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Association Between Alcohol Consumption and Risk of Cardiovascular Disease and All-Cause Mortality in Patients With Hypertension: A Meta-Analysis of Prospective Cohort Studies
Abstract and Figures
Objective:
To conduct a meta-analysis summarizing the risk of cardiovascular disease (CVD) and all-cause mortality (ACM) in relation to alcohol consumption in patients with hypertension, focusing on clarifying dose-response associations.
Patients and methods:
PubMed and EMBASE were searched for eligible prospective cohort studies from December 3, 1949, through January 18, 2014. The semi-parameter method and dose-response analysis were used.
Results:
Nine studies (11 cohorts) were included in the meta-analysis. Compared with the lowest alcohol level (abstainers/occasional drinkers), the pooled relative risk (RR) was 0.72 (95% CI, 0.68-0.77) for the third highest category (median, 10 g/d), 0.81 (95% CI, 0.71-0.93) for the second highest category (median, 20 g/d), and 0.60 (95% CI, 0.54-0.67) for the highest category (median, 30 g/d). A J-shaped relationship between alcohol use and ACM was observed, and the nadir (RR, 0.82; 95% CI, 0.76-0.88) was found to be at a dose of 8 to 10 g of alcohol consumption per day.
Conclusion:
Findings of this meta-analysis suggest that low-to-moderate alcohol consumption was inversely significantly associated with the risk of CVD and ACM in patients with hypertension.
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... There are four additional meta-analyses with relevance to alcohol and CVD published after the NNR2012 (25)(26)(27)(28). They differ slightly concerning study designs and population characteristics. ...
... The review by Huang et al. included nine studies (11 cohorts) that focused on specific effects of alcohol consumption among hypertensive subjects (28). They assessed the effect of alcohol on CVD comprising both fatal and non-fatal MI, heart failure and stroke and ACM or total mortality in hypertensive subjects. ...
... The four additional meta-analyses added further support for a protective effect of alcohol on the risk of MI (25)(26)(27)(28). The findings are pointing at a potential causal protective association between light to moderate alcohol intake and coronary artery disease, but the pattern is influenced by socio-economic status, suggesting unmeasured confounding influence. ...
The objective of this scoping review is to evaluate the updated evidence on the consumption of alcohol and health outcomes regarded as relevant for the Nordic and Baltic countries, including cardiovascular disease, cancer, and all-cause mortality. It is based on the previous Nordic Nutrition Recommendations of 2012 and relevant papers published until 31 May 2021. Current evidence from mainly observational epidemiological studies suggests that regular, moderate alcohol consumption may confer protective effects against myocardial infarction (MI) and type 2 diabetes. Mendelian randomization analyses do not fully support these findings, possibly because these analyses may fail to identify low alcohol intake. For several cancers, it is not possible to set any safe limit. All-cause mortality is not increased with light to moderate alcohol intake in middle-aged and older adults who do not engage in binge drinking. Total abstinence is associated with the lowest risk of mortality in young adults. Observational studies on alcohol consumption are hampered by a number of inherent methodological issues such as ascertainment of alcohol intake, selection of appropriate exposure groups, and insufficient control of confounding variables, colliders, and mediators. It should also be emphasized that there is a socio-economic contribution to the alcohol-health axis with a stronger detrimental effect of alcohol in the lower social classes. The above issues contribute to the complexity of unravelling the causal web between alcohol, mediators, confounders, and health outcome.
... In addition, at which levels of alcohol consumption this threshold occurs and how strong the effects of alcohol consumption on MVD are may differ by background levels of oxidative stress (which are presumably higher in e.g. individuals with, versus without, a history of cardiovascular disease) [10][11][12] and by sex [13,14]. ...
... We tested for interaction by history of cardiovascular disease and sex. We a priori hypothesized that the shape of the association may differ between individuals with and without a history of cardiovascular disease [10][11][12] and between men and women [13,14]. We used a likelihood ratio test to test for interaction. ...
Background
Microvascular dysfunction (MVD) is an important contributor to major clinical disease such as stroke, dementia, depression, retinopathy, and chronic kidney disease. Alcohol consumption may be a determinant of MVD.
Objective
Main objectives were (1) to study whether alcohol consumption was associated with MVD as assessed in the brain, retina, skin, kidney and in the blood; and (2) to investigate whether associations differed by history of cardiovascular disease or sex.
