Biphasic alcohol response differs in heavy versus light drinkers

BACKGROUND: Most studies of risk factors for alcohol-related problems have focused on biological family history as a primary risk factor. However, other factors, such as early-age heavy drinking, are also risk factors for sustained or progressive heavy consumption. Little is currently known about the mechanisms underlying binge or heavy drinking. METHODS: This study examined the acute subjective and objective effects of ethanol in heavy drinkers versus light drinkers. Thirty-four subjects participated in this within-subjects study consisting of three early-evening testing sessions in which subjects consumed a beverage containing either 0.8 or 0.4 g/kg ethanol or placebo. RESULTS: Compared with lighter drinkers, heavy drinkers were more sensitive to the positive stimulant-like effects of ethanol (p < 0.05), especially during the increasing limb of the blood alcohol curve. Heavy drinkers also showed less sedation and cortisol response after alcohol than the light drinkers (p < 0.05). CONCLUSIONS: The results indicate that young adult binge drinkers show a biphasic alcohol response, with heightened sensitivity to stimulant-like alcohol effects and greater tolerance to sedative alcohol effects compared with their light-drinking counterparts.     

Individual Differences in the Biphasic Effects of Ethanol

Ethanol exerts both stimulant-like and sedative-like subjective and behavioral effects in humans depending on the dose, the time after ingestion and, we will argue, also on the individual taking the drug. This study assessed stimulant-like and sedative-like subjective and behavioral effects of ethanol during the ascending and descending limbs of the blood alcohol curve across a range of doses in nonproblem social drinkers. Forty-nine healthy men and women, 21 to 35 years old, consumed a beverage containing placebo or ethanol (0.2, 0.4, or 0.8 g/kg) on four separate laboratory sessions, in randomized order and under double-blind conditions. Subjective and behavioral responses were assessed before and at regular intervals for 3 hr after ingestion of the beverage. The lowest dose of ethanol (0.2 g/kg) only produced negligible subjective effects compared to placebo. The moderate dose (0.4 g/kg) increased sedative-like effects 90 min after ethanol ingestion but did not increase ratings of stimulant effects at any time. The highest dose (0.8 g/kg) increased ratings of both stimulant- and sedative-like effects during the ascending limb and produced only sedative-like effects during the descending limb. Closer examination of the data revealed that individual differences in response to the highest dose of ethanol accounted for this unexpected pattern of results: about half of the subjects reported stimulant-like effects on the ascending limb and sedative-like effects on the descending limb after 0.8 g/kg ethanol, whereas the other half did not report stimulant-like effects at any time after administration of ethanol. These results challenge the simple assumption that ethanol has biphasic subjective effects across both dose and time, and extend previous findings demonstrating individual differences in response to ethanol.     

Relative frequency of heavy drinking and the risk of alcohol dependence

Data from a national representative sample of US adults were analyzed to determine the association between the relative frequency of heavy drinking (the proportion of drinking occasions on which 5 + drinks were consumed) and past-year alcohol dependence, adjusting for the influences of average ethanol intake and sociodemographic factors. Fifty-seven percent of current drinkers reported never drinking 5 + drinks, and 21% drank 5 + drinks at least once but on less than 10% of all drinking occasions. Nine percent reported drinking 5 + drinks on at least half of all drinking occasions. Average daily intake was positively correlated with the relative frequency of heavy drinking, and both consumption measures were positively associated with the risk of alcohol dependence. Increases in either relative frequency of heavy drinking or average ethanol intake reduced, but did not eliminate, the effect of the other on the risk of dependence. The excess risk of dependence associated with frequent heavy drinking varied among population subgroups and was increased by age, education, and female gender.     

