Maurizio Trevisan, Joan Dorn, Karen Falkner, Marcia Russell, Malathi Ram, Paola Muti, Jo L.

Freudenheim, Thomas Nochajaski & Kathy Hovey

Addiction, September 2003 (99) 313-322

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

Pros

Cons

Reduced heart risk Reduce chances of coronary artery disease Stroke prevention Reduce development of blocked arteries in your legs

Slow brain activity Interfere with sleep and sexual function Raise your blood pressure Heartburn, headaches Binge Drinking Liver, Kidney, Lung and heart disease Stroke Osteoporosis Obesity Increase risk of types of cancer

How much was consumed Rate of consumption What is in stomach Presence of carbonation Mood status Sex Race

Medline, Pubmed, EBSCO Host Google, Yahoo Coronary Heart Disease Cardiovascular Disease Emerging Risk Factors Epidemiology

Type of question asked: HARM/CAUSATION/ETIOLOGY

Study Population

Interviews and P.E. CENTER OF PREVENTIVE MEDICINE, UNIVERSITY OF BUFFALO

Develop Disease (MI, CVD)

Do Not Develop Disease (NO MI, CVD)

CASES

CONTROLS

CASE-CONTROL STUDY (1993-1998)

NIAGARA

ERIE

Designed to investigate many aspects of drinking previously not well investigated in regard to their relation with myocardial infarction
Currency? Frequency? Food? Day?

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 or prevalence of the condition in this group affected by this exposure?

In white males aged 35-69 years old (Patient population) how effective is 12-24 month alcohol consumption and pattern (Intervention of interest) compared to alcohol abstinence (Comparison intervention) in reducing the risk of non-fatal myocardial infarction (Outcome)?

Majority of Reports to date have shown evidence supporting a potential protective effect of alcohol consumption on CHD disease

Most studies have focused on the amount of alcohol consumed

However, few studies have addressed the pattern of alcohol use.

Methods - Population

Cases 427 white men

Discharged alive with a diagnosis of incident MI 55% of identified and eligible cases Interviewed and physical examination Queried 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

Controls = 905 white men

Randomly selected men 52% of identified and eligible cases Interviewed and physical examination Queried 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

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 drinking asked for Fridays, Saturdays, Sundays and weekdays Addressed proportion of drinking that took place with a meal Responses to questions used to compute 7 variables for analyses

Methods Intervention-Comparison

Life-time abstainers Non-current drinkers Current drinkers non daily drinkers, daily drinkers 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 mixed pattern Weekly drinking pattern less than weekly drinkers, weekly non-daily drinkers, all week drinkers

Multiple logistic regression ODDS RATIO 95% confidence interval Dependent variable: MI status Independent variables: drinking categories

Two sets of analyses used: a. All participants were included; life-time abstainers were reference category b. Only participants who were current drinkers included; reference categories vary according to the specific drinking pattern analysis enabled adjustment for amount of alcohol consumed

 Alcohol

consumption is associated with lower risk of non-fatal myocardial infarction compared to lifetime abstinence

 DATA

TABLE Drinkers exhibited LOWER ODDS Ratio Compared to LIFE TIME-ABSTAINERS (Reference)

NOT PRESENTED IN

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)

Infrequent drinkers have lower MI risk than lifetime abstainers. Weekend drinkers do not differ significantly from life-time abstainers with regard to MI risk. Weekend drinkers have significantly higher risks of MI compared to less than weekly drinkers or drinkers throughout the week Drinkers with meals or snacks have lower MI risk than either life-time abstainers or participants who drank without food

ANALYSIS 1 ALL PARTICIPANTS INCLUDED

 DATA

NOT PRESENTED IN TABLE When total ounces are considered, participants in the mid-and high tertiles of ethanol consumption show similar MI Risk compared to participants 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

 Typical

study of between group differences:

White/Caucasian Americans vs. African Americans vs. 2002 Microsoft Corporation. Hispanic/Latino Americans vs. Asian Americans/Pacific Islanders

White
5

Relative

Black
4

rates of alcohol dependence

Native Amer
3

Sample

Mex. Hispanic
2

average = 3.5%

Other Hispanic
1

Asian/Pac Is.
0 population rate %
Source: SAMHSA National Household Survey (1991-1993)

Age

Hispanic Asian Native Black White Amer. 99 870 224 1128 426 2181 244 2079

45-64 166 >65 1336

Alcohol affects men and women differently. Women become more impaired than men from drinking the same amount of alcohol.
Are generally smaller in size

Have less body water

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

The way in which alcohol is consumed may affect cardiovascular health. Consuming alcoholic beverages in a concentrated fashion (weekend only) and without food may counteract any potential benefit of alcohol on the cardiovascular system Findings need to be further explored because it may have implications for the kind of advice given both to patients and to the population at large with regard to drinking habits and their relationship with health