Design
We used cross-sectional data from The Maastricht Study (N = 3,120 participants, 50.9% men, mean age 60 years, and 27.5% with type 2 diabetes [the latter oversampled by design]). We used regression analyses to study the association between total alcohol (per unit and in the categories, i.e. none, light, moderate, high) and MVD, where all measures of MVD were combined into a total MVD composite score (expressed in SD). We adjusted all associations for potential confounders; and tested for interaction by sex, and history of cardiovascular disease. Additionally we tested for interaction with glucose metabolism status.
Results
The association between total alcohol consumption and MVD was non-linear, i.e. J-shaped. Moderate versus light total alcohol consumption was significantly associated with less MVD, after full adjustment (beta [95% confidence interval], -0.10 [-0.19; -0.01]). The shape of the curve differed with sex (Pinteraction = 0.03), history of cardiovascular disease (Pinteraction < 0.001), and glucose metabolism status (Pinteraction = 0.02).
Conclusions
The present cross-sectional, population-based study found evidence that alcohol consumption may have an effect on MVD. Hence, although increasing alcohol consumption cannot be recommended as a policy, this study suggests that prevention of MVD may be possible through dietary interventions.
... Alcohol consumption is prevalent in vast populations [1,2]. Although many health effects of alcohol consumption or alcohol addiction, such as alcoholic liver, have been assessed [3][4][5][6][7], the impact on the absorption of a metal(loid) across the intestinal barrier, its entry into the bloodstream and organ sites (i.e., oral bioavailability), and its toxicity has rarely been investigated. ...
Alcohol consumption alters gut microflora and damages intestinal tight junction barriers, which may affect arsenic (As) oral bioavailability. In this study, mice were exposed to arsenate in the diet (6 μg/g) over a 3-week period and gavaged daily with Chinese liquor (0.05 or 0.10 mL per mouse per day). Following ingestion, 78.0% and 72.9% of the total As intake was absorbed and excreted via urine when co-exposed with liquor at daily doses of 0.05 or 0.10 mL, significantly greater than when As was supplied alone (44.7%). Alcohol co-exposure significantly altered gut microbiota but did not significantly alter As biotransformation in the intestinal tract or tissue. Significantly lower relative mRNA expression was observed for genes encoding for tight junctions in the ileum of liquor co-exposed mice, contributing to greater As bioavailability attributable to enhanced As absorption via the intestinal paracellular pathway. However, As concentration in the liver, kidney, and intestinal tissue of liquor-treated mice was decreased by 24.4%–42.6%, 27.5%–38.1%, and 28.1%–48.9% compared to control mice. This was likely due to greater renal glomerular filtration rate induced by alcohol, as suggested by significantly lower expression of genes encoding for renal tight junctions. In addition, in mice gavaged daily with 0.05 mL liquor, the serum antidiuretic hormone level was significantly lower than control mice (2.83 ± 0.59 vs. 5.40 ± 1.10 pg/mL), suggesting the diuretic function of alcohol consumption, which may facilitate As elimination via urine. These results highlight that alcohol consumption has a significant impact on the bioavailability and accumulation of As.
... 6,7 On the other hand, a meta-analysis has observed that low to moderate alcohol consumption is inversely and signicantly associated with the risk of cardiovascular disease and mortality in patients with SAH. 8 erefore, early detection and appropriate treatment are warranted, and control of SAH produce important individual and collective health and economic benets. Conventional treatment of its complications includes pharmacological therapy and costly interventions to contain the damage such as coronary revascularization surgery, carotid endarterectomy, or dialysis that consume government budgets. ...
... Generally, reduction of alcohol consumption for the prevention of hypertension is controversial [49][50][51]. Alcohol consumption in patients with hypertension is reportedly inversely associated with cardiovascular events and all-cause mortality [52]; our findings were inconsistent with this, possibly due to the assessment of alcohol consumption, the outcomes of interest, and the large proportion of Caucasian patients in our study. Overall, our results highlighted the importance of smoking cessation, a comparatively feasible and economical measure for promoting population health and reducing the disease burden. ...
Background
Cardiometabolic multimorbidity (CMM) is becoming increasingly common in patients with hypertension, and it is well established that healthy lifestyle plays a key role in the prevention of hypertension. However, the association between combined lifestyle factors and CMM in patients with hypertension is uncertain.
