The benefit of alcohol in moderation

Small amounts of alcohol were held to be beneficial in the 19th century, but the idea died out. Scientific evidence that moderate amounts prolonged life, published in 1926, was ignored. Further evidence accumulated from the early 1950s but the belief that alcohol was only harmful had become so ingrained that the idea has been taken seriously only since the early 1980s. Now, the evidence that small amounts reduce the risk of vascular disease by about a third and reduce total mortality in middle and old age is massive. Alternative explanations for the observed inverse relationships have been ruled out and beneficial effects have been shown to be biologically plausible. The reduction in mortality is mainly attributable to ischaemic heart disease and cerebral thrombosis, but some other diseases may also contribute to it. The increasing mortality with larger amounts is attributable to many causes that have long been recognized. The optimum level varies with sex and age and may be zero under about age 45 years. The benefit is directly due to ethanol and the extra benefit attributed to wine is due to the pattern of drinking. Public policy needs to take account of medical and social effects other than mortality and will vary in different communities depending on background patterns of injury and disease.     

Clopidogrel in the treatment of ischaemic heart disease

Clopidogrel is an effective antiplatelet agent that has undergone rigorous assessment in the setting of ischaemic heart disease over the last decade. There is extensive evidence for the use of this drug in patients undergoing percutaneous coronary intervention, in those with stable ischaemic heart disease and also in those with acute coronary syndromes. This article examines the use of clopidogrel in patients with ischaemic heart disease.     

Serum lipids and lipoproteins in ischaemic heart disease following withdrawal of long-term metroprolol treatment

Summary In 39 patients who had been treated with metoprolol 100–200 mg daily or placebo for three years after acute myocardial infarction, serum lipids and lipoproteins were studied while the patients were on treatment as well as after its withdrawal. Withdrawal was performed over 1 week. Treatment had to be reinstituted in 6 patients (1 ex placebo and 5 ex metoprolol) because of aggravated symptoms.During the entire study period total cholesterol was significantly higher in the metoprolol withdrawal group and LDL cholesterol tended to be higher. HDL cholesterol in both groups increased significantly during the initial 28-day period following withdrawal of treatment. In both groups VLDL triglycerides tended to decrease during the first 28 day without treatment. Other lipoprotein fractions in both groups were unchanged.Overall, in patients who tolerated the ending of 3 years of treatment with metoprolol after myocardial infarction, there was no significant effect on lipoprotein fractions as compared to a placebo group.     

Haemodynamic effects and kinetics of concomitant intravenous disopyramide and atenolol in patients with ischaemic heart disease

Summary The haemodynamic effects of concomitant intravenous administration of disopyramide (Norpace) and atenolol (Tenormin) were studied in a cross-over trial in 7 patients with ischaemic heart disease. Following 150 mg disopyramide i.v. the cardiac index (CI) and stroke volume index (SVI) decreased by 14% and 26%, respectively and the heart rate (HR) and preejection period index (PEPI) increased by 13% and 19%, respectively. A decrease in CI of 14% and HR of 21%, respectively were noted after intravenous administration of 7.5 mg atenolol; PEPI increased by 10% whereas SVI remained unchanged. The cardiac Index (CI) fell by 33% following the administration of both drugs. The effect on CI of the two drugs was additive. The effect of disopyramide and atenolol on HR, SVI and PEPI was not significantly modified by coadministration of the other drug. No change in blood pressure was observed after disopyramide or atenolol. A correlation () of 0.540 and 0.387 was observed between the change in PEPI and the log free and total serum concentrations of disopyramide, respectively. Combined intravenous use of the two drugs in patients with incipient or overt heart failure is not recommended, unless it is due to the arrhythmia to be treated.     

Divergent drinking patterns and factors affecting homemade alcohol consumption (the case of Russia)

BackgroundUnrecorded homemade alcohol consumption has been less examined in the literature. Previous studies of homemade alcohol in Russia have almost entirely focused upon the use of samogon (moonshine) attributed to the northern style of drinking. No systematic analysis is available regarding the production and consumption of homemade wine. This paper explores the drinking patterns demonstrated by consumers of samogon and homemade wine in Russia. The main factors affecting the consumption of these beverages are investigated.MethodsData were collected from a 2014 nationwide survey of 14,986 respondents aged 15+ years. Beverage preferences, volume of consumed alcohol, drinking habits, and alcohol availability were the main measures reported. Demographic, socio-economic, spatial, and policy-related factors affecting homemade alcohol consumption are examined using logistic regression.ResultsThe percentages of samogon and homemade wine consumers were similar, although a greater volume of samogon in pure alcohol was consumed compared to homemade wine. The groups of samogon and homemade wine consumers showed very little overlap. Unlike homemade wine consumers, samogon drinkers consumed larger amounts of alcohol and were more engaged in frequent and excessive drinking, drinking without meals and drinking in marginal public settings. Gender, education, regional affiliation, and type of residence showed opposite associations with regard to the consumption of samogon and homemade wine. Availability of homemade alcohol in the neighbourhood was the most influential predictor due to respondents’ own production, presence of homemade alcohol in friendship networks and at illegal market. The prices of manufactured alcohol and the consumption of homemade alcohol did not show significant relationships.ConclusionConsumers of samogon and homemade wine demonstrate contrasting drinking patterns that are largely driven by different factors. Samogon is consumed in a more hazardous manner, whereas homemade wine is consumed in a more moderate and law-abiding way. Illegal commercial samogon should be a special concern for alcohol policy.     

