Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers

Lower cardiovascular mortality rates in lighter drinkers (versus abstainers or heavier drinkers) in population studies have been substantially due to lower coronary artery disease (CAD) mortality. Controversy about this U-shaped curve focuses on whether alcohol protects against CAD or, because of other traits, whether abstainers are at increased risk. Inclusion of ex-drinkers among abstainers in some studies has led to speculation that this might be the trait increasing the risk of abstainers. This new prospective study among 123,840 persons with 1,002 cardiovascular (600 CAD) deaths showed that ex-drinkers had higher cardiovascular and CAD mortality risks than lifelong abstainers in unadjusted analyses, but not in analyses adjusted for age, gender, race, body mass index, marital status and education. Use of alcohol was associated with higher risk of mortality from hypertension, hemorrhagic stroke and cardiomyopathy, but with lower risk from CAD, occlusive stroke and nonspecific cardiovascular syndromes. Subsets free of baseline cardiovascular or CAD risk had U-shaped alcohol-CAD curves similar to subsets with baseline risk. Among ex-drinkers, maximal past intake and reasons for quitting (medical versus non-medical) were unrelated to cardiovascular or CAD mortality. These data show that: (1) alcohol has disparate relations to cardiovascular conditions; (2) higher cardiovascular mortality rates among ex-drinkers are due to confounding traits related to past alcohol use; and (3) the U-shaped alcohol-CAD relation is not due to selective abstinence by persons at higher risk. The findings indirectly support a protective effect of lighter drinking against CAD.     

Alcoholic beverage preference, 29-year mortality, and quality of life in men in old age

BACKGROUND: Harms of excessive alcohol consumption are obvious, but moderate wine consumption is frequently advocated for prevention of cardiovascular diseases. We compared 29-year mortality and quality of life in old age by alcoholic beverage preference (beer, wine, or spirits) in a cohort of men whose socioeconomic status was similar in their adult life. METHODS: In 1974, cardiovascular risk factors and beverage preference were assessed in 2468 businessmen and executives aged 40-55 years. Of them, 131 did not use alcohol, 455 did not report a single preference, and 694, 251, and 937 preferred beer, wine, and spirits, respectively. Quality of life with a RAND-36 Short Form (SF)-36 instrument was surveyed in 2000 in survivors. Mortality was retrieved from registers during the 29-year follow-up. RESULTS: Alcoholic beverage preference tracked well during the follow-up. Total alcohol consumption was not significantly different between preference groups. Men with wine preference had the lowest total mortality due to lower cardiovascular mortality. With the spirits group as the reference category and age, cardiovascular risk factors, and total alcohol consumption as covariates, wine drinkers had a 34% lower total mortality (relative risk 0.66; 95% confidence interval, 0.45-0.98); relative risk for beer preferers was 0.91 (95% confidence interval, 0.68-1.14). In 2000, wine preferers had the highest scores in all RAND-36 scales; general health (p =.007) and mental health (p =.01) were also significantly different. CONCLUSION: In this male cohort from the highest social class, wine preference was associated with lower mortality and better quality of life in old age. Mortality advantage was independent of overall alcohol consumption and cardiovascular risk factors, but contributing personal characteristics or early life differences cannot be excluded.     

Biological markers of alcohol consumption in nondrinkers,drinkers, and alcohol-dependent Brazilian patients

