hazard ratio (HR) 1.33, 95% CI 1.08 to 1.63) than men with an intake of 20 drinks/week also had a higher risk (HR 1.23, 95% CI 0.78 to 1.96) than women in the low intake category. The higher risk among men was primarily driven by mortality (HR 1.51, 95% CI 1.20 to 1.89), whereas the risk found among women was driven by thromboembolism (HR 1.71, 95% CI 0.81 to 3.60).

CONCLUSIONS: High alcohol intake predicts thromboembolism or death, even after adjustment for established clinical risk factors, and may help identify high risk AF patients who could be targeted for stroke and cardiovascular prevention strategies.

06 May 2014 In Cardiovascular System

Habitual light to moderate alcohol intake (up to 1 drink per day for women and 1 or 2 drinks per day for men) is associated with decreased risks for total mortality, coronary artery disease, diabetes mellitus, congestive heart failure, and stroke. However, higher levels of alcohol consumption are associated with increased cardiovascular risk. Indeed, behind only smoking and obesity, excessive alcohol consumption is the third leading cause of premature death in the United States. Heavy alcohol use (1) is one of the most common causes of reversible hypertension, (2) accounts for about one-third of all cases of nonischemic dilated cardiomyopathy, (3) is a frequent cause of atrial fibrillation, and (4) markedly increases risks of stroke-both ischemic and hemorrhagic. The risk-to-benefit ratio of drinking appears higher in younger individuals, who also have higher rates of excessive or binge drinking and more frequently have adverse consequences of acute intoxication (for example, accidents, violence, and social strife). In fact, among males aged 15 to 59 years, alcohol abuse is the leading risk factor for premature death. Of the various drinking patterns, daily low- to moderate-dose alcohol intake, ideally red wine before or during the evening meal, is associated with the strongest reduction in adverse cardiovascular outcomes. Health care professionals should not recommend alcohol to nondrinkers because of the paucity of randomized outcome data and the potential for problem drinking even among individuals at apparently low risk. The findings in this review were based on a literature search of PubMed for the 15-year period 1997 through 2012 using the search terms alcohol, ethanol, cardiovascular disease, coronary artery disease, heart failure, hypertension, stroke, and mortality. Studies were considered if they were deemed to be of high quality, objective, and methodologically sound.

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