Alcohol consumption and risk of coronary heart disease in older adults: the Cardiovascular Health Study

OBJECTIVES: To evaluate several aspects of the relationship between alcohol use and coronary heart disease in older adults, including beverage type, mediating factors, and type of outcome. DESIGN: Prospective cohort study. SETTING: Four U.S. communities. PARTICIPANTS: Four thousand four hundred ten adults aged 65 and older free of cardiovascular disease at baseline. MEASUREMENTS: Risk of incident myocardial infarction or coronary death according to self-reported consumption of beer, wine, and spirits ascertained yearly. RESULTS: During an average follow-up period of 9.2 years, 675 cases of incident myocardial infarction or coronary death occurred. Compared with long-term abstainers, multivariate relative risks of 0.90 (95% confidence interval (CI)=0.71-1.14), 0.93 (95% CI=0.73-1.20), 0.76 (95% CI=0.53-1.10), and 0.58 (95% CI=0.39-0.86) were found in consumers of less than one, one to six, seven to 13, and 14 or more drinks per week, respectively (P for trend=.007). Associations were similar for secondary coronary outcomes, including nonfatal and fatal events. No strong mediators of the association were identified, although fibrinogen appeared to account for 9% to 10% of the relationship. The associations were statistically similar for intake of wine, beer, and liquor and generally similar in subgroups, including those with and without an apolipoprotein E4 allele. CONCLUSION: In this population, consumption of 14 or more drinks per week was associated with the lowest risk of coronary heart disease, although clinicians should not recommend moderate drinking to prevent coronary heart disease based on this evidence alone, because current National Institute on Alcohol Abuse and Alcoholism guidelines suggest that older adults limit alcohol intake to one drink per day.     

The association of alcohol consumption and incident heart failure: the Cardiovascular Health Study.

OBJECTIVES: We investigated the association between alcohol consumption and incident congestive heart failure (CHF) both overall and after adjusting for incident myocardial infarction (MI). BACKGROUND: Moderate alcohol consumption has been associated with lower risk of CHF and MI. METHODS: The Cardiovascular Health study, a prospective cohort study of cardiovascular disease risk factors and outcomes, followed 5,888 subjects > or =65 years old for 7 to 10 years. Cox models were used to estimate the adjusted risk of CHF by reported alcohol consumption. RESULTS: There were 5,595 subjects at baseline at risk for incident CHF with alcohol data and 1,056 events during follow-up. Compared with abstainers, the adjusted risk of CHF was lower among subjects who reported consuming 1 to 6 drinks per week (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.67 to 1.00, p = 0.05) and 7 to 13 drinks per week (HR 0.66, 95% CI 0.47 to 0.91, p = 0.01). Time-dependent adjustment for incident MI altered only slightly the association between moderate alcohol consumption and CHF (for 1 to 6 drinks per week, HR 0.84, 95% CI 0.65 to 1.04; for 7 to 13 drinks per week, HR 0.69, 95% CI 0.49 to 0.99). Baseline former drinkers had a higher risk of CHF than abstainers (HR 1.51, p < 0.01), but those who quit during the study did not have a higher risk (HR 0.83, 95% CI 0.66 to 1.03). CONCLUSIONS: Moderate alcohol use is associated with a lower risk of incident CHF among older adults, even after accounting for incident MI and other factors.     

The stability of baseline‐defined categories of alcohol consumption during the adult life‐course: a 28‐year prospective cohort study

Background and aims

Studies that report the relationship between alcohol consumption and disease risk have predominantly operationalized drinking according to a single baseline measure. The resulting assumption of longitudinal stability may be simplistic and complicate interpretation of risk estimates. This study aims to describe changes to the volume of consumption during the adult life‐course according to baseline categories of drinking.

Design

A prospective observational study.

Setting

United Kingdom.

Participants

A cohort of British civil servants totalling 6838 men and 3372 women aged 34–55 years at baseline, followed for a mean 19.1 (standard deviation = 9.5) years.

