26 April 2017 In Cardiovascular System

PURPOSE OF REVIEW: Previous research suggests that low-moderate alcohol consumption may have cardioprotective effects, while heavy or binge-pattern drinking is harmful. New evidence and research methodology may inform safe thresholds of alcohol use. This review examines recent evidence regarding alcohol's effect on cardiovascular disease, with a special consideration of pattern, drink type, and total quantity.

RECENT FINDINGS: New epidemiologic research confirms the potential harmful cardiovascular effects of heavy episodic alcohol use and does not support the previous observation that low-moderate alcohol use protects against stroke. Alcohol consumption also appears to have a continuous positive relationship with the risk of atrial fibrillation. In addition, Mendelian randomization analyses suggest that alcohol may have a direct causal role in adverse cardiovascular effects. Recent studies have confirmed that heavy alcohol use (>14 drinks per week in women and >21 drinks per week in men) and heavy episodic drinking are associated with an increased risk of mortality. New research raises concerns that even low-moderate alcohol use may not offer cardio- or cerebrovascular protection. Drinking >/=3 drinks per day on a regular basis or >/=5 drinks in any one episode should be discouraged.

15 December 2016 In Cardiovascular System

Alcohol is popular in Western culture, supported by a perception that modest intake is cardioprotective. However, excessive drinking has detrimental implications for cardiovascular disease. Atrial fibrillation (AF) following an alcohol binge or the "holiday heart syndrome" is well characterized. However, more modest levels of alcohol intake on a regular basis may also increase the risk of AF. The pathophysiological mechanisms responsible for the relationship between alcohol and AF may include direct toxicity and alcohol's contribution to obesity, sleep-disordered breathing, and hypertension. We aim to provide a comprehensive review of the epidemiology and pathophysiology by which alcohol may be responsible for AF and determine whether alcohol abstinence is required for patients with AF.

25 October 2016 In Cardiovascular System

BACKGROUND: The effects of light to moderate alcohol consumption on cardiac mechanics remain poorly understood. The aim of this study was to investigate the dose-response relationship between alcohol consumption and left ventricular (LV) and left atrial (LA) function using myocardial deformation.

METHODS: In total 3,946 asymptomatic participants (mean age, 49.7 +/- 10.7 years; 65% men) were consecutively studied using comprehensive echocardiography and two-dimensional speckle-tracking in a cross-sectional, retrospective manner. Global LV longitudinal and circumferential strain and LA strain were assessed and related to habitual alcohol consumption pattern (fewer than one, one to six, or more than six drinks per week) before and after propensity matching.

RESULTS: With increasing weekly alcohol consumption, participants displayed greater LV eccentric remodeling, impaired diastolic function, and more attenuated global longitudinal strain, LA strain (adjusted coefficients, -1.07 [95% CI, -1.95 to -0.19] and -3.73 [95% CI, -5.36 to -2.11]), and early diastolic strain rates (adjusted coefficients, 0.07 [95% CI, 0.03-0.11] and 0.33 [95% CI, 0.24-0.42]) for one to six and more than six drinks per week, respectively (P < .05 for all) in a dose-response manner. Participants with recent alcohol abstinence displayed cardiac mechanics intermediate between those of nondrinkers and current drinkers. After propensity matching (n = 1,140), participants currently consuming more than one drink per week continued to have significantly attenuated global longitudinal strain and all LA mechanics compared with those consuming fewer than one drink per week (P < .05 for all).

CONCLUSIONS: Habitual alcohol consumption, even at light to moderate doses, is associated with both reduced LV and LA mechanics in a dose-dependent manner. Whether such observations are reversible or related to future atrial fibrillation deserves further study.

28 August 2015 In Cardiovascular System

AIMS: Light-to-moderate drinking has been associated with reduced risk of heart failure (HF). We have examined the association between alcohol consumption and incident HF in older British men.

METHODS AND RESULTS: Prospective study of 3530 men aged 60-79 years with no diagnosed HF or myocardial infarction (MI) at baseline and followed up for a mean period of 11 years, in whom there were 198 incident HF cases. Men were divided into 6 categories of alcohol consumption: none, <1, 1-6, 7-13, 14-34 and >/=35 drinks/week. There was no evidence that light-to-moderate drinking is beneficial for risk of HF. Heavy drinking (>/=35 drinks/week) was associated with significantly increased risk of HF. Using the large group of men drinking 1-6 drinks/week as the reference group, the relative HRs (95% confidence interval) for HF adjusted for age, lifestyle characteristics, blood pressure, atrial fibrillation and renal dysfunction were 0.97 (0.59 to 1.63), 1.39 (0.86 to 2.25), 1.00, 0.94 (0.64 to 1.43), 1.16 (0.78 to 1.71) and 1.91 (1.02 to 3.56) for the 6 alcohol groups, respectively. The increased risk associated with heavy drinking was attenuated after adjustment for N-terminal pro-brain natriuretic peptide (NT-proBNP) (HR=1.43 (0.76 to 1.69)). Stratified analysis showed heavy drinking was associated with increased HF risk only in those with ECG evidence of myocardial ischaemia.

CONCLUSIONS: There was no evidence that light-to-moderate drinking is beneficial for the prevention of HF in older men without a history of an MI. Heavier drinking (>/=5 drinks/day), however, was associated with increased risk of HF in vulnerable men with underlying myocardial ischaemia.

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