A dose–response perspective on college drinking and related problems

Aims In order to examine the degree to which heavy drinking contributes to risks for problems among college drinkers this paper develops and tests a dose–response model of alcohol use that relates frequencies of drinking specific quantities of alcohol to the incidence of drinking problems. Methods A mathematical model was developed that enabled estimation of dose–response relationships between drinking quantities and drinking problems using self‐report data from 8698 college drinkers across 14 campuses in California, USA. The model assumes that drinking risks are a direct monotone function of the amount consumed per day and additive across drinking days. Drinking problems accumulate across drinking occasions and are the basis for cumulative reports of drinking problems reported by college drinkers. Results Statistical analyses using the model showed that drinking problems were related to every drinking level, but increased fivefold at three drinks and more gradually thereafter. Problems were associated most strongly with occasions on which three drinks were consumed, and more than half of all reported problems were related to occasions on which four or fewer drinks were consumed. There were some important differences in dose–responsiveness between men and women and between different groups of ‘light’, ‘moderate’ and ‘heavier’ drinkers. Conclusion Many problems among college students are associated with drinking relatively small amounts of alcohol (two to four drinks). Programs to reduce college drinking problems should emphasize risks associated with low drinking levels.     

Effects of acute social stress on alcohol consumption in healthy subjects

BACKGROUND: There has been renewed interest in interactions between stress and use of drugs and alcohol. Although there is evidence that stress increases drug use in human drug users and in laboratory animals, the processes by which stress affects drug-motivated behavior are not understood. Here we examined the effects of an acute social stressor (performing a mental arithmetic task in front of an audience) on consumption of ethanol or placebo beverages in healthy social drinkers. METHODS: Thirty-seven men and women, ages 21-35, were randomly assigned to a placebo (n = 15) or ethanol group (n = 22). Subjects participated in two sessions, one with stress (Trier Social Stress Test) the other without stress. In each session, immediately after the stress or no-stress period, subjects consumed the first dose (placebo or 0.3 g/kg of ethanol for men or 0.2 g/kg for women). Then, subjects were allowed to choose up to six more beverages (0.1 g/kg each for the ethanol group or placebo beverages for the placebo group). Measures included percentage of beverage consumed, salivary cortisol level, heart rate, blood pressure, and subjective ratings of mood and drug effect. RESULTS: Subjects in both the placebo and ethanol groups consumed significantly more of their beverages after stress, compared to no stress. Stress increased anxiety, uneasiness, and produced some stimulant-like effects and, in the ethanol group, it dampened some of the acute subjective effects of ethanol. The direct physiologic and mood effects of the stress were fairly short-lived. CONCLUSIONS: It is concluded that acute stress may produce a modest increase in alcohol consumption in healthy, nonproblem social drinkers but that this increase is not directly related to the pharmacological effects of the drug. Nonpharmacological factors may include expectancies, thirst, or nonspecific facilitation of ongoing behaviors.     

Drinking habits among older persons: findings from the NHANES I Epidemiologic Followup Study (1982-84). National Health and Nutrition Examination Survey

OBJECTIVES: To describe alcohol use and its sociodemographic correlates among persons aged 65 years and older in a US probability sample. DESIGN: Cross-sectional analysis of a national probability sample-based cohort study. SETTING: Multiple sites throughout the United States. PARTICIPANTS: A total of 3448 persons aged 65 and older who participated in the first wave of the NHANES I Epidemiologic Followup Study (1982-84). MEASUREMENTS: We describe the alcohol use behaviors and demographic characteristics of 3448 persons aged 65 and older. Least squares regression models were used to assess associations between older persons' sociodemographic characteristics and alcohol use. RESULTS: Sixty percent of the sample reported having 12 or more drinks of alcohol in at least 1 year of their lives. Seventy-nine percent of these older drinkers were currently drinking. Twenty-five percent of all drinkers drank daily (31% men, 19% women). Using gender-specific definitions (men >2 drinks/day; women >1 drink/day), 16% of men drinking alcohol and 15% of women drinking alcohol were heavy drinkers. Younger age, male gender, and higher income were associated with greater alcohol use. CONCLUSIONS: Most older persons who ever drank alcohol in their lifetimes were currently drinking. In addition, a substantial number of older persons were drinking currently at levels that may place them at risk of adverse health consequences.     

