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Maurizio Trevisan, Joan Dorn, Karen Falkner, Marcia Russell, Malathi Ram,Paola Muti, Jo L. Freudenheim, Thomas Nochajaski & Kathy HoveyAddiction, September 2003 (99) 313-322
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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
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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
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How much was consumed
Rate of consumption
What is in stomach Presence of carbonation
Mood status
Sex
Race
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Medline, Pubmed, EBSCO Host Google, Yahoo
Coronary Heart Disease Cardiovascular Disease
Emerging Risk Factors
Epidemiology
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Type of question asked:
HARM/CAUSATION/ETIOLOGY
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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
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NIAGARA
ERIE
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Designed to investigate many aspectsof drinking previously not wellinvestigated in regard to their relation
with myocardial infarction
Currency?Frequency?Food?
Day?
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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?
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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)?
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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.
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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
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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
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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
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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
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Multiple logistic regression ODDS RATIO
95% confidence interval
Dependent variable: MI status Independent variables: drinking categories
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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
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Alcohol consumption isassociated with lower risk of
non-fatal myocardialinfarction compared to life-time abstinence
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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)
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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
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ANALYSIS 1 ALL PARTICIPANTS INCLUDED
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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
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ANALYSIS 2 CURRENT DRINKERS
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Typical study of betweengroup differences:White/Caucasian Americans vs.African Americans vs.
Hispanic/Latino Americans vs.
Asian Americans/Pacific Islanders
2002 Microsoft Corporation.
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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
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Age Hispanic Asian NativeAmer.
Black White
45-64 166 99 224 426 244
>65 1336 870 1128 2181 2079
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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
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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
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