Methods
This prospective analysis included the data (obtained from the UK biobank) of participants with hypertension who did not have coronary heart disease (CHD), stroke, or diabetes. The outcome was the occurrence of CMM, defined as ≥ 1 disease of CHD, stroke, and diabetes that occurred in participants with hypertension. Four lifestyle factors (smoking, alcohol consumption, diet, and physical activity) were assessed using a weighted healthy lifestyle score, and participants were divided into four groups: the very unhealthy, unhealthy, healthy, and very healthy groups. The flexible parameter Royston-Parmar proportional hazard model was used to estimate hazard ratios (HRs) between lifestyles and CMM, as well as the difference in CMM-free life expectancy.
Results
During a median follow-up of 12.2 years, 9812 (18.4%) of the 53,397 hypertensive patients occurred CMM. Compared with the very unhealthy group, the very healthy group had a 41% reduction in the risk for CMM in hypertensive patients and a 32–50% reduction in the risk for specific cardiometabolic diseases such as CHD, stroke, and diabetes. For each lifestyle factor, non-smoking had the greatest protective effect against CMM (HR: 0.64, 95% confidence interval (CI) 0.60–0.68). A lifestyle combining multiple healthy factors extended CMM-free life expectancy (e.g., six years longer at age 45 years for participants in the very healthy group).
Conclusions
Combined healthy lifestyle factors were associated with a lower risk for CMM in hypertensive patients. This suggests that combined healthy lifestyle should be supported to decrease disease burden.
... In the present chapter, there was no increase in risk of mortality and subsequent events among patients with higher alcohol intake. This accords with the 2010 meta-analysis and another meta-analysis of hypertensive individuals [120,179], but contradicts some research reports from general populations [27,34]. The discordance between findings from the present chapter and those of general population studies may be partly explained by CVD patients' advancing age. ...
Moderate alcohol consumption has been reported to be cardio-protective among apparently healthy individuals, but it remains unclear if this association is also present in those with cardiovascular disease (CVD). Inconsistency exists across guidelines regarding the recommended drinking limits for CVD patients. This thesis consists of three studies aiming to better understand alcohol consumption in this patient population and its association with long-term prognosis. By pooling the results from de novo analyses of three cohorts and 12 published studies identified through a systematic review, meta-analyses of 48423 CVD patients (Study 1) found lower risk of mortality and subsequent cardiovascular events for an alcohol consumption up to 105 grams per week compared to current non-drinking. These effects, however, were significantly attenuated or absent after distinguishing former drinkers from non-drinkers. Meanwhile, little is known about the longitudinal dynamics of alcohol consumption in CVD patients and the associated health risks. With repeated-measures data from two cohorts (n=12502), Study 2 plotted CVD patients’ mean trajectory of weekly alcohol consumption as a function of time, centred on the date of diagnosis and spanning up to 30 years before and after the diagnosis. For male patients, mean consumption increased over time, peaked at eight years before diagnosis at 95 grams per week, and declined afterwards. A flatter trajectory was seen in female patients, which remained stable at around 30 grams per week and started to decline after diagnosis. In Study 3, alcohol consumption trajectory was further differentiated into six distinct groups in an inception cohort of 1306 patients with incident CVD and related to their subsequent mortality risk from all causes. Patients who consistently drank moderately (within 112 grams per week) had a similar risk of mortality as those who were continuous non-drinkers. While increases in risk were found among patients who stopped drinking compared to continuous moderate drinkers, former drinkers also had the worst self-rated health. Temporal variability in alcohol consumption highlights the importance of taking a longitudinal approach to examine alcohol health relations. Findings indicating protective effects of baseline moderate drinking in CVD patients may be largely explained by a referent group contaminated by less healthy former drinkers and are not seen when considering long-term drinking trajectories. This thesis provides novel knowledge about alcohol’s relation to cardiovascular health, which could be used to inform CVD patient care and low-risk drinking guidelines.