BACKGROUND: The purpose of this study was to compare the sensitivity and specificity of some new and traditional biological markers and indicators of health among Brazilian nondrinkers, drinkers, and alcohol-dependent patients. MATERIAL AND METHODS: We evaluated 130 nondrinkers, 167 drinkers, and 183 alcohol-dependent drinkers from Brazil who participated in the WHO/ISBRA Study on State and Trait Markers of Alcohol Use and Dependence. A standardized WHO/ISBRA Interview Schedule provided background information on the subjects' characteristics including reported health problems and alcohol consumption. Blood samples were analyzed for aspartate aminotransferase (AST), carbohydrate deficient transferrin (CDT), gamma-glutamyltransferase (GGT), blood alcohol levels (BAL), and platelet adenylate cyclase activity (basal levels [AC] and levels after stimulation with Gpp(NH)p, cesium fluoride, and forskolin). RESULTS: The alcohol-dependent drinkers presented higher levels of AST, GGT, AC, CDT, and BAL than the nondrinkers and drinkers, whose levels were similar. Sex differences in the sensitivity of CDT and AC were found. The alcohol-dependent women presented a lower prevalence of abnormal values of CDT and Gpp(NH)p-stimulated AC than the alcohol-dependent men, despite the fact that they presented similar alcohol consumption levels. The alcohol-dependent drinkers presented a higher prevalence of clinical disorders than the nondrinkers and drinkers. The drinkers and alcohol-dependent patients presented significantly higher rates of gastritis than the nondrinkers. CONCLUSIONS: Sex differences in the sensitivity of CDT and AC suggest that these markers are not as sensitive at detecting excessive alcohol use in women as they are in men. If data from this Brazilian sample are compared with those reported for international samples, relevant differences are detected, which suggests that genetic and cultural differences should be considered in the selection of biological markers of heavy alcohol consumption.     

Evidence of tick-borne organisms in mule deer (Odocoileus hemionus) from the western United States

Free-ranging mule deer (MD; Odocoileus hemionus) from Arizona and California were tested for evidence of infection with several tick-borne pathogens, including species of Ehrlichia, Anaplasma, Babesia, and Borrelia. Of 125 mule deer tested from Arizona, 29 (23%) and 11 (9%) had antibodies reactive to E. chaffeensis and A. phagocytophilum by indirect immunofluorescent antibody testing, respectively; none of the six MD tested from California were seropositive. Using a commercial competitive ELISA kit, antibodies reactive to Anaplasma spp. were detected in 19 (15%) MD from Arizona and four of six (67%) MD from California. Polymerase chain reaction (PCR) testing for tick-borne pathogens was conducted on blood samples from 29 MD from Arizona and 11 MD from California. Twenty-two of 29 (75.9%) MD from Arizona had PCR evidence of infection with at least one tick-borne pathogen. We detected an Anaplasma sp. in 19 of 29 (65.5%) MD and a Babesia sp. in 10 of 29 (34%) MD. Sequencing of these amplicons indicated that the Anaplasma sp. was the same that had previously been detected in MD from California and the Babesia sp. was similar to one previously detected in a reindeer (Rangifer tarandus tarandus) from California. All of the California MD had evidence of infection with a tick-borne pathogen. Two different species of Anaplasma spp. were detected in MD from California, eight of of 11 MD were infected with an Anaplasma sp., and three of 11 MD were infected with A. ovis. This is the first report of a mule deer naturally infected with A. ovis. Ten of 11 MD from California were infected with a Babesia-like organism previously associated with human disease, and a single MD was PCR positive for Borrelia coriaceae, which has been associated with epizootic bovine abortion. Together, these data suggest that MD in northern Arizona and eastern California are exposed to several pathogens of human and veterinary importance.     

Alarming Trends: Mortality from Alcoholic Cirrhosis in the United States

BackgroundAlcoholic cirrhosis is an advanced form of alcohol-related liver disease. In the United States, between 2010 and 2016, alcohol-related liver disease was the primary cause of nearly 1 in 3 liver transplants, surpassing hepatitis C.MethodsWe utilized the US Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database to compare trends in mortality from alcoholic cirrhosis in the United States in 1999 and 2019. We defined mortality from alcoholic cirrhosis as International Classification of Diseases code K70.3 (alcoholic cirrhosis of liver). We calculated mortality rates and mortality rate ratios (MRRs) per 100,000 from alcoholic cirrhosis in 10-year age groups from 25 to 85+ as measures of effect and 95% confidence intervals to test for significance.ResultsIn 1999, there were 6007 deaths from alcoholic cirrhosis among 180,408,769 aged 25-85+ years, yielding a mortality rate of 3.3 per 100,000. In 2019, there were 23,780 deaths from alcoholic cirrhosis among 224,981,167 aged 25-85+ years, yielding a mortality rate of 10.6 per 100,000. The overall MRR of 3.2 was statistically significant. (P < .001), and was apparent in each 10-year age group.ConclusionsThese alarming trends in mortality from alcoholic cirrhosis in the United States contribute to the formulation of many hypotheses. These require testing in analytic studies designed a priori to do so. Meanwhile, clinical and public health efforts are necessary to curb the epidemics of heavy alcohol consumption and overweight and obesity in the United States that may be contributing to these alarming trends.     