Measurements

The volume of weekly alcohol consumption was estimated from data concerning the frequency and number of drinks consumed. Baseline categories were defined: non‐current drinkers, infrequent drinkers, 0.1–50.0 g/week, 50.1–100.0 g/week, 100.1–150.0 g/week, 150.1–250.0 g/week and >250.0 g/week. For women, the highest category was defined as > 100.0 g/week. Baseline frequency was derived as ‘daily or almost daily’ and ‘not daily or almost daily’. Trajectories were estimated within baseline categories using growth curve models.

Findings

Trajectories differed between men and women, but were relatively stable within light‐to‐moderate categories of baseline consumption. Drinking was least stable within the highest categories of baseline consumption (men: > 250.0 g/week; women: > 100.0 g/week), declining by 47.0 [95% confidence interval (CI) = 40.7, 53.2] and 16.8 g/week (95% CI = 12.6, 21.0), respectively, per 10‐year increase in age. These declines were not a consequence of sudden transitions to complete abstention. Rates of decline appear greatest in older age, with trajectories converging toward moderate volumes.

Conclusion

Among UK civil servants, consumption within baseline drinking categories is generally stable during the life‐course, except among heavier baseline drinkers, for whom intakes decline with increasing age. This shift does not appear to be driven by transitions to non‐drinking. Cohorts of older people may be at particular risk of misclassifying former heavy drinkers as moderate consumers of alcohol.     

Risk factors for depression and anxiety in abstainers, moderate drinkers and heavy drinkers

Aims. To identify risk factors for depression and anxiety that are more prevalent in abstainers than in moderate drinkers and to estimate their contribution to U-shaped relationships of depression and anxiety with alcohol consumption. Design. Cross-sectional general population sample. Setting. Canberra, Australia. Participants. 2725 subjects completed questionnaires, including 1128 men and 1258 women aged 18-59 years. Measurements. Consumption categories from AUDIT quantity/frequency items: (1) non-drinkers (no alcohol in the past year), (2) occasional drinkers (monthly or less), (3) lower-level drinkers (up to 14 standard drinks per week for men and seven for women), (4) higher-level drinkers (up to 28 and 14 standard drinks per week, respectively), and (5) those drinking at hazardous or harmful levels (over 28 and 14 standard drinks per week, respectively). Goldberg and DSSI/sAD depression and anxiety scales. A range of demographic, socio-economic, socio-environmental and personality factors. Findings. Non-drinkers were more likely than lower-level drinkers to have low status occupations, poor education, current financial hardship, poor social support and recent stressful life events, and scored lower on extraversion, fun-seeking and drive. Many of these characteristics also applied to hazardous/harmful drinkers. In multivariate models, these risk factors accounted for a substantial part of the higher depression and anxiety scores of non-drinkers and occasional drinkers relative to lower-level drinkers. Conclusions. Abstainers have a range of characteristics known to be associated with anxiety, depression and other facets of ill health, and these factors may contribute significantly to their elevated levels of depression and anxiety.     

Alcohol Consumption Among Older Adults in Primary Care

Background Alcohol misuse is a growing public health concern for older adults, particularly among primary care patients. Objectives To determine alcohol consumption patterns and the characteristics associated with at-risk drinking in a large sample of elderly primary care patients. Design Cross-sectional analysis of multisite screening data from 6 VA Medical Centers, 2 hospital-based health care networks, and 3 Community Health Centers. Participants Patients, 43,606, aged 65 to 103 years, with scheduled primary care appointments were approached for screening; 27,714 (63.6%) consented to be screened. The final sample of persons with completed screens comprised 24,863 patients. Measurements Quantity and frequency of alcohol use, demographics, social support measures, and measures of depression/anxiety. Results Of the 24,863 older adults screened, 70.0% reported no consumption of alcohol in the past year, 21.5% were moderate drinkers (1–7 drinks/week), 4.1% were at-risk drinkers (8–14 drinks/week), and 4.5% were heavy (>14 drinks/week) or binge drinkers. Heavy drinking showed significant positive association with depressive/anxiety symptoms [Odds ratio (OR) (95% CI): 1.79 (1.30, 2.45)] and less social support [OR (95% CI): 2.01 (1.14, 2.56)]. Heavy drinking combined with binging was similarly positively associated with depressive/anxiety symptoms [OR (95%): 1.70 (1.33, 2.17)] and perceived poor health [OR (95% CI): 1.27 (1.03, 1.57)], while at-risk drinking was not associated with any of these variables. Conclusions The majority of participants were nondrinkers; among alcohol users, at-risk drinkers did not differ significantly from moderate drinkers in their characteristics or for the 3 health parameters evaluated. In contrast, heavy drinking was associated with depression and anxiety and less social support, and heavy drinking combined with binge drinking was associated with depressive/anxiety symptoms and perceived poor health.     

