Per capita alcohol consumption and all-cause mortality in Canada, 1950-98

AIMS: To estimate the relationship between per capita alcohol consumption and male all-cause mortality in Canada. DATA AND METHOD: The outcome measure comprised annual data on male all-cause mortality for the period 1950-98. Alcohol sales (in litres 100% alcohol) were used as proxy for per capita consumption. The data were analysed using the Box-Jenkins technique. Two models were estimated, one including only female mortality as control, the other in addition cigarette sales. RESULTS: The first model yielded a significant alcohol effect that implied a 2.9%[standard error (SE) = 0.6%] increase in mortality given a 1-litre increase in consumption. This estimate coincides with that obtained for northern Europe in previous research. When cigarette sales were included in the model the alcohol effect was still statistically significant but markedly reduced, to 1.7% (SE = 0.6%). CONCLUSIONS: Total mortality is a classic indicator of the general health status of the population. Its relationship with per capita consumption of alcohol supports the view that total consumption is a concern for public health.     

Per capita alcohol consumption and ischaemic heart disease mortality

Aim. To test the hypothesis that alcohol consumption is inversely related to ischaemic heart disease (IHD) mortality at the population level. Most individual-level studies find a reduced risk of IHD with a moderate level of alcohol consumption, but it is as yet unknown whether this association also exists at the aggregate level. Measurements. The study period was approximately 1950 to 1995; 14 EU countries and Norway were included. Time series analyses on differenced data were utilized, and age-standardized IHD mortality for men and women in the age groups 30-44, 45-59, 60-74 and 30-74 years was measured. The effects of alcohol (sales per capita) were controlled for a weighted lag of per capita sales of cigarettes. Findings. There was a random distribution of insignificant negative and positive alcohol effect estimates. A slight indication of a cardioprotective effect of alcohol among 30- to 44-year-old women in high consumption countries could be observed (significant for Italy). Mean alcohol effect estimates were nearly exactly zero (absent alcohol effect) among men and weakly positive among women. Because changes in cigarette consumption were often significantly and positively related to subsequent changes in IHD mortality, poor validity in the IHD time series cannot explain the unsystematic findings. Including a 6-year weighted lag of alcohol consumption changed the weak positive effect among women to an absent alcohol effect. A brief analysis of abstinence rates indicated no particular relationship to IHD mortality. Conclusion. The alleged cardioprotective alcohol effect is absent at the population level, and great caution should be taken concerning alcohol policies for cardioprotective purposes.     

Changes in per capita alcohol sales during the partial privatization of British Columbia's retail alcohol monopoly 2003–2008: a multi-level local area analysis

Aim   To investigate the independent effects on liquor sales of an increase in (a) the density of liquor outlets and (b) the proportion of liquor stores in private rather than government ownership in British Columbia between 2003/4 and 2007/8.
Design   The British Columbia Liquor Distribution Branch provided data on litres of ethanol sold through different types of outlets in 89 local health areas of the province by beverage type. Multi-level regression models were used to examine the relationship between per capita alcohol sales and outlet densities for different types of liquor outlet after adjusting for potential confounding social, economic and demographic factors as well as spatial and temporal autocorrelation.
Setting   Liquor outlets in 89 local health areas of British Columbia, Canada.
Findings   The number of private stores per 10 000 residents was associated significantly and positively with per capita sales of ethanol in beer, coolers, spirits and wine, while the reverse held for government liquor stores. Significant positive effects were also identified for the number of bars and restaurants per head of population. The percentage of liquor stores in private versus government ownership was also associated significantly with per capita alcohol sales when controlling for density of liquor stores and of on-premise outlets ( P  < 0.01).
Conclusion   The trend towards privatisation of liquor outlets between 2003/04 and 2007/08 in British Columbia has contributed to increased per capita sales of alcohol and hence possibly also to increased alcohol-related harm.     

