06 May 2014 In Cardiovascular System

BACKGROUND: Ample evidence exists for a protective effect of moderate alcohol consumption on cardiovascular risk. Recently, genotype of alcohol dehydrogenase 1C (ADH1C) has been reported to modify the impact of alcohol consumption on the risk of coronary heart disease (CHD). This study investigates whether ADH1C genotype modifies the effect of alcohol consumption on CHD risk and high-density lipoprotein (HDL) cholesterol level.

DESIGN: Prospective cohort study.

METHODS: Analyses of the joint effects of alcohol consumption and ADH1C genotype on CHD risk and HDL cholesterol level using Cox proportional hazards models and linear models.

RESULTS: Participants who were homozygous or heterozygous for the slow metabolizing gamma2-allele and reported alcohol intake of more than 14 g/day showed a 64% [hazard rate ratio (HRR), 0.36; 95% confidence interval (CI), 0.16-0.80] reduction in CHD risk. This effect was particularly pronounced in men (HRR, 0.27; 95% CI, 0.11-0.67). Women who reported alcohol intake > or =2 g/day showed a nonsignificant risk reduction (HRR, 0.39; 95% CI, 0.07-2.17). No significant interactions were found among alcohol consumption, ADH1C genotype, and HDL cholesterol levels.

CONCLUSIONS: In this study, alcohol dehydrogenase modifies the effect of alcohol consumption on coronary risk. The results support the protective effect of alcohol consumption on CHD risk and suggest a causal association of alcohol intake and lower CHD risk. The impact of ADH1C on the relationship between alcohol and HDL cholesterol is less clear.

06 May 2014 In Cardiovascular System

OBJECTIVES: This study examined the association between alcohol use, the occurrence of cardiovascular events, and plaque phenotype in patients after femoral or carotid endarterectomy for arterial occlusive disease. Alcohol has been shown to have cardiovascular protective effects in patients with cardiovascular disease as well as in healthy individuals. Whether alcohol consumption induces changes in atherosclerotic plaque composition has not been investigated.

METHODS: Consecutive femoral (n = 224) and carotid (n = 693) endarterectomy specimens underwent histologic examination for the presence of collagen, calcifications, smooth muscle cells, macrophages, fat, and intraplaque thrombus. Patients were monitored for 3 years after the initial operation and investigated for the occurrence of cardiovascular events. Primary outcome was the composite end point "major cardiovascular event." Alcohol consumption was categorized as no alcohol use, 1 to 10 U/wk, or >10 U/wk.

RESULTS: The Kaplan-Meier estimate of the major cardiovascular event rate after 3 years of follow-up in the femoral group was 35% for no alcohol use and 21% for 1 to 10 U/wk, whereas only 10% of the group >10 U/wk sustained a major cardiovascular event (P = .010). The plaques of alcohol consumers in the femoral group contained significantly smaller lipid cores and less macrophage infiltration than in abstainers. In the carotid group, the major cardiovascular event rate was similar in all three groups, and in addition, no difference in plaque composition was observed.

CONCLUSIONS: This study shows an inverse relationship between alcohol use and major cardiovascular events after endarterectomy for lower extremity arterial occlusive disease, accompanied by a more stable plaque phenotype. However, no such relationship could be observed for patients with cerebrovascular disease.

06 May 2014 In Cardiovascular System

Alcohol has diverse effects on the cardiovascular system. Moderate drinking is associated with a decreased risk of cardiovascular disease, yet increasing amounts of alcohol consumption are known to increase blood pressure. These opposing effects have led to interest in the effect of moderate alcohol consumption on the risk of coronary heart disease (CHD) in patients with hypertension. To test the hypothesis that moderate alcohol consumption decreases the risk of myocardial infarction (MI) in patients with hypertension, we used data on 5,164 participants in the Physicians' Health Study who were apparently healthy and free of CHD at baseline. Incident MI was ascertained by annual follow-up questionnaires and validated through review of medical records. Cox proportional hazard model was used to compute multivariable-adjusted hazard ratios with corresponding 95% confidence intervals. From 1982 to 2008, 623 cases of MI occurred. Compared to subjects consuming 8 drinks per week adjusted for age, body mass index, smoking, exercise, diabetes, multivitamin use, vegetable intake, breakfast cereal intake, and cholesterol (p for trend <0.0022). Similar inferences could be made for the secondary outcomes of angina pectoris and any CHD (which included MI, angina pectoris, and previous revascularization). In conclusion, our data demonstrated an inverse relation between moderate alcohol consumption and CHD in hypertensive men.

06 May 2014 In Cardiovascular System

BACKGROUND: Limited data are available on the benefit of combining healthy dietary and lifestyle behaviors in the prevention of myocardial infarction (MI) in women.

METHODS: We used factor analysis to identify a low-risk behavior-based dietary pattern in 24 444 postmenopausal women from the population-based prospective Swedish Mammography Cohort who were free of diagnosed cancer, cardiovascular disease, and diabetes mellitus at baseline (September 15, 1997). We also defined 3 low-risk lifestyle factors: nonsmoking, waist-hip ratio less than the 75th percentile (< 0.85), and being physically active (at least 40 minutes of daily walking or bicycling and 1 hour of weekly exercise).

RESULTS: During 6.2 years (151 434 person-years) of follow-up, we ascertained 308 cases of primary MI. Two major identified dietary patterns, "healthy" and "alcohol," were significantly associated with decreased risk of MI. The low-risk diet (high scores for the healthy dietary pattern) characterized by a high intake of vegetables, fruit, whole grains, fish, and legumes, in combination with moderate alcohol consumption (>/= 5 g of alcohol per day), along with the 3 low-risk lifestyle behaviors, was associated with 92% decreased risk (95% confidence interval, 72%-98%) compared with findings in women without any low-risk diet and lifestyle factors. This combination of healthy behaviors, present in 5%, may prevent 77% of MIs in the study population.

CONCLUSION: Most MIs in women may be preventable by consuming a healthy diet and moderate amounts of alcohol, being physically active, not smoking, and maintaining a healthy weight.

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