Combined Alcohol and Energy Drink Use: Hedonistic Motives,Adenosine, and Alcohol Dependence

Consumption of alcohol mixed with energy drinks (AmED) has been associated with both short‐ and long‐term risks beyond those observed with alcohol alone. AmED use has been associated with heavy episodic (binge) drinking, risky behaviors, and risk of alcohol dependence. Laboratory research has demonstrated that AmED beverages lead to greater motivation to drink versus the same amount of alcohol consumed alone. However, the reason consumers find AmED beverages particularly appealing has been unclear. A recent report by Droste and colleagues (Alcohol Clin Exp Res 2014; 38:2087–2095) is the first study to investigate motivations related to AmED consumption and to determine which motives predict AmED consumption patterns, experience of drinking‐related harms, and risk of alcohol dependence. The findings of this study significantly enhance our understanding of why AmED consumption is related to the risk of alcohol dependence and change our understanding of why consumers choose AmED beverages. The authors report that hedonistic motives strongly predicted AmED use and the harms associated with use. While intoxication‐reduction motives predicted self‐reported accidents and injuries, these motives did not predict AmED consumption patterns and risk of dependence. The risk of alcohol dependence may arise from repeated experiences when drinking alcohol is more pleasurable when energy drinks are consumed with the alcohol. This commentary will focus on why energy drinks might increase the rewarding properties of alcohol in social drinkers. In addition, discussion is provided explaining why more research on the neurotransmitter, adenosine, may actually inform us about the mechanisms contributing to the development of alcohol dependence.     

Haloperidol Reduces Stimulant and Reinforcing Effects of Ethanol in Social Drinkers

BACKGROUND: Despite abundant preclinical support for a role of dopamine (DA) in the stimulant-like and reinforcing effects of ethanol, there have been few studies directly investigating this mechanism in human subjects. This study examined the effect of a DA antagonist, haloperidol, on the subjective stimulant-like effects of acute doses of ethanol and on ethanol reinforcement in healthy human volunteers. It was hypothesized that a low dose of the DA D2/D3 antagonist haloperidol (3 mg) would attenuate stimulant-like subjective effects of ethanol (0.75 g/kg) and reduce the number of drinks chosen during a subsequent choice phase. METHODS: Seventeen healthy men and women, 21 to 35 years old, participated in four laboratory sessions conducted at 1-week intervals. During the four sessions they received, in randomized order under double-blind conditions, capsules containing haloperidol or placebo followed by three drinks containing ethanol (0.75 g/kg) or placebo, at 30-min intervals. Subjective and behavioral responses were measured before and after the beverages. After the third beverage, subjects could choose up to five additional doses of the beverage they had ingested. RESULTS: Haloperidol reduced the number of ethanol beverages subjects chose without altering placebo beverage choices. Haloperidol also dampened some of the subjective effects of ethanol, especially in subjects who experienced stimulation after ethanol. Haloperidol reduced stimulant-like and euphorigenic effects of ethanol in subjects who experienced stimulant effects (n = 8) but had no effect in subjects who did not experience stimulation from ethanol (n = 9). CONCLUSIONS: These findings suggest that DA plays a role in the stimulant-like, euphorigenic, and reinforcing qualities of ethanol in humans. However, the findings also raised new questions about the link between the subjective and reinforcing effects of ethanol.     

Many college freshmen drink at levels far beyond the binge threshold

BACKGROUND: Binge drinking is a dichotomous variable that allows researchers to sort students into categories based upon a specific threshold of consumption, commonly 4 (females) or 5 (males) drinks. Crossing the binge threshold increases the risk of negative alcohol-related consequences. The use of such thresholds has played a vital role in the study of college drinking. While extremely valuable, the dichotomous nature of binge drinking variables removes information about how heavily students actually drink, leaving the characterization of college drinking incomplete. The present study examined patterns of alcohol use beyond the binge threshold. METHODS: The data set consisted of self-reported 2-week drinking histories from 10,424 first-semester freshmen at 14 schools across the United States during the fall of 2003. The number of students who reached the 4+/5+ binge-drinking threshold was calculated, as was the number who reached 2 times (8+/10+ drinks) or 3 times (12+/15+ drinks) the binge threshold. Logistic regression analyses were used to explore gender differences and to assess whether frequent binge drinkers (3+ binges per 2 weeks) were more likely than infrequent binge drinkers (1-2 binges per 2 weeks) to reach high peak levels of consumption. RESULTS: Roughly 1 of 5 males consumed 10+ drinks and 1 of 10 females consumed 8+ drinks, twice the binge threshold, at least once in the previous 2 weeks. Gender differences were observed at every drinking level and were particularly large at higher peak levels. Frequent binge drinkers were more likely than infrequent binge drinkers to consume 2 or 3 times the binge threshold. DISCUSSION: A surprisingly large percentage of students, particularly males, drink at peak levels well beyond the binge threshold. Such findings suggest that schools might make additional progress in the battle against alcohol misuse by focusing on extreme drinking practices in addition to binge drinking per se.     