凝血纤溶指标的变化与缺血性心脏病的关系

为探讨缺血性心脏病（IHD）患者的凝血、纤溶变化及其临床意义，用高效液相色谱仪测定了26例急性心肌梗塞（AMI）、26例不稳定型心绞痛（UAP）、20例正常对照者的尿纤维蛋白肽A（FPA）、并用相应方法同步测定了血浆D－二聚体（D－Dimer）、组织型纤溶酶原激活物（t－PA）及其抑制物（PAI）活性、并对其中UAP患者进行跟踪随访。结果表明：AMI、UAP患者尿FPA值均比对照组高；血浆D－Dimer水平及PAI活性亦高，t－PA活性降低，且AMI和UAP患者之间也有显著性差异。经随访发现半年内发展为AMI的UAP者当初其尿FPA值和血浆D－Dimer值均较高。表明凝血纤溶系统的变化在IHD的发生、发展中起着重要作用、研究凝血纤溶指标对于探讨其发病机理及预后判定均有一定帮助。     

Reduced high-frequency QRS components in patients with ischemic heart disease compared to normal subjects

Analysis of high-frequency QRS components (HF-QRS) might provide an additional method when diagnosing various heart diseases, for example ischemic heart disease (IHD). This study compares HF-QRS in normal subjects to those in patients with IHD, and also analyzes HF-QRS considering gender and age. A total of 63 normal subjects and 64 patients with IHD were included. Signal-averaged electrocardiograms (ECGs) from the 12 standard leads were analyzed in the frequency interval of 150-250 Hz. The results showed that the summed 12 lead HF-QRS in patients with IHD were significantly lower than in normal subjects (mean summed HF-QRS was 33.5 microV in the IHD group, 43.7 microV in normal individuals, P <.0005). HF-QRS were not statistically associated with gender or age (P =.820 and P =.573, respectively). However, the inter-individual variation of HF-QRS was large in both groups which probably limits the clinical usefulness of the method.     

扩张性心肌病与缺血性心肌病的心电图鉴别诊断

目的:比较扩张性心肌病(DCM)与缺血性心肌病(IHD)在ECG上的特征,为临床的鉴别诊断提供依据。方法:已确诊的DCM及IHD患者各20名,超声心动图显示左室内径增大,心功能Ⅱ～Ⅳ级,行体表心电图检查,测量Rv6.Rv5,Rv5+Sv1,RⅠ,RⅡ,RⅢ,RⅠ+Ⅲ,RV6/Rmax及异常Q波的分布情况。结果:两组的Rv2,Rv5+Sv1,R1+SⅡ差别无显著意义(P>0.05),但DCM组Rv6较IHD组显著增加(P<0.05),RⅠ、Ⅱ、Ⅲ降低(P<0.05);Rv6/Rmax也比IHD组明显增多(P<0.05),Rv6/Rmax>3.0的DCM组占67％,而IHD组竟无1例。IHD的异常Q波更常见(60％),而DCM的则仅为25％。结论:ECG的RVv6/Rmax>3.0对左心室扩大的DCM和IHD有较重要的鉴别诊断意义。     

Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol--the case of Canada

Aims To analyse post‐war variations in per capita alcohol consumption in relation to gender‐specific liver cirrhosis mortality in Canadian provinces and to assess the extent to which alcohol bears a different relation to cirrhosis deaths with mention of alcohol (alcoholic cirrhosis) compared to cirrhosis deaths without mention of alcohol (non‐alcoholic cirrhosis). Data and method Annual liver cirrhosis mortality rates by 5‐year age groups were converted into gender‐specific and age‐adjusted mortality rates. Outcome measures included total cirrhosis—the conventional measure of liver cirrhosis—alcoholic cirrhosis and non‐alcoholic cirrhosis. Per capita alcohol consumption was measured by alcohol sales and weighted with a 10‐year distributed lag model. A graphical analysis was used to examine the regional relationship and the Box–Jenkins technique for time‐series analysis was used to estimate the temporal relationship. Findings Geographical variations in alcohol consumption corresponded to variations in total liver cirrhosis and particularly alcoholic cirrhosis, whereas non‐alcoholic cirrhosis rates were not associated geographically with alcohol consumption. In general, for all provinces, time‐series analyses revealed positive and statistically significant effects of changes in alcohol consumption on cirrhosis mortality. In Canada at large, a 1‐litre increase in per capita consumption was associated with a 17% increase in male total cirrhosis rates and a 13% increase in female total cirrhosis rates. Alcohol consumption had a stronger impact on alcoholic cirrhosis, which increased by fully 30% per litre increase in alcohol per capita for men and women. Although the effect on the non‐alcoholic cirrhosis rate was weaker (12% for men and 7% for women) it was nevertheless statistically significant and suggests that a large proportion of these deaths may actually be alcohol‐related. Conclusions Some well‐established findings in alcohol research were confirmed by the Canadian experience: per capita alcohol consumption is related closely to death rates from liver cirrhosis and alcohol‐related deaths tend to be under‐reported in mortality statistics.     