Calcium antagonists in the treatment of hypertension in patients with ischaemic heart disease

Are lives saved or heart attacks prevented by antihypertensive therapy, as a result of blood pressure reduction alone, or because of other properties of the antihypertensive medications which are independent of blood pressure lowering? Long-acting calcium antagonists seem to be as effective as thiazide diuretics and angiotensin-converting enzyme (ACE) inhibitors in preventing all-cause mortality and stroke in patients with hypertension, but are probably inferior to ACE inhibitors in preventing coronary artery disease. In patients with symptomatic coronary artery disease, calcium antagonists are generally as effective as β-blockers in relieving angina and improving exercise time-to-onset of angina or ischaemia. Unstable angina or myocardial infarction require treatment with a β-blocker, with an ACE inhibitor added when necessary for blood pressure control or if there is significant left ventricular (LV) dysfunction. If β-blockers are contraindicated and if there is no LV dysfunction, a non-dihydropyridine calcium antagonist can be substituted.     

Comparative effects of alinidine and propranolol in ischaemic heart disease

Summary The effects of single oral doses of alinidine 40 mg, propranolol 40 mg or placebo during a maximal exercise test on a bicycle ergometer in patients with angina pectoris were studied in a randomised, double blind study. 2 and 5 h after drug intake a small fall in resting heart rate and systolic blood pressure was observed both after alinidine and propranolol. At a fixed work load both drugs decreased heart rate, systolic blood pressure, double product and the extent of ST segment depression. Total work performed and time to appearance of angina pectoris were increased 2 h alinidine and propranolol. The same effects were still apparent 5 h after propranolol but not after alinidine. At peak exercise neither drug had any effect on the extent of ischaemic ST segment depression.     

Serum magnesium,calcium, phosphate and PTH following long-term beta-blockade in ischaemic heart disease

Summary In 40 patients with ischaemic heart disease the serum levels of magnesium, parathyroid hormone (PTH), phosphate, calcium, and ionized calcium remained unchanged and within normal limits following treatment for 12 months with alprenolol (n=20) or placebo (n=20). No changes occurred during a 2 week withdrawal period. The clinical implication is that the non-cardioselective betablocker alprenolol can be given to patients with ischaemic heart disease without the risk of inducing potentially cardiotoxic disturbances in serum magnesium and serum calcium levels. Whether this applies to cardioselective beta-blockers remains to be established.     

All‐cause mortality and fatal alcohol poisoning in Belarus, 1970–2005

Introduction and Aims . Although alcohol appears to be an important contributor to the burden of disease in the countries of eastern Europe, little systematic research has been undertaken on its impact on mortality in the former Soviet republic of Belarus. There may be a number of factors underlying the particularly negative effect of alcohol on mortality in Belarus, including the pattern of drinking and use of surrogates. A solid body of research and empirical evidence suggests that hazardous patterns of alcohol consumption (binge drinking) lead to quicker and deeper intoxication, increasing the propensity for alcohol‐related mortality. Design and Method . To estimate the aggregate level effect of binge drinking on the all‐cause mortality rate, trends in the all‐cause mortality and fatal alcohol poisoning rates (as a proxy for binge drinking) in Belarus from 1970 to 2005 were analysed employing AutoRegressive Integrated Moving Average (ARIMA) time–series analysis in order to assess a bivariate relationship between the two time–series. Results . The results of time–series analysis suggest a close relationship between all‐cause mortality and fatal alcohol poisoning rates at the population level. Conclusions . This study supports the hypothesis that alcohol and all‐cause mortality are connected closely in countries where the drinking culture is characterised by heavy drinking episodes and adds to the growing body of evidence that a substantial proportion of total mortality in Belarus is due to acute effects of binge drinking.     