Measuring average alcohol consumption: the impact of including binge drinks in quantity-frequency calculations

AIMS: Average daily alcohol consumption is usually calculated based on self-reports of the quantity (number of drinks consumed per drinking-day) and frequency (number of drinking-days) of alcohol consumption within a given time period. However, this method may underestimate average daily alcohol consumption (and in turn, the prevalence of heavy drinking), because studies demonstrate that respondents do not typically include binge drinking occasions in estimates of their 'usual' or 'average' daily alcohol consumption. DESIGN: We used the Behavioral Risk Factor Surveillance System (BRFSS), an annual random-digit telephone survey of US adults aged 18 years or older, to estimate average daily alcohol consumption using standard quantity-frequency questions, and then recalculated this measure by including self-reports of binge drinking. The proportion of respondents who met a standard, sex-specific definition of heavy drinking based on average daily alcohol consumption was then assessed nationally and for each state. FINDINGS: Compared to standard quantity-frequency methods, including binge drinks in calculations of average daily alcohol consumption increased the relative prevalence of heavy drinking among all adults by 19% to 42% (depending on the method used to estimate the number of drinks per binge). Among binge drinkers, the overall prevalence of heavy drinking increased 53% relative to standard quantity-frequency methods. As a result, half of women binge drinkers and half of binge drinkers aged 55 or older met criteria for heavy drinking. CONCLUSIONS: Including binge drinks (especially the application of age- and sex-specific estimates of binge drinks) in the calculation of average daily alcohol consumption can improve the accuracy of prevalence estimates for heavy drinking among US adults, and should be considered to increase the usefulness of this measure for alcohol surveillance.     

Alcohol consumption and prognosis in patients with left ventricular systolic dysfunction after a myocardial infarction

OBJECTIVES: We assessed the influence of alcohol intake on the development of symptomatic heart failure (HF) in patients with left ventricular (LV) dysfunction after a myocardial infarction (MI). BACKGROUND: In contrast to protection from coronary heart disease, alcohol consumption has been linked to cardiodepressant effects and has been considered contraindicated in patients with HF. METHODS: The Survival And Ventricular Enlargement (SAVE) trial randomized 2231 patients with a LV ejection fraction (EF) <40% following MI to an angiotensin-converting enzyme inhibitor or placebo. Patients were classified as nondrinkers, light-to-moderate drinkers (1 to 10 drinks/week), or heavy drinkers (>10 drinks/week) based on alcohol consumption reported at baseline. The primary outcome was hospitalization for HF or need for an open-label angiotensin-converting enzyme inhibitor. Analyses were repeated using alcohol consumption reported three months after MI. RESULTS: Nondrinkers were older and had more comorbidities than light-to-moderate and heavy drinkers. In univariate analyses, baseline light-to-moderate alcohol intake was associated with a lower incidence of HF compared with nondrinkers (hazard ratio [HR] 0.71; 95% confidence interval [CI] 0.57 to 0.87), whereas heavy drinking was not (HR 0.91; 95% CI 0.67 to 1.23). After adjustment for baseline differences, light-to-moderate baseline alcohol consumption no longer significantly influenced the development of HF (light-to-moderate drinkers HR 0.93; 95% CI 0.75 to 1.17; heavy drinkers HR 1.25; 95% CI 0.91 to 1.72). Alcohol consumption reported three months after the MI similarly did not modify the risk of adverse outcome. CONCLUSIONS: In patients with LV dysfunction after an MI, light-to-moderate alcohol intake either at baseline or following MI did not alter the risk for the development of HF requiring hospitalization or an open-label angiotensin-converting enzyme inhibitor.     