冠状动脉心肌桥与缺血性心脏病

目的　探讨冠状动脉心肌桥 (心肌桥 )的特征和心肌桥与缺血性心脏病 (IHD)的关系。方法　回顾性分析接受冠状动脉造影的 2 398例患者 ,其中共检出心肌桥 2 2例。结果　心肌桥检出率为 0 92 % ;心肌桥最常出现在左前降支 ;心肌桥段冠状动脉收缩期狭窄是最主要征象 :心肌桥近段冠状动脉粥样硬化检出率为 5 4 5 % ;有心肌桥患者临床均表现出不同程度心绞痛和心肌梗死。结论　冠状动脉收缩期狭窄是心肌桥最主要征象 ;冠状动脉心肌桥可导致缺血性心脏病。     

Evaluation of ischemic heart disease and viability by cardiac MRI

In ischemic heart disease, cardiac MRI, besides being the gold standard for evaluation of quantitative ventricular function, enables evaluation of myocardial wall thickness, T2-weighted imaging for myocardial edema and infarct quantification and transmurality. Delayed hyperenhancement sequences are highly predictive of scar formation, being associated with myocyte necrosis. The extent and transmurality of delayed hyperenhancement has prognostic implications and is inversely proportional to the degree of functional recovery after acute myocardial infarction. A greater transmural extent of infarction (eg, hyperenhancement involving >50% of the wall thickness) can predict regions that are less likely to improve in function after therapy. The ultimate focus of MRI in ischemic heart disease is in diagnosis, quantification of myocardium at risk, salvageable myocardium, perfusion defects and differentiation of viable myocardium from non viable myocardium to enable prognostication.     

Cirrhosis mortality in Ontario: effects of alcohol consumption and Alcoholics Anonymous participation

AIMS: We test the hypotheses that cirrhosis mortality rates are positively associated with per capita alcohol consumption and negatively associated with Alcoholics Anonymous (AA) membership rates. DESIGN: The impact of alcohol consumption levels and AA membership rates on cirrhosis mortality rates in Ontario from 1968 to 1989 were examined. Time-series analyses with ARIMA modelling were applied to male and female cirrhosis mortality rates in three age groups: 15-44, 45-64 and 65 + years. Missing AA membership data were interpolated using two methods: linear splines and cubic splines. FINDINGS: In general, cirrhosis mortality rates were positively associated with alcohol consumption and negatively associated with AA membership. For some age and gender combinations, these effects were not statistically significant. CONCLUSIONS: The limits of this study include restrictions in the length of series available and in the ability to infer causality. Despite these limitations, these findings are consistent with previous research demonstrating that per capita consumption is a strong determinant of cirrhosis mortality rates, and also that higher levels of AA membership can reduce cirrhosis mortality rates.     

Hyperuricemia and increased risk of ischemic heart disease in a large Chinese cohort

Aims

There is an ongoing discussion on whether serum uric acid (SUA) predicts ischemic heart disease (IHD) independently of other metabolic factors, which, if confirmed, would signify a role for uric acid in the pathogenesis of cardiovascular disease. We investigated whether such a relation exists for ethnic Chinese with low CVD risk.