Ethanol impairs saccadic and smooth pursuit eye movements without producing self-reports of sedation

It has been suggested that eye movements provide a sensitive tool to assess the sedative-like properties of drugs. However, the relationship between sedative-like subjective effects and impairment in eye movements is not clear. For example, it is not clear whether drugs with stimulant-like effects can also impair eye movements. This study evaluated whether ethanol, a drug with both sedative-like and stimulant-like properties, impairs eye movements, and whether the impairment observed after ethanol is related to its sedative properties. Twenty healthy men and women, aged 21 to 35, consumed beverages containing placebo or ethanol (0.4 or 0.8 g/kg) on three separate laboratory sessions, in randomized order. Eye movement and psychomotor and subjective responses were assessed before and at regular intervals for 3 hr after ingestion of the beverage. Subjects were divided post hoc into two groups, based on their sedative-like or stimulant-like subjective responses to ethanol. Nine subjects reported increases in sedative-like effects after ethanol and 11 reported decreases in sedative-like effects, and increases in stimulant-like effects, after alcohol. Despite their distinctly different subjective responses to ethanol, the groups did not differ in the magnitude, time-course or quality of responses on the eye movement measures. In both groups, ethanol decreased peak saccadic eye velocity and smooth pursuit gain. These results demonstrate the dissociation between impairment in eye movements and subjective feelings of sedation after ethanol, and show that eye movements can be impaired even when subjects are reporting stimulant-like effects. The findings suggest that impaired eye movements are not a nonselective index of sedation, but may be related to specific drug actions on brain regions involved in generating these eye movements.     

Prospective study of moderate alcohol consumption and risk of hypertension in young women

BACKGROUND: Heavy alcohol consumption is associated with an increased risk of hypertension. However, the effect of moderate alcohol consumption; the specific effects of wine, beer, and liquor; and the pattern of drinking in relation to risk of hypertension among young women are unclear. METHODS: We prospectively examined the association between alcohol consumption and subsequent risk of hypertension among 70 891 women 25 to 42 years of age. RESULTS: During the 8 years of follow-up, 4188 cases (5.9%) of incident hypertension were reported. After adjustment for multiple covariates, the association between alcohol consumption and risk of hypertension followed a J-shaped curve. Compared with nondrinkers, the risk of developing hypertension according to average number of drinks consumed per day was as follows: 0.25 or less, 0.96 (95% confidence interval [CI], 0.89-1.03); 0.26 to 0.50, 0.86 (95% CI, 0.75-0.98); 0.51 to 1.00, 0.92 (95% CI, 0.82-1.04); 1.01 to 1.50, 1.00 (95% CI, 0.80-1.24); 1.51 to 2.00, 1.20 (95% CI, 0.92-1.58); and more than 2.0 drinks, 1.31 (95% CI, 1.02-1.68). Exclusion of past drinkers yielded similar results. Among women in the highest category of alcohol consumption, there was a suggestion that the increased risk of hypertension was present regardless of the specific beverage consumed (beer, wine, or liquor). Episodic drinking, defined as consumption of more than 10.5 drinks over 3 or fewer days per week, was not associated with increased risk of hypertension (relative risk, 0.80; 95% CI, 0.51-1.23). CONCLUSIONS: The association between alcohol consumption and risk of chronic hypertension in young women follows a J-shaped curve, with light drinkers demonstrating a modest decrease in risk and more regular heavy drinkers demonstrating an increase in risk.     