Alcohol use and mortality from coronary heart disease: the role of high-density lipoprotein cholesterol. The Multiple Risk Factor Intervention Trial Research Group.

OBJECTIVE: To study the association between alcohol consumption and death from coronary heart disease and to determine the extent to which the association can be explained by the high-density lipoprotein (HDL) cholesterol level. DESIGN: A cohort study involving men enrolled in the Multiple Risk Factor Intervention Trial (MRFIT). SETTING: Community-based study. PARTICIPANTS: Men (n = 11,688) at high risk for developing coronary heart disease but without clinical evidence of it. More than 90% of the men were white, and the average age was 46 years. Five percent of the men abstained from alcohol during the trial, 81% consumed fewer than 21 alcoholic drinks per week, and 14% consumed more than 21 alcoholic drinks per week. MEASUREMENTS: Average alcohol intake over 7 years was calculated for MRFIT participants who were alive at the end of the trial and who had at least three follow-up records of alcohol consumption. Post-trial mortality during a 3.8-year period was assessed. RESULTS: The adjusted relative risk for death from coronary heart disease for each increase of 7 drinks per week was 0.89 (95% CI, 0.80 to 1.00), with an apparent dose-response relationship. The average HDL level was associated with the average alcohol intake in a least-squares regression model (beta = -0.0074; P less than 0.01). When the average HDL level was included in the proportional hazards model for mortality from coronary heart disease, the absolute value of the coefficient for average drinks per week declined 45%, yielding an adjusted relative risk for each additional 7 drinks per week of 0.94 (CI, 0.84 to 1.05). CONCLUSION: In middle-aged men who are light to moderate drinkers, the inverse association between alcohol consumption and death from coronary heart disease can be explained, in large part, by the HDL cholesterol level, which increases with alcohol consumption. However, alcohol consumption cannot be recommended because of the known adverse effects of excess alcohol use.     

The Role of the Flushing Response in the Relationship Between Alcohol Consumption and Insulin Resistance

Background: Facial flushing responses to drinking, because of intolerance to alcohol, are observed in some people, especially Asians. This study examined the role of flushing responses in the relationship between alcohol consumption and insulin resistance (IR). Methods: Participants in this cross‐sectional analysis included 624 Korean men (80 nondrinkers, 306 nonflushing drinkers, and 238 flushing drinkers) who were free of cardiovascular disease and diabetes. Data on the flushing response to drinking and alcohol consumption were collected from medical records. IR was estimated using the Homeostasis Model Assessment (HOMA_IR). On the basis of comparisons with nondrinkers, the risk of IR according to the quantity of alcohol consumed per week was analyzed among nonflushers and flushers. Results: After adjusting for age, exercise status, smoking status, BMI, waist circumference, blood pressure, high‐density lipoprotein cholesterol, and triglycerides using a logistic regression model, we found a low risk of IR among nonflushers who consumed ≤4 drinks (1 drink = 14 g of alcohol) per week (OR = 0.3). In contrast, a higher risk of IR was associated with nonflushers who consumed >20 drinks per week (OR = 3.5). On the other hand, only a higher risk of IR was associated with flushers who consumed >12 drinks per week (>12 to 20 drinks: OR = 4.7; >20 drinks: OR = 3.5). Conclusions: The amount of drinking associated with the development of IR in flushers was lower than in nonflushers. Additionally, no positive effect of moderate drinking on IR was observed in flushers. The findings support acetaldehyde‐derived mechanisms in the development of alcohol‐related IR.     

Brief physician and nurse practitioner-delivered counseling for high-risk drinking

BACKGROUND: The objective of this study was to determine the effects of a brief primary care provider-delivered counseling intervention on the reduction of alcohol consumption by high-risk drinkers. The intervention was implemented as part of routine primary care medical practice. METHODS: We performed a controlled clinical trial with 6- and 12-month follow-up. Three primary care practices affiliated with an academic medical center were randomly assigned to special intervention (SI) or usual care (UC). A total of 9,772 primary care patients were screened for high-risk drinking. A fourth site was added later. From the group that was screened, 530 high-risk drinkers entered into the study, with 447 providing follow-up at 12 months. The intervention consisted of brief (5-10 minute) patient-centered counseling plus an office system that cued providers to intervene and provided patient educational materials. RESULTS: At 12-month follow-up, after controlling for baseline differences in alcohol consumption, SI participants had significantly larger changes (P=.03) in weekly alcohol intake compared to UC (SI=-5.7 drinks per week; UC=-3.1 drinks per week), and of those who changed to safe drinking at 6 months more SI participants maintained that change at 12 months than UC. CONCLUSIONS: Project Health provides evidence that screening and very brief (5-10 minute) advice and counseling delivered by a patient's personal physician or nurse practitioner as a routine part of a primary care visit can reduce alcohol consumption by high-risk drinkers.     