Epidemiology of neonatal respiratory failure in the United States: projections from California and New York.

We wanted to determine the incidence, cost, outcome, and patterns of care for neonates requiring mechanical ventilation (MV) in the United States. Using 1994 state hospital discharge data from California and New York, we conducted an observational study of all neonatal hospitalizations (n = 16,405) with MV, comparing outcomes at centers of different technological capability, and generating national projections using census and natality reports. The MV rate was 18 per 1,000 live births. Although the incidence was much higher in lower birth weight (BW) babies, one-third had normal BW. The incidence was higher in boys (20 versus 15.6 per 1,000) and in blacks (29 per 1,000). Hospital mortality was 11.1%, higher in minority groups, and associated with low BW, congenital anomalies, and major hemorrhage. Mean hospital length of stay and costs were 31.1 d and $51,700. Half of all deaths occurred at lower level centers. There are 80,000 cases per year in the United States with 8,500 deaths and total hospital costs of $4.4 billion. We conclude neonatal respiratory failure is common, expensive, and frequently fatal. There are a surprisingly large number of normal BW cases and there are large racial differences.     

New microbicides enter trials in United States

Two potential candidates in the microbicide research pipeline are set to be examined in clinical trials, with research to focus on the safety and acceptability in healthy women and women infected with HIV.     

Prevalence of hepatitis C and coinfection with HIV among United States veterans in the New York City metropolitan area

OBJECTIVES: The aims of this study were to determine the prevalence of hepatitis C virus (HCV) infection and its risk factors, as well as the prevalence of coinfection with HIV and its risk factors, among patients with confirmed HCV infection. METHODS: In a 1-day cross-sectional HCV survey at six Veterans Affairs Medical Centers in the New York City metropolitan area, all 1943 patients undergoing phlebotomy for any reason were asked to be tested for HCV antibody by enzyme immumoassay (EIA). A total of 1098 patients (57%) agreed to HCV testing, 1016 of whom also completed a questionnaire on demographics and HCV risk factors. All HCV EIA(+) samples were confirmed by HCV RNA and HCV recombinant immunoblot assay (RIBA) antibody testing and were also tested for HCV viral load, HCV genotype, and antibodies to HIV in a blinded fashion. RESULTS: The prevalence of confirmed HCV infection was 10.6% (95% CI = 8.7-12.4%), and the prevalence of HCV viremia was 8.2% (95% CI = 6.6-9.8%). The rate of HCV viremia among anti-HCV(+) patients was 77.6%, and HCV genotype 1 was present in 87.5% of viremic patients. Independent risk factors for HCV infection were injection drug use (OR = 35.6, 95% CI = 16.9-75.2), blood exposure during combat (OR = 2.6, 95% CI = 1.2-5.7), alcohol abuse (OR = 2.4; 95% CI = 1.2-4.8), and service in the Vietnam era (OR = 2.1; 95% CI = 1.0-4.5). Coinfection with HIV was present in 24.8% of anti-HCV(+) patients. The only independent risk factor for coinfection was age <50 yr (OR = 3.7, 95% CI = 1.1-12.1). CONCLUSIONS: U.S. veterans who are receiving medical care at VA medical centers in the New York City metropolitan area have a much higher rate of chronic hepatitis C than the general population, with a high frequency of genotype 1. Coinfection with HIV is very common in patients with confirmed HCV infection, and these patients should routinely be offered HIV testing.     

Co-infection of hepatitis B and hepatitis C virus in human immunodeficiency virus-infected patients in New York City,United States