Methods and results

Enrolled, between 1994 and 1996, were 128,569 adults ≥ 20 years from four ‘MJ’ Health Check-up Clinics in Taiwan. Excluded were those with heart disease, previous stroke(s), renal disease, and/or cancer. Physical examinations, biospecimen collections, and structured questionnaires were executed according to standardised protocols. We identified IHD events according to the ICD-9-CM codes 410-414 using hospitalisation records obtained from the National Health Insurance and the Death Certification Registry databases. The Cox proportional hazard model was used to estimate the hazard ratios (HRs) between SUA and IHD events. A total of 2049 subjects (1239 men, 810 women) developed IHD from baseline to Dec. 31, 2002. Men had a higher IHD incidence than did women (2.84 vs. 1.61 1/1000 person-years; p < 0.0001). The risk-factor-adjusted HRs (95% confidence-interval [CI]) for hyperuricemiae (SUA ≥ 7.0/≥6.0 mg/dL) were 1.25 (1.11-1.40) for men and 1.19 (1.02-1.38) for women. In the low-risk population (lacking the NCEP-ATPIII metabolic syndrome components), a significant association was still observed (adjusted HR: 1.54 [1.09-2.17]).

Conclusion

The hyperuricemia was independently associated with the development of IHD not only in the general population but also in those without any metabolic risk factor for NCEP ATPIII. Hyperuricemia may be considered as a potential risk factor for IHD.     

Sex differences in the prevalence of ischemic heart disease and in the response to a stress test in a working population

In a study 4422 males and 1663 females aged 18–60 yearswere examined in order to determine the prevalence of ischemicheart disease and the response to an exercise stress test. The prevalence of ischemic heart disease was 7.3 times as highin males as it was in females. In normotensive, asymptomaticsubjects under 45 years of age an abnormal electrocardiographicresponse to stress testing was 3.8 times higher in females thanit was in males (95% confidence limits 2.2–6.3). However,in an older age group, it was more frequent in males. The predictive value of a positive test after a six-year follow-upwas 18.0 per 100 in males and 8.6 per 100 in females. These results confirm that the positive response to stress testinghas different meanings in males and females.     

The association between orthostatic increase in pulse pressure and ischemic heart disease

The clinical meaning of changes in PP with posture remains unclear. We performed treadmill exercise testing on 144 subjects to diagnose ischemic heart disease, and measured the PPs in the supine and standing positions. The differences in the two PPs ranged between ?35 and 45?mmHg. Eleven subjects were diagnosed with significant coronary ischemia. The differences in the PPs were significantly increased, and PP in the standing position was significantly elevated in these subjects. A large difference in the PPs in the standing and supine positions was associated with significant coronary ischemia, independent of significant covariables.     

Gilbert syndrome and ischemic heart disease: a protective effect of elevated bilirubin levels

Background: Oxidation processes play an important role in atherogenesis. Bilirubin IX is recognised as a potent antioxidant. In the present study, we assessed the role of elevated serum bilirubin levels in the prevention of ischemic heart disease (IHD). Methods: The occurrence of IHD was determined in Gilbert syndrome (GS) patients above 40 years (n=50). The diagnosis was based on past medical history and ECG criteria. The occurrence was related to that of the comparable general population (n=2296). Serum biochemistry, including the total antioxidant status was evaluated in the GS subjects, IHD patients (n=38) and control subjects (n=38). Results: The prevalence of IHD in GS subjects (aged 49.7±9.0 years) was 2% (0.05–10.7%, 95% confidence interval), compared to 12.1% in a general population (P<0.05). Bilirubin, total antioxidant capacity and high density lipoprotein (HDL) cholesterol were found to be significantly higher in GS subjects compared to control groups (P<0.05). According to linear discriminant analysis, hyperbilirubinemia rather than elevation of HDL cholesterol levels seemed to be more important in protection from IHD. Conclusions: In the present study, low prevalence of IHD in GS subjects was detected. It may be presumed that chronic hyperbilirubinemia prevent the development of IHD by increasing the serum antioxidant capacity.     

T-wave inversion after a severe head injury without ischemic heart disease

Electrocardiographic changes mimicking an acute coronary event with T-wave inversion have been reported in the resting electrocardiogram in patients without ischemic heart disease but with acute ischemic stroke, or subarachnoid hemorrhage, or intracerebral hemorrhage, or a severe head injury. We present a case of T-wave inversion in a 73-year-old Italian woman admitted to the Emergency Department following a severe head injury. Pericarditis, pericardial effusion, and acute coronary event were excluded. Ischemic stroke, subarachnoid hemorrhage, and intracerebral hemorrhage were also excluded. Also this case focuses attention on T-wave inversion after a severe head injury without ischemic heart disease.     