Subjective and objective responses to ethanol in moderate/heavy and light social drinkers

BACKGROUND: Individuals who drink heavily are at an increased risk for adverse consequences of drinking and progression of their drinking habits to abuse or dependence. Therefore, it is important to delineate factors associated with their heavy drinking. METHODS: We examined individual differences in subjective and objective responses to ethanol associated with level of consumption by reanalyzing data from the nine heaviest and nine lightest social drinkers from each of two independently collected subject samples: Holdstock and de Wit (1998) and King et al. (1997). The light drinkers in both samples consumed five or less alcoholic drinks per week, whereas the moderate/heavy drinkers consumed eight or more drinks per week with frequent binge episodes. Acute subjective and objective responses to ethanol (0.6 or 0.8 g/kg) or placebo were compared in the two groups at baseline and during rising and falling blood alcohol concentrations. RESULTS: Moderate/heavy drinkers reported greater stimulant-like and fewer sedative-like and aversive subjective effects after ethanol than did lighter drinkers. These differences occurred in the absence of any group differences in breath alcohol levels, performance effects, or neuroendocrine changes or in overall reports of feeling any drug effects. CONCLUSIONS: These data indicate that habitual moderate/heavy ethanol use was associated with greater stimulant-like effects after an acute dose of alcohol. This finding is consistent with the idea (Newlin and Thomson, 1990, 1999) that individuals who experience greater stimulant-like effects during the ascending limb and lesser sedative-like effects on the descending limb of the blood alcohol concentration curve may be at greater risk for developing ethanol use disorders. Although we cannot determine the causality of this association, sensitivity to the stimulant effects of ethanol may play an important role in the continuation of heavy ethanol use and the increased risk of negative consequences from this use.     

Alcohol use and functional disability among cognitively impaired adults.

BACKGROUND: The extent to which alcohol exposure increases risk for functional disability among older adults with cognitive impairment has not previously been assessed. OBJECTIVE: To examine the potential relationship between alcohol use and functional disability among older cognitively impaired adults. DESIGN: Retrospective medical record review. SETTING: Hospital-based geriatric assessment center. PARTICIPANTS: Two hundred forty-two consecutive participants with Mini-Mental Status Examination scores of < or = 24. MEASUREMENTS: Proxy-reported alcohol intake was classified in categories of never, former, light (< 1 drink/week), moderate (> or = 1 but < 14 drinks/week), and heavy (> or = 14 drinks/week) drinkers, and functional status was determined by proxy-reported performance in seven basic (BADL) and seven instrumental (IADL) activities of daily living (0 = poorest function and 14 = best function). RESULTS: Compared with never drinkers, moderate drinkers demonstrated higher mean BADL (12.2 vs 11.4, P = .033) and IADL scores (6.6 vs 5.6, P = .067), whereas heavy drinkers had higher BADL (12.8 vs 11.4, P = .019) but lower IADL scores (4.8 vs 5.6, P = .425). Former drinkers demonstrated both lower BADL (10.8 vs 11.4, P = .107) and IADL scores (3.9 vs 5.6, P = .011) compared with never drinkers. Evaluation of a potential dose-response effect was limited due to low numbers of light and heavy drinkers. CONCLUSIONS: Among cognitively impaired adults, moderate and heavy drinkers demonstrated better BADL function, whereas former drinkers had poorer IADL function, compared with never drinkers. Prospective studies that incorporate additional measures of exposure (e.g., cumulative lifetime consumption) and function (e.g., performance-based tests) may provide a more comprehensive understanding of alcohol's effects among older cognitively impaired adults.     