Drinking patterns and harm of unrecorded alcohol in Russia: a qualitative interview study

Background: Consumption of unrecorded alcohol (alcohol, consumed as a beverage, but not reflected in official statistics) has been linked to heavy drinking and alcohol-related mortality in Russia, with different studies looking for possible toxic components or other explanations. This study explores self-reported drinking behaviors of people diagnosed with alcohol dependence to elicit the perspectives of consumers of unrecorded alcohol.

Methods: Semi-structured in-depth expert interviews were conducted with patients (n?=?25) of state-run addiction treatment centers of two Russian cities. Interviews were analyzed using thematic content analysis.

Results: A strict hierarchy between different types of unrecorded alcohol products, their ascribed quality, and the subjective harm caused by their consumption was found, with home-made spirits for own consumption at the top and technical fluids at the bottom. The ranking order correlated with product price, social status of associated consumers, and severity of their alcohol dependence. Binge drinking was the prevailing drinking pattern and shifts from recorded to unrecorded consumption within a single binge or a zapoi (continuous drinking for at least two days) were typical. Consumption of low-quality unrecorded alcohol was associated with stronger hang-overs, zapois, alcohol psychoses and poisonings, and other indicators of alcohol attributable harm, while no such connection was found for spirits for own consumption.

Conclusions: In the dominant explanation patterns of the consumers, the experienced alcohol-induced harm is attributed to alcohol quality, while a thorough analysis of their reported drinking behaviors cannot exclude specific drinking patterns linked to the severity of alcohol dependence as the main determinants of the described health detriments.     

A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease

Issues. Alcohol has been implicated in both the popular press and scientific literature as having a protective effect for at least a dozen conditions including coronary heart disease (CHD). Approach. Epidemiological evidence for an apparent protective effect of alcohol on CHD is now being challenged on a number of fronts. This paper is a synopsis of those various challenges as they currently stand. Key Findings. The argument that systematic misclassification of ex‐drinkers and occasional drinkers to ‘abstainer’ categories among epidemiological studies might explain apparent protective effects of moderate alcohol consumption on CHD has recently been supported by new meta‐analyses and independent research. The influence of uncontrolled or unknown factors on the relationship between alcohol and disease cannot be ruled out. Exclusion of participants on the basis of ill‐health severely reduces study sample size and new analyses suggest that doing so might artificially create the appearance of protective effects. The ability of respondents to accurately recall their own alcohol consumption is in serious doubt and very few individuals maintain one single drinking level or style throughout life. The relationship between alcohol and some conditions might be a function of drinking patterns but few studies have addressed the issue. Implications. Popular perceptions regarding the strength of evidence for alcohol's protective effect on a growing number of conditions might be misguided. Conclusion. It is time for the wider research, health and medical community to seriously reflect on the quality of current evidence for apparent protective effects of alcohol on human disease.[Chikritzhs T, Fillmore K, Stockwell T. A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease. Drug Alcohol Rev 2009;28:441–444]     

Moderate alcohol use and reduced mortality risk: Systematic error in prospective studies

The majority of prospective studies on alcohol use and mortality risk indicates that abstainers are at increased risk of mortality from both all causes and coronary heart disease (CHD). This meta-analysis of 54 published studies tested the extent to which a systematic misclassification error was committed by including as ‘abstainers’ many people who had reduced or stopped drinking, a phenomenon associated with ageing and ill health. The studies judged to be error free found no significant all-cause or cardiac protection, suggesting that the cardiac protection afforded by alcohol may have been over-estimated. Estimates of mortality from heavier drinking may also be higher than previously estimated.     

Increased risk of ischaemic heart disease mortality in elderly men using anxiolytics-hypnotics and analgesics

Objectives: An increased risk of all-cause and cardiovascular mortality in users of anxiolytic-hypnotic drugs (AHD) has been reported, and use of analgesics may be an additional factor. Therefore, we examined the association of AHD and analgesic use, alone and in combination, with all-cause and ischaemic heart disease (IHD) mortality. Methods: Multivariate 10-year survival analysis in a population based cohort of 500 men born in 1914. Relative risks (RR) were adjusted by relevant confounders (blood pressure, serum cholesterol, diabetes mellitus, smoking habit, high alcohol consumption, history of previous IHD, cancer, and other diseases). Results: The RR of both all-cause and IHD mortality were significantly increased among those using both AHD and analgesics compared to those who took neither of these drugs: RR=1.8 for all-cause mortality, and RR=2.7 for IHD mortality. Conclusion: Although the number of cases was small, warranting interpretative caution, the current study suggests that the combined use of AHD (mainly benzodiazepines) and analgesics seems to be associated with an increase in all-cause and IHD mortality in elderly men.