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.     

Effects of alcohol on simulated driving and perceived driving impairment in binge drinkers

Background:  Binge drinking (heavy episodic alcohol use) is associated with high rates of impaired driving and myriad alcohol-related accidents. However, the underlying reasons for the heightened accident risk in this demographic group are not known. This research examined acute alcohol effects on simulated driving performance and subjective ratings of intoxication and driving ability in binge and nonbinge drinkers.
Methods:  Young social drinking college students (24 binge drinkers and 16 nonbinge drinkers) participated in this study. Participants attended a session during which they received a moderate dose of alcohol (0.65 g/kg) and a session during which they received a placebo. A simulated driving task measured participants' driving performance in response to each dose. Subjective responses to each dose were also assessed, including ratings of sedation, stimulation, and driving ability.
Results:  The acute dose of alcohol impaired multiple aspects of driving performance in both binge and nonbinge drinkers. Under alcohol, all participants had greater difficulty in maintaining their lane position, maintaining the appropriate speed and made multiple driving errors compared to placebo performance. By contrast, compared with nonbinge drinkers, binge drinkers reported feeling less sedated by the alcohol and reported having a greater ability to drive following the acute dose of alcohol.
Conclusions:  Reduced subjective intoxication and perceived driving impairment in binge drinkers may account for the greater accident risk in this demographic group. Binge drinkers may lack the internal sedation cue that helps them accurately assess that they are not able to effectively drive a vehicle after drinking.     

Drinking Patterns and Myocardial Infarction: A Linear Dose–Response Model

Background: The relation of alcohol intake to cardiovascular health is complex, involving both protective and harmful effects, depending on the amount and pattern of consumption. Interpretation of data available on the nature of these relations is limited by lack of well‐specified, mathematical models relating drinking patterns to alcohol‐related consequences. Here we present such a model and apply it to data on myocardial infarction (MI). Methods: The dose–response model derived assumes: (1) each instance of alcohol use has an effect that either increases or decreases the likelihood of an alcohol‐related consequence, and (2) greater quantities of alcohol consumed on any drinking day add linearly to these increases or decreases in risk. Risk was reduced algebraically to a function of drinking frequency and dosage (volume minus frequency, a measure of the extent to which drinkers have more than 1 drink on days when they drink). In addition to estimating the joint impact of frequency and dosage, the model provides a method for calculating the point at which risk related to alcohol consumption is equal to background risk from other causes. A bootstrapped logistic regression based on the dose–response model was conducted using data from a case‐control study to obtain the predicted probability of MI associated with current drinking patterns, controlling for covariates. Results: MI risk decreased with increasing frequency of drinking, but increased as drinking dosage increased. Rates of increasing MI risk associated with drinking dosage were twice as high among women as they were among men. Relative to controls, lower MI risk was associated with consuming < 4.55 drinks per drinking day for men (95% CI: 2.77 to 7.18) and < 3.08 drinks per drinking day for women (95% CI: 1.35 to 5.16), increasing after these cross‐over points were exceeded. Conclusions: Use of a well‐specified mathematical dose–response model provided precise estimates for the first time of how drinking frequency and dosage each contribute linearly to the overall impact of a given drinking pattern on MI risk in men and women.     

Relationship between drinking alcohol and atherosclerotic risk factors in female Japanese workers of different ages

