Revised Journal 1alcohol and Cvd

8/2/2019 Revised Journal 1alcohol and Cvd

1/31

Maurizio Trevisan, Joan Dorn, Karen Falkner, Marcia Russell, Malathi Ram,Paola Muti, Jo L. Freudenheim, Thomas Nochajaski & Kathy HoveyAddiction, September 2003 (99) 313-322


2/31


3/31

Increased risk of cardiovascular diseases(Coronary Heart Disease, Stroke, Hypertension)

Increased risk of cancer:(liver, stomach, colon, pancreas, breast, mouth,throat)

Impaired immune system

Malnutrition Reproductive problems


4/31

Pros Reduced heart risk

Reduce chances of coronaryartery disease

Stroke prevention

Reduce development ofblocked arteries in your legs

ConsSlow brain activity

Interfere with sleep andsexual function

Raise your blood pressure

Heartburn, headachesBinge Drinking

Liver, Kidney, Lung andheart disease

Stroke

Osteoporosis

Obesity Increase risk of types of

cancer


5/31

How much was consumed

Rate of consumption

What is in stomach Presence of carbonation

Mood status

Sex

Race


6/31

Medline, Pubmed, EBSCO Host Google, Yahoo

Coronary Heart Disease Cardiovascular Disease

Emerging Risk Factors

Epidemiology


7/31

Type of question asked:

HARM/CAUSATION/ETIOLOGY


8/31

Study Population

DevelopDisease(MI, CVD)

Do NotDevelopDisease(NO MI,CVD)

CASES CONTROLS

CASE-CONTROL STUDY

(1993-1998)

Interviews and

P.E.

CENTER OF

PREVENTIVE

MEDICINE,

UNIVERSITYOF BUFFALO


9/31

NIAGARA

ERIE


10/31

Designed to investigate many aspectsof drinking previously not wellinvestigated in regard to their relation

with myocardial infarction

Currency?Frequency?Food?

Day?


11/31

Harm/Causation/Etiology Population (patient) Who was studied? Intervention (exposure, risk factor) - Which

main exposure/risk factor am I considering? Comparison - What is the main alternative

to compare with the exposure?

Outcome - How is the incidence orprevalence of the condition in this groupaffected by this exposure?


12/31

In white males aged 35-69 years old(Patient population) how effective is12-24 month alcohol consumption

and pattern (Intervention of interest)compared to alcohol abstinence(Comparison intervention) in reducingthe risk of non-fatal myocardial

infarction (Outcome)?


13/31

Majority of Reports

to date have shownevidencesupporting apotential protectiveeffect of alcoholconsumption onCHD disease

Most studieshave focused onthe amount of

alcoholconsumed

However, fewstudies haveaddressed thepattern of alcoholuse.


14/31

Cases 427 white menDischarged alive with a diagnosis of incident MI

55% of identified and eligible cases

Interviewed and physical examinationQueried about a number of drinking habits Reference period: 12-24 months prior to MI

Queried about a number of life-style habits:Smoking habits, physical activity, dietary

Habits, personal medical history

Methods - Population


15/31

Controls = 905 white men

Randomly selected men

52% of identified and eligible cases

Interviewed and physical examinationQueried about a number of drinking habits Reference period: 12-24 months prior to interview

Queried about a number of life-style habits:Smoking habits, physical activity, dietary

Habits, personal medical history

Methods - Population


16/31

Interview Questions on Use of Alcoholic Beverages Size of container used and amount of alcoholic

beverage usually consumed

On a typical 28 day period as framework

quantity-frequency questions on alcohol drinkingasked for Fridays, Saturdays, Sundays andweekdays

Addressed proportion of drinking that took place

with a meal Responses to questions used to compute 7

variables for analyses


17/31

Life-time abstainers

Non-current drinkers

Current drinkers non daily drinkers, dailydrinkers

Ounces of ethanol consumed in 12 months

Ounces of ethanol consumed in a drinking day

Pattern of drinking in relation to food consumption with meals, with snacks, no food, with a mixedpattern

Weekly drinking pattern less than weeklydrinkers, weekly non-daily drinkers, all week

drinkers

Methods Intervention-Comparison


18/31

Multiple logistic regression ODDS RATIO

95% confidence interval

Dependent variable: MI status Independent variables: drinking categories


19/31

Two sets of analyses used:a. All participants were included; life-time

abstainers were reference category

b. Only participants who were currentdrinkers included; reference categoriesvary according to the specific drinkingpattern analysis enabled adjustment for

amount of alcohol consumed


20/31

Alcohol consumption isassociated with lower risk of

non-fatal myocardialinfarction compared to life-time abstinence


21/31

DATA NOT PRESENTED INTABLE

Drinkers exhibited LOWER

ODDS Ratio Compared to LIFETIME-ABSTAINERS (Reference)

Low Tertile: OR 0.48 (0.23-1.02)

Medium Tertile: OR 0.51 (0.24-1.07)

High Tertile: OR 0.52 (0.24-1.10)


22/31

Infrequent drinkers have lower MI risk than life-time abstainers.

Weekend drinkers do not differ significantly fromlife-time abstainers with regard to MI risk.

Weekend drinkers have significantly higher risksof MI compared to less than weekly drinkers ordrinkers throughout the week

Drinkers with meals or snacks have

lower MI risk than either life-timeabstainers or participants who drank

without food

ANALYSIS 1 ALL PARTICIPANTS INCLUDED


23/31

ANALYSIS 1 ALL PARTICIPANTS INCLUDED


24/31

DATA NOT PRESENTED IN TABLE

When total ounces are considered,participants in the mid-and hightertiles of ethanol consumptionshow similar MI Risk compared toparticipants in the lowest tertile

(Reference) Low Tertile: OR 1.00 (Reference) Medium Tertile: OR 1.06 (0.73-1.54)

High Tertile: OR 1.19 (0.81-1.73)

ANALYSIS 2 CURRENT DRINKERS


25/31

ANALYSIS 2 CURRENT DRINKERS


26/31


27/31

Typical study of betweengroup differences:White/Caucasian Americans vs.African Americans vs.

Hispanic/Latino Americans vs.

Asian Americans/Pacific Islanders

2002 Microsoft Corporation.


28/31

Relative ratesof alcoholdependence

Sampleaverage= 3.5%

0

1

2

3

4

5

6

population

rate %

White

Black

Native Amer

Mex. Hispanic

Other Hispanic

Asian/Pac Is.

Source: SAMHSA National Household Survey (1991-1993)

7


29/31

Age Hispanic Asian NativeAmer.

Black White

45-64 166 99 224 426 244

>65 1336 870 1128 2181 2079


30/31

Alcohol affects men and womendifferently. Women become more

impaired than men from drinking thesame amount of alcohol.

Are generally smaller in size

Have less body water

Have less dehydrogenase(Dehydrogenase is an enzyme in the stomach that breaks down alcohol.)

Have more estrogen


31/31

The way in which alcohol is consumed may affect

cardiovascular health. Consuming alcoholic beverages in a concentrated

fashion (weekend only) and without food maycounteract any potential benefit of alcohol on thecardiovascular system

Findings need to be further explored because itmay have implications for the kind of advicegiven both to patients and to the population atlarge with regard to drinking habits and theirrelationship with health

Revised Journal 1alcohol and Cvd

Documents

Transcript of Revised Journal 1alcohol and Cvd