Is There a Relationship Between Excessive Drinking and Functional Impairment in Older Persons?

OBJECTIVES: To investigate the relationship between (1) two thresholds of excessive alcohol drinking, (2) binge drinking, and (3) impairments in functional status in older drinkers. DESIGN: Cross-sectional study. SETTING: Ten internal medicine practices affiliated with an academic medical center. PARTICIPANTS: One hundred sixty-one persons aged 60 and older who reported drinking one or more drinks in the previous 3 months. MEASUREMENTS: Two commonly used thresholds of excessive drinking: (1) eight to 14 drinks per week for women and men (lower threshold) and (2) more than 14 drinks per week for women and men (higher threshold); a measure of binge drinking (> or =3 drinks per occasion for women or > or =4 drinks per occasion for men); and self-reported instrumental activities of daily living (IADLs) and advanced activities of daily living (AADLs). RESULTS: Compared with older persons consuming seven or fewer drinks per week, those exceeding the higher threshold of excessive drinking were more likely to have impairments in IADLs (adjusted odds ratio (AOR) = 8.4) and, to a lesser extent, AADLs (AOR = 3.7); those exceeding the lower threshold were more likely to have impairments in IADLs (AOR 5 6.0) but not in AADLs (AOR = 1.7). Binge drinkers were also more likely to have impairments in IADLs (AOR = 3.0) but not in AADLs (AOR = 1.5). CONCLUSIONS: In this group of older men and women, drinking more than seven drinks per week was associated with impairments in IADLs and, to a lesser extent, AADLs. Drinking more than three drinks per occasion was associated with impairments in IADLs.     

Older adults' alcohol consumption and late-life drinking problems: a 20-year perspective

Aims   The aim of this study was to identify changes in patterns of alcohol consumption over a 20-year interval among older women and men, and to examine the associations between guideline-defined excessive drinking and late-life drinking problems.
Design, participants and measures   A community sample of 719 adults between 55 and 65 years of age who consumed alcohol at or prior to baseline participated in a survey of alcohol consumption and drinking problems and was followed 10 years and 20 years later.
Findings   The likelihood of excessive drinking declined over the 20-year interval as adults matured into their 70s and 80s. However, at ages 75–85, 27.1% of women and 48.6% of men consumed more than two drinks per day or seven drinks per week. At comparable guideline levels of alcohol consumption, older men were more likely to have drinking problems than were older women. Consumption of more than two drinks per day or seven drinks per week was identified as a potential conservative guideline for identifying excessive drinking associated with an elevated likelihood of drinking problems.
Conclusions   A substantial percentage of older adults who consume alcohol engage in guideline-defined excessive drinking and incur drinking problems. The finding that older men may be more likely than older women to experience problems when they drink beyond guideline levels suggests that alcohol guidelines for men should not be set higher than those for women.     

Alcohol intake, type of beverage, and risk of breast cancer in pre- and postmenopausal women

BACKGROUND: Most studies of the relation between alcohol consumption and breast cancer have shown a modestly increased risk, although the results are still conflicting. METHODS: The aim of this prospective population-based cohort study was to assess the influence of alcohol intake and type of beverage (beer, wine, or spirits) on breast cancer risk in relation to menopausal status. Among 13,074 women aged 20 to 91 years, we examined the relationship between breast cancer risk, total alcohol intake, and type of alcohol in relation to menopausal status. The women were classified as premenopausal or as postmenopausal at younger than 70 years or 70 years or more. RESULTS: During follow-up, 76 premenopausal and 397 postmenopausal women developed breast cancer. Premenopausal women who had an intake of more than 27 drinks per week had a relative risk of breast cancer of 3.49 (95% confidence limits, 1.36-8.99) compared with light drinkers (p = 0.011), whereas there were no differences in risk in the lower-intake categories. The increased risk of breast cancer among premenopausal women was independent of the type of alcohol. Postmenopausal women older than 70 years of age who had an intake of more than six drinks per week of spirits had a relative risk of breast cancer of 2.43 (95% confidence limits, 1.41-4.20) compared with women who consumed less than one drink of spirits per week (p = 0.0014). CONCLUSIONS: Total alcohol intake of more than 27 drinks per week increases breast cancer risk in premenopausal women independently of the type of alcohol. Among postmenopausal women, an intake of spirits of more than six drinks per week increases breast cancer risk.     