Increase in the incidence of alcoholic pancreatitis and alcoholic liver disease in Iceland: impact of per capita alcohol consumption

Abstract

Objective: To analyze the incidence of acute alcoholic pancreatitis and of severe alcoholic liver disease (ALD) and its association with per capita alcohol consumption with identification of both alcoholic cirrhosis (AC) and severe alcoholic hepatitis (AH), in a population-based setting.

Methods: A search was undertaken in diagnoses database for diagnostic codes in order to find patients hospitalized with incident acute alcoholic pancreatitis (AP) and alcoholic liver disease in Iceland in 2001–2015. Diagnoses were verified in all patients who were retrospectively reviewed. Those with ALD had either AC or AH. Alcohol sales during the study period were obtained from Statistics Iceland.

Results: Overall, 273 patients with acute AP, mean age at diagnosis 50 (14) years, 74% males and 159 patients with ALD, mean age 57 (11) years, 73% males, were identified. Mean per capita alcohol consumption was 6.95 (0.4) liters and increased by 21% over the study period. The annual incidence of AP increased from 4.2 per 100.000 to 9.5 and ALD from 1.6 to 6.1 per 100.000. Trend analysis showed a significant annual increase of 7% (RR 1.07, 95%CI 1.04–1.10) for AP and an annual increase of 10.5% (RR 1.10, 95%CI 1.06–1.15) for ALD. The increase was only significant in males.

Conclusions: Increase per capita alcohol consumption over a 15?year study period was associated with an increase in the incidence of severe alcoholic liver disease and alcohol-related acute pancreatitis in males but not in females.     

Sonographic fatty liver, overweight and ischemic heart disease

AIM: To demonstrate the prevalence of sonographic fatty liver, overweight and ischemic heart disease (IHD) among the male workers in Taiwan, and to investigate the possible association of these three factors. METHODS: From July to September 2003, a total of 2 088 male aircraft-maintenance workers aged from 22 to 65 years (mean 40.5) underwent an annual health examination, including anthropometrical evaluation, blood pressure measurement, personal medical history assessment, biochemical blood analysis, abdominal ultrasonographic examination and digital electrocardiography (ECG). The Student's t-test, x2 test and multivariate logistic regression analysis were utilized to evaluate the relationship between IHD and salient risk factors. RESULTS: The all-over prevalence of overweight was 41.4%, and that of fatty liver was 29.5% (mild, moderate and severe fatty liver being 14.5%, 11.3%, and 3.7%, respectively); while the prevalence of ischemic changes on ECG was 17.1% in this study. The abnormal rates for conventional IHD risk factors including hypertension, dyslipidemia, hyperglycemia and overweight increased in accordance with the severity of fatty liver. Overweight and severity of fatty liver were independently associated with increased risks for developing IHD. Overweight subjects had a 1.32-fold (95%CI: 1.01-1.73) increased IHD risk. Participants with mild, moderate, and severe fatty liver had a 1.88-fold (95%CI: 1.37-2.6), 2.37-fold (95%CI: 1.66-3.37) and 2.76-fold (95%CI: 1.62-4.72) increased risk for developing IHD. The prevalence of ischemic ECG for the fatty liver-affected subjects with or without overweight was 30.1% and 19.1%, while that of overweight subjects free from fatty liver was 14.4%. Compared to the subjects without fatty liver nor overweight, IHD risk for the three subgroups above was as follows: OR: 2.95 (95%CI: 2.31-4.09), OR: 1.60 (95%CI: 1.07-2.39) and OR: 1.11 (95%CI: 0.78-1.56), respectively. CONCLUSION: The presence of fatty liver and its severity should be carefully considered as independent risk factors for IHD. Results of the study suggest the synergistic effect between fatty liver and overweight for developing IHD. Abdominal sonographic examination may provide valuable information for IHD risk assessment in addition to limited report about liver status, especially for overweight males.