AIM： To study the prevalence and risk factors associated with triple infection with human immunodeficiency virus （HIV）/hepatitis B virus （HBV）/hepatitis C virus （HCV） in an urban clinic population. METHODS： Retrospective chart review of 5639 patients followed at St. Luke＇s-Roosevelt Hospital HIV Clinic （Center for Comprehensive Care） in New York City, USA from January 1999 to May 2007. The following demographic characteristics were analyzed： age, sex, race and HIV risk factors. A multiple logistic regression analysis was performed to evaluate the influence of demographic factors on acquisition of these viruses. RESULTS： HIV/HBV, HIV/HCV and HIV/HBV/HCV infections were detected in 252/5639 （4.47%）, 1411/5639 （25.02%） and 89/5639 （1.58%） patients, respectively. HIV/HBV co-infections were associated with male gender （OR 1.711; P = 0.005）, black race （OR 2.091, P 〈 0.001）, men having sex with men （MSM） （OR 1.747, P = 0.001）, intravenous drug use （IDU） （OR 0.114, P 〈 0.001）, IDU and heterosexual activity （OR 0.247; P = 0.018）, or unknown （OR 1.984, P = 0.004）.HIV/HCV co-infections were associated with male gender （OR 1.241; P = 0.011）, black race （OR 0.788; P = 0.036）, MSM （OR 0.565; P 〈 0.001）, IDU （OR 8.956; P 〈 0.001）, IDU and heterosexual activity （OR 9.106; P 〈 0.001）, IDU and MSM （OR 9.179; P 〈 0.001）, or transfusion （OR 3.224; P 〈 0.001）. HIV/HBV/HCV coinfections were associated with male gender （OR 2.156; P = 0.015）, IDU （OR 6.345; P 〈 0.001）, IDU and heterosexual activity （OR 9.731; P 〈 0.001）, IDU and MSM （OR 9.228; P 〈 0.001）, or unknown （OR 4.219; P = 0.007）. CONCLUSION： Our study demonstrates that coinfection with HBV/HCV/HIV is significantly associated with IDU. These results highlight the need to intensify education and optimal models of integrated care, particularly for populations with IDU, to reduce the risk of viral transmission.     

LKM-positive autoimmune hepatitis in the western United States: a case series

OBJECTIVE: LKM-positive, or type 2, autoimmune hepatitis is characterized by the presence of antibodies directed against liver-kidney microsomes (LKM1). Although described frequently in southern Europe and the Mediterranean, this subtype of autoimmune liver disease seems to be extremely rare in northern Europe and in the United States. We report here five cases of LKM-positive autoimmune hepatitis that were seen at our center in the period 1989-1999. METHODS: We reviewed the medical records of all patients with the diagnosis of AIH in our institution during the period 1989-1999, and found that five patients had type 2 AIH. All patients were female; four of five were young, and four of five presented with overt cirrhosis. RESULTS: One patient died, one underwent liver transplantation and two are currently awaiting liver transplantation. Response to conventional immunosuppressive therapy was poor and two patients required treatment with cyclosporine and tacrolimus respectively. Four of five patients had at least one associated autoimmune disorder, including IgE-induced IgA deficiency, idiopathic thrombocytopenic purpura (ITP), and arthritis. HLA class II DR4 was present in two patients. CONCLUSIONS: LKM-positive autoimmune hepatitis seems to be a subset of autoimmune hepatitis with distinct clinical features; although rare, it is occasionally encountered in the western United States. Prompt diagnosis and appropriate immunosuppressive treatment are recommended, as well as early referral to transplantation centers. Clinicians should be aware of this condition in the setting of young female patients with unexplained severe liver disease.     

Intelligence in relation to later beverage preference and alcohol intake

AIMS: The health effects of drinking may be related to psychological characteristics influencing both health and drinking habits. This study aims to examine the relationship between intelligence, later beverage preference and alcohol intake. DESIGN: Prospective cohort study. SETTING: Zealand, Denmark. PARTICIPANTS: A total of 900 obese men and a random population sample of 899 young men. MEASUREMENTS: Intelligence testing at the draft board examinations over a 22-year period between 1956 and 1977. Percentage of wine of total alcohol intake (wine pct), preference for wine (wine pct >50), heavy drinking (>21 drinks per week) and non-drinking (<1 drink per week), and vocational education from follow-ups of the initial study sample in 1981-83 and 1992-94. FINDINGS: A strong dose-response-like association was found between intelligence quotient (IQ) in young adulthood and beverage preferences later in life in both the obese and the random population sample. At the first follow-up a 30-point advantage in IQ [2 standard deviations (SD)] was found to be associated with an odds ratio (OR) for preferring wine over beer and spirits of 1.7 (1.3-2.4). At the second follow-up the corresponding OR was 2.8 (2.0-3.9). A 30-point advantage in IQ was found to be associated with an OR for being a non-drinker of 0.5 (0.3-0.8) at the first follow-up and second follow-up. We examined whether, at the second follow-up, the association between IQ, beverage preferences and non-drinking could be explained by socio-economic position (SEP). The association between IQ and non-drinking disappeared when controlling for SEP. The association between IQ and beverage preferences was attenuated, but remained statistically significant. IQ was not associated with heavy drinking. CONCLUSION: Irrespective of socio-economic position, a high IQ was associated with preference for wine to other beverages, but IQ was not related similarly to alcohol consumption.     