Alcohol intake and its relationship with bone mineral density, falls, and fracture risk in older men

OBJECTIVES: To examine the association between alcohol intake and problem drinking history and bone mineral density (BMD), falls and fracture risk. DESIGN: Cross-sectional and prospective cohort study. SETTING: Six U.S. clinical centers. PARTICIPANTS: Five thousand nine hundred seventy-four men aged 65 and older. MEASUREMENTS: Alcohol intake and problem drinking histories were ascertained at baseline. Follow-up time was 1 year for falls and a mean of 3.65 years for fractures. RESULTS: Two thousand one hundred twenty-one participants (35.5%) reported limited alcohol intake (<12 drinks/y); 3,156 (52.8%) reported light intake (<14 drinks/wk), and 697 (11.7%) reported moderate to heavy intake (> or =14 drinks/wk) in the year before baseline. One thousand one men (16.8%) had ever had problem drinking. In multivariate models, as alcohol intake increased, so did hip and spine BMD (P for trend < .001). Greater alcohol intake was not associated with greater risk for nonspine or hip fractures. Men with light intake, but not moderate to heavy intake, had a lower risk of two or more incident falls (light intake: relative risk (RR) = 0.77, 95% confidence interval (CI) = 0.65-0.92; moderate to heavy intake: RR = 0.83, 95% CI = 0.63-1.10) than abstainers. Men with problem drinking had higher femoral neck (+1.3%) and spine BMD (+1.4%), and a higher risk of two or more falls (RR = 1.59; 95% CI = 1.30-1.94) than those without a history of problem drinking and similar total hip BMD and risk of fracture. CONCLUSION: In older men, recent alcohol intake is associated with higher BMD. Alcohol intake and fracture risk is unclear. Light alcohol intake may decrease the risk of falling, but a history of problem drinking increased fall risk.     

Moderate Alcohol Consumption Protects Against Colorectal Adenomas in Smokers

Background Although some studies have shown an association between alcohol consumption and colorectal adenomas, the effect of moderate alcohol consumption is not well defined, nor is the interaction between alcohol and smoking. Aim To investigate the relationship between different levels of alcohol consumption and colorectal adenomas and to determine whether smoking modifies this relationship. Methods Eligible patients who underwent a complete colonoscopy were included (179 cases and 466 controls). Alcohol consumption was obtained from a lifestyle questionnaire. Patients were divided into three groups: (1) Abstainers: 0 drinks/week; (2) Moderate drinkers: > 0 to <7 drinks/week; (3) Heavy drinkers: > 7 drinks/week. Odds ratios (OR) were calculated using logistic regression, controlling for gender, age, body mass index, use of non-steroidal anti-inflammatory medications. Results were stratified by the number of years smoked. Results The proportion of patients with adenomas was 29.6% in abstainers, 22.1% in moderate drinkers, and 36.7% in heavy drinkers. The relationship between alcohol consumption and colorectal adenomas varied significantly by smoking history. For individuals who had never smoked, heavy drinkers were at significantly increased odds of having an adenoma compared to moderate drinkers (OR 3.08; 95% CI: 1.50–6.32), while no difference was seen for abstainers (OR 0.99; 95% CI: 0.52–1.89). Similarly, among individuals who had smoked 1–14 years, heavy drinkers were at increased odds of having an adenoma compared to moderate drinkers (OR 2.61; 95% CI: 1.04–6.51), and no difference was seen for abstainers (OR 1.02; 95% CI: 0.33–3.10). Somewhat unexpectedly, among individuals who had smoked for 15 or more years, abstainers were at increased odds of having an adenoma compared to moderate drinkers (OR 2.04; 95% CI: 0.91–4.59), while heavy drinkers were not at increased odds of having an adenoma (OR 0.73; 95% CI: 0.27–1.97). Conclusions Consumption of less than seven alcohol drinks per week does not increase the risk of having a colorectal adenoma. We found evidence in this study that moderate alcohol consumption among long-term smokers may potentially decrease the risk of an adenoma compared to abstainers.     