AIM: To determine whether age influences the relationships of drinking alcohol with blood pressure and lipids in women. METHODS: The subjects were 53,911 female Japanese workers (20-69 years old) receiving annual health checkups at each workplace. The subjects were divided into three groups by daily average amount of ethanol consumed (non-drinkers; light drinkers, less than 30g ethanol/day; heavy drinkers, 30g ethanol/day or more). Blood pressure, body mass index (BMI) and total and HDL cholesterol were measured. RESULTS: In the age groups from twenties to fifties, BMI was significantly lower in light drinkers than in non-drinkers. In the forties and fifties age groups, systolic blood pressure in heavy drinkers was higher than that in non-drinkers, while no significant difference was found between non- and heavy drinkers in the twenties and thirties age groups. Diastolic blood pressure was higher in heavy drinkers than in non-drinkers in all age groups. Blood total cholesterol tended to be lower in drinkers than in non-drinkers at ages less than 60 years, while this relation was not observed in the sixties age group. Blood HDL cholesterol and atherogenic index tended to become higher and lower, respectively, with an increase in the amount of alcohol drinking in all age groups. CONCLUSION: In elderly women, the elevating effect of drinking on systolic blood pressure is increased and the lowering effects on BMI and blood total cholesterol are decreased. These results imply that drinking alcohol has less beneficial and more harmful effects on atherosclerotic risk in elderly women.     

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.     

Alcohol use and cardiovascular disease preventive services

BACKGROUND: Moderate drinking is associated with decreased cardiovascular mortality. Biological effects may mediate this association, but differences in utilization of preventive services may be important. DESIGN AND METHODS: Cross-sectional analysis of adults participating in the Third National Health and Nutrition Examination Survey with data on alcohol use and prior use of services for the detection and treatment of hypertension and hypercholesterolaemia. Regression models were analysed to provide age-, sex- and race-adjusted risk estimates for outcomes related to these services for several patterns of alcohol use relative to regular light drinkers. RESULTS: Hypertension was more common in most alcohol use strata compared with regular light drinkers (adjusted prevalence ratios 1.22 for lifelong abstainers, 1.33 for nonlifelong abstainers, 1.35 for infrequent moderate drinkers, 2.01 for frequent moderate drinkers, 1.73 for infrequent heavy drinkers and 1.98 for regular heavy drinkers, P-values < 0.05). Having had blood pressure measured was similar in all drinking strata. The prevalence of hypercholesterolaemia was similar in drinking strata, but most drinking patterns were associated with lower use of services to detect high cholesterol (prevalence ratios 0.7 for lifelong abstainers, 0.8 for nonlifelong abstainers, infrequent moderate and regular moderate drinkers, 0.6 for infrequent heavy drinkers, and 0.7 for regular heavy drinkers, P-values < 0.05). CONCLUSIONS: The utilization of cardiovascular disease preventive services may contribute to the beneficial association of moderate drinking with cardiovascular mortality. Additional research is needed to estimate the influence of differences in health services utilization on the association of alcohol use with cardiovascular disease outcomes.     

Binge Drinking and Suboptimal Self‐Rated Health Among Adult Drinkers

Background: Binge drinking accounts for more than half of the 79,000 annual deaths in the United States that are owing to excessive drinking. The overall objective of our study was to examine the prevalence of binge drinking and consumption levels associated with suboptimal self‐rated health among the general population of adult drinkers in all 50 states and territories in the United States. Methods: The study included a total of 200,587 current drinkers who participated in the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey. We estimated the prevalence of binge drinking (i.e., ≥5 drinks on 1 occasion for men or ≥4 drinks on 1 occasion for women) and heavy drinking (i.e., an average of >14 drinks per week for men or >7 drinks per week for women), as well as the average number of binge episodes per person during a 30‐day period. Odds ratios were produced with multivariate logistic regression models using binge‐drinking levels as a predictor; status of suboptimal self‐rated health was used as an outcome variable while controlling for sociodemographic, health, and behavioral risk factors. Results: We estimate that 34.7 million adult drinkers in the United States engaged in binge drinking in 2008, including an estimated 42.2% who reported either heavy drinking or at least 4 binge‐drinking episodes in a 30‐day period. Binge drinking with such levels was associated with a 13–23% increased likelihood of reporting suboptimal self‐rated health, when compared to the nonbinge drinkers. Conclusions: Binge drinking continues to be a serious public health concern. Frequent binge drinkers or binge drinkers who consume alcohol heavily are especially at risk of suboptimal self‐rated health. Our findings underscore the importance of broad‐based implementation in health care settings of screening for and brief interventions to address alcohol misuse, as well as the continuing need to implement effective population‐based prevention strategies to reduce alcohol‐related morbidity and mortality.     

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.