Disseminated paracoccidioidomycosis (South American blastomycosis) in the United States

Paracoccidioidomycosis or South American blastomycosis (SAB) is a systemic mycosis endemic to South America but rarely recognized in North America. Visceral dissemination has not been described in the eight cases previously reported from the United States. The patient we describe represents the first case of visceral disseminated SAB, with testicular, adrenal and probable hepatic involvement, diagnosed in the United States. The pathogenesis, clinicopathologic manifestations and therapy of SAB, with particular attention to disseminated paracoccidioidomycosis with adrenal insufficiency, is reviewed.     

College Drinking among Latinos(as) in the United States and Mexico

Background and Objectives: Existing studies of Latino(a) college students in the United States suggest that self‐reported alcohol consumption tends to be higher among males, and that drinking among Latinas is often influenced by social and contextual factors. The current study extended this work by examining both self‐reported drinking levels and predictors of drinking among Latino(a) college students in the United States and Mexico (MX). Methods: Latino(a) college students (N = 376) from three universities in the South Central United States and Northern Mexico completed pencil‐and‐paper surveys about alcohol. Results: US Latino students (vs. MX males), reported drinking more frequently and had more positive expectancies about alcohol. Latinas in the United States (vs. MX females) were more likely to report regular drinking. Across countries, both female gender and the Mexican orientation component of acculturation predicted lower reported alcohol consumption. Positive expectancies about drinking predicted increased drinking. Conclusions and Scientific Significance: Self‐reported college drinking and expectancies about alcohol may differ subtly among individuals in the United States and Mexico based on gender and endorsement of traditional Mexican values. These findings could ultimately be applied to the development of more tailored programs for the treatment and prevention of alcohol abuse on college campuses. (Am J Addict 2012;21:544–549)     

Conifer pollen sensitivity in western New York: cedar pollens.

Cedar pollens might be significant allergens in areas where they have not been so considered but are prevalent. Eastern red cedar (Juniperus virginiana) and white cedar (Thuja occidentalis, American arbor vitae) are common plants in western New York. We analyzed skin test results from 158 patients with asthma, rhinitis, or both; 102 had positive skin tests to at least one pollen. Among those, 52 patients (51%) had positive skin tests to at least one of the cedar pollens. Patients sensitive on skin testing to cedar pollen were strongly likely (p < 0.0001) to be sensitive to deciduous tree, grass, or ragweed pollen. Sensitivity on skin testing to indigenous cedar pollens is common in our area of western New York and therefore could be clinically significant.     

Emergence of a New Lineage of Cache Valley Virus (Bunyaviridae: Orthobunyavirus) in the Northeastern United States

Cache Valley virus (CVV; Family Bunyavidae, Genus Orthobunyavirus) is a mosquito-borne zoonosis that frequently infects humans and livestock in North and Central America. In the northeastern United States, CVV transmission is unpredictable from year-to-year and may derive from the periodic extinction and reintroduction of new virus strains into this region. To evaluate this possibility, we sequenced and analyzed numerous CVV isolates sampled in Connecticut during an 18-year period to determine how the virus population may change over time. Phylogenetic analyses showed the establishment of a new viral lineage during 2010 that became dominant by 2014 and appears to have originated from southern Mexico. CVV strains from Connecticut also grouped into numerous sub-clades within each lineage that included viruses from other U.S. states and Canada. We did not observe the development and stable persistence of local viral clades in Connecticut, which may reflect the episodic pattern of CVV transmission. Together, our data support the emergence of a new lineage of CVV in the northeastern United States and suggest extensive dispersal of viral strains in North America.