Seven-year changes in alcohol consumption and subsequent risk of cardiovascular disease in men

BACKGROUND: Few studies have examined whether changes in alcohol consumption influence future cardiovascular risk. OBJECTIVE: To examine whether 7-year changes in alcohol consumption are associated with the subsequent risk of cardiovascular disease (CVD). METHODS: We prospectively followed up 18,455 men aged 40 to 84 years from the Physicians' Health Study with no history of CVD or cancer. Alcohol consumption was reported on the baseline and the 7-year questionnaires; follow-up for this analysis began after the 7-year questionnaire (median follow-up, 5.8 years). There were 1091 CVD cases, including myocardial infarction, angina pectoris, revascularization, stroke, and CVD-related death. RESULTS: Among men initially consuming 1 drink per week or less (n=7360), those with moderate increases (>1 to <6 drinks per week) in alcohol consumption had a borderline significant (P=.05) 29% reduced risk of CVD compared with men with no changes (-1 to 1 drink per week). Among men initially consuming greater than 1 to 6 drinks per week (n=6612), those with moderate increases had a nonsignificant (P=.32) 15% decrease in CVD risk compared with men with no changes. Finally, among men initially consuming 1 drink per day or more (n=4483), those who increased intake had a 63% increased risk of CVD compared with men with no changes. CONCLUSIONS: These prospective data suggest that, among men with initially low alcohol consumption (相似文献   

Predicting the Development of Late-Life Late-Onset Drinking Problems: A 7-Year Prospective Study

There has been little empirical study of risk factors for the development of late-life late-onset drinking problems. In the current prospective study, we compare two groups of older adults who, at a baseline assessment, were nonproblem drinkers: individuals who developed drinking problems over the course of the next 7 years ( n = 77) and those who did not ( n = 197). Late-onset problem drinkers reported mild to moderate drinking problems and spontaneous remission rates were high. Compared with stable nonproblem drinkers, late-onset problem drinkers at baseline were more likely to report incipient problems, heavier alcohol consumption, greater friend approval of drinking, more reliance on avoidance coping strategies, were more likely to smoke, and were less likely to have acute medical conditions that could potentially be complicated by alcohol consumption. Contrary to expectation, life stressors did not predict drinking problem onset. However, compared with stable nonproblem drinkers, late-onset problem drinkers were more likely to have a history of responding to stressors and negative affect with increased alcohol consumption.     

Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population

BACKGROUND: The three consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) are increasingly used as a screener for alcohol use disorders (AUDs) and risk drinking. METHODS: In a representative sample of US adults 18 years of age and older, AUDIT-C scores (derived from consumption questions embedded in a large national survey) were used to estimate sensitivity, specificity, and areas under receiver operator characteristic curves (AUROCs) for alcohol dependence, any AUD, and risk drinking. AUDs were defined according to DSM-IV criteria. For men, risk drinking was defined as consuming >14 drinks per week or >4 drinks in a single day at least once a month; for women, the weekly and daily limits were >7 drinks and >3 drinks, respectively. The derived AUDIT-C was evaluated among past-year drinkers (n = 26,946), within the total population (n = 43,093), in groups defined by age, sex, and race/ethnicity, and among pregnant women, persons attending an emergency room, and college students. RESULTS: For past-year drinkers, the AUROCs for the derived AUDIT-C were 0.887 for alcohol dependence, 0.860 for any AUD, and 0.966 for risk drinking. Scores were higher in the total population, 0.931, 0.917, and 0.981, respectively. The derived AUDIT-C performed slightly better in screening for dependence among women than men. Screening for risk drinking was better among men, probably because the third AUDIT-C question directly mirrors one of the definitions of risk drinking for men but not for women. Performance in pregnant women, past-year emergency room patients, and college students was on a par with performance in the general population. CONCLUSIONS: The derived AUDIT-C performs well in screening for AUDs and risk drinking. The use of variable cut points for men and women improves its sensitivity and specificity. Validation in a realistic screening situation, in which the AUDIT-C questions are asked as stand-alone and not embedded items, is a critical future step.