22 March 2016 In Cardiovascular System

BACKGROUND: Although considerable research describes the cardiovascular effects of habitual moderate and heavy alcohol consumption, the immediate risks following alcohol intake have not been well characterized. Based on its physiological effects, alcohol may have markedly different effects on immediate and long-term risk.

METHODS AND RESULTS: We searched CINAHL, Embase, and PubMed from inception to March 12, 2015, supplemented with manual screening for observational studies assessing the association between alcohol intake and cardiovascular events in the following hours and days. We calculated pooled relative risks and 95% confidence intervals for the association between alcohol intake and myocardial infarction, ischemic stroke, and hemorrhagic stroke using DerSimonian and Laird random-effects models to model any alcohol intake or dose-response relationships of alcohol intake and cardiovascular events. Among 1056 citations and 37 full-text articles reviewed, 23 studies (29 457 participants) were included. Moderate alcohol consumption was associated with an immediately higher cardiovascular risk that was attenuated after 24 hours, and even protective for myocardial infarction and hemorrhagic stroke (approximately 2-4 drinks: relative risk=30% lower risk) and protective against ischemic stroke within 1 week (approximately 6 drinks: 19% lower risk). In contrast, heavy alcohol drinking was associated with higher cardiovascular risk in the following day (approximately 6-9 drinks: relative risk=1.3-2.3) and week (approximately 19-30 drinks: relative risk=2.25-6.2).

CONCLUSIONS: There appears to be a consistent finding of an immediately higher cardiovascular risk following any alcohol consumption, but, by 24 hours, only heavy alcohol intake conferred continued risk.

22 March 2016 In Cardiovascular System

OBJECTIVES: To investigate and quantify the potential dose-response association between alcohol consumption and risk of coronary artery disease (CAD).

METHODS: We searched the PubMed database from inception to March 2015 and reviewed the reference list of relevant articles to identify prospective studies assessing the association between alcohol consumption and risk of CAD. Study-specific relative risk (RR) estimates were combined using a random-effects model. Publication bias was estimated using Begg's funnel plot and Egger's regression asymmetry test. The meta-analysis included 18 prospective studies, with a total of 214 340 participants and 7756 CAD cases. The pooled adjusted RRs were 0.62 (95% confidence interval [CI] 0.56-0.68) for highest alcohol consumption amount versus lowest amount. Begg's and Egger's regression tests provided no evidence of substantial publication bias (P = 0.762 for Begg's test and 0.172 for Egger's test).

RESULTS: In a dose response analysis, we observed a nonlinear association between alcohol consumption and risk of CAD (P for nonlinearity <0.00). Compared with non-drinkers, the RRs (95% CI) of CAD across levels of alcohol consumption were 0.75 (0.70-0.80) for 12 g/d, 0.70 (0.66-0.75) for 24 g/d, 0.69 (0.64-0.75) for 36 g/d, 0.70 (0.64-0.77) for 60 g/d, 0.74 (0.67-0.83) for 90 g/d, and 0.83 (0.67-1.04) for 135 g/d.

CONCLUSIONS: Alcohol consumption in moderation is associated with a reduced risk of CAD with 36 grams/d of alcohol conferring a lower risk than other levels.

24 February 2016 In General Health

OBJECTIVE: To systematically review all the prospective cohort studies that have analysed the relation between adherence to a Mediterranean diet, mortality, and incidence of chronic diseases in a primary prevention setting. DESIGN: Meta-analysis of prospective cohort studies.

DATA SOURCES: English and non-English publications in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from 1966 to 30 June 2008. Studies reviewed Studies that analysed prospectively the association between adherence to a Mediterranean diet, mortality, and incidence of diseases; 12 studies, with a total of 1 574,299 subjects followed for a time ranging from three to 18 years were included.

RESULTS: The cumulative analysis among eight cohorts (514,816 subjects and 33,576 deaths) evaluating overall mortality in relation to adherence to a Mediterranean diet showed that a two point increase in the adherence score was significantly associated with a reduced risk of mortality (pooled relative risk 0.91, 95% confidence interval 0.89 to 0.94). Likewise, the analyses showed a beneficial role for greater adherence to a Mediterranean diet on cardiovascular mortality (pooled relative risk 0.91, 0.87 to 0.95), incidence of or mortality from cancer (0.94, 0.92 to 0.96), and incidence of Parkinson's disease and Alzheimer's disease (0.87, 0.80 to 0.96).

CONCLUSIONS: Greater adherence to a Mediterranean diet is associated with a significant improvement in health status, as seen by a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinson's disease and Alzheimer's disease (13%). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.

24 February 2016 In Diabetes

BACKGROUND: Previous cohort studies have shown that moderate alcohol consumption was associated with a lower risk of type 2 diabetes (T2D). However, whether these associations differ according to the characteristics of patients with T2D remains controversial.

OBJECTIVE: The purpose of this study was to explore and summarize the evidence on the strength of the association between alcohol consumption and the subsequent risk of T2D by using a dose-response meta-analytic approach.

DESIGN: We identified potential studies by searching the PubMed, Embase, and Cochrane Library databases up to 24 March 2015. Prospective observational studies that evaluated the relation between alcohol consumption and the risk of T2D and reported its effect estimates with 95% CIs were included.

RESULTS: Analyses were based on 706,716 individuals (275,711 men and 431,005 women) from 26 studies with 31,621 T2D cases. We detected a nonlinear relation between alcohol consumption and the risk of T2D, which was identified in all cohorts (P-trend < 0.001, P-nonlinearity < 0.001), in men (P-trend < 0.001, P-nonlinearity < 0.001), and in women (P-trend < 0.001, P-nonlinearity < 0.001). Compared with the minimal category of alcohol consumption, light (RR: 0.83; 95% CI: 0.73, 0.95; P = 0.005) and moderate (RR: 0.74; 95% CI: 0.67, 0.82; P < 0.001) alcohol consumption was associated with a lower risk of T2D. However, heavy alcohol consumption had little or no effect on subsequent T2D risk. Furthermore, the summary RR ratio (RRR; male to female) of the comparison between moderate alcohol consumption and the minimal alcohol categories for T2D was significantly higher, and the pooled RRR (current smoker to never smoker) of light alcohol consumption was significantly reduced.

CONCLUSIONS: Light and moderate alcohol consumption was associated with a lower risk of T2D, whereas heavy alcohol consumption was not related to the risk of T2D.

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