Alzheimer’s disease (AD) is the most common dementia disorder worldwide. At present, there are no effective treatment strategies to improve or prevent the development of the disease. Over the past few years, various cinnamon varieties and their bioactive ingredients have generated significant interest in cinnamon for the treatment of patients with mild to moderate AD by inhibiting tau protein aggregation and preventing amyloid formation. Therefore, in this chapter, we provide a large amount of comprehensive data on the interaction of cinnamon or cinnamon extracts with AD. In addition, we focused on the pathogenesis of AD and the effects of cinnamon on the AD pathway. Finally, we conducted a summative analysis of other natural plants with the potential to treat AD. In summary, this chapter mainly reviews the effects and potential mechanisms of cinnamon in the prevention and treatment of AD. On this basis, cinnamon is emphasized as an exciting new strategy for the treatment of neurodegenerative diseases. Of course, further studies at the molecular level and long-term clinical trials are needed to determine the safety and efficacy of different cinnamon cultivars in the treatment of AD.KeywordsPlant extractsCinnamon essential oilActive compoundsAizheimer’s diseaseNeurodegenerative diseasesAction mechanism
Document Reviewers
Luis Alcocer (Mexico), Christina Antza (Greece), Mustafa Arici (Turkey), Eduardo Barbosa (Brazil), Adel Berbari (Lebanon), Luís Bronze (Portugal), John Chalmers (Australia), Tine De Backer (Belgium), Alejandro de la Sierra (Spain), Kyriakos Dimitriadis (Greece), Dorota Drozdz (Poland), Béatrice Duly-Bouhanick (France), Brent M. Egan (USA), Serap Erdine (Turkey), Claudio Ferri (Italy), Slavomira Filipova (Slovak Republic), Anthony Heagerty (UK), Michael Hecht Olsen (Denmark), Dagmara Hering (Poland), Sang Hyun Ihm (South Korea), Uday Jadhav (India), Manolis Kallistratos (Greece), Kazuomi Kario (Japan), Vasilios Kotsis (Greece), Adi Leiba (Israel), Patricio López-Jaramillo (Colombia), Hans-Peter Marti (Norway), Terry McCormack (UK), Paolo Mulatero (Italy), Dike B. Ojji (Nigeria), Sungha Park (South Korea), Priit Pauklin (Estonia), Sabine Perl (Austria), Arman Postadzhian (Bulgaria), Aleksander Prejbisz (Poland), Venkata Ram (India), Ramiro Sanchez (Argentina), Markus Schlaich (Australia), Alta Schutte (Australia), Cristina Sierra (Spain), Sekib Sokolovic (Bosnia and Herzegovina), Jonas Spaak (Sweden), Dimitrios Terentes-Printzios (Greece), Bruno Trimarco (Italy), Thomas Unger (The Netherlands), Bert-Jan van den Born (The Netherlands), Anna Vachulova (Slovak Republic), Agostino Virdis (Italy), Jiguang Wang (China), Ulrich Wenzel (Germany), Paul Whelton (USA), Jiri Widimsky (Czech Republic), Jacek Wolf (Poland), Grégoire Wuerzner (Switzerland), Eugene Yang (USA), Yuqing Zhang (China).
Objectives:
The purposes of this study were to investigate the association between excessive alcohol consumption and control of hypertension and the associations stratified by sex, age, and duration of hypertension among Korean adults who were diagnosed with hypertension under medication.
Methods:
This study was cross-sectional design with a secondary data analysis using national data from the Korea National Health and Nutrition Evaluation Survey (KNHANES) collected from 2013 to 2018, including 4278 participants who were diagnosed with hypertension under medication. A multiple logistic regression analysis was conducted to evaluate the associations between excessive alcohol consumption and hypertension control while controlling for potential confounding variables.
Results:
The hypertensive patients who consumed excessive alcohol were more associated with uncontrolled hypertension (OR, 1.31; 95% CI, 1.04-1.65) than those who do not consumed excessive alcohol. Specially, Excessive consumption of alcohol in men and young adults (<65 years) and short duration of hypertension (<5 years) were significantly more associated with uncontrolled hypertension compared to their counterparts.
Discussion:
To improve blood pressure (BP) control in hypertensive patients, healthcare plan should be focused to modifiable risk factors and the intervention for unhealthy alcohol consumption should be part of comprehensive treatment for hypertension.
An umbrella review of meta-analyses was performed to summarize the evidence of associations between alcohol consumption and health outcomes and to assess its credibility. Meta-analyses of prospective cohort studies reporting the associations of alcohol consumption with health outcomes were identified. We recalculated the random-effects summary effect size and 95% confidence interval, heterogeneity, and small-study effect for each meta-analysis and graded the evidence. Fifty-nine publications reporting 224 meta-analyses of prospective cohort studies with 140 unique health outcomes were included, in which there were 49 beneficial associations and 25 harmful associations with nominally statistically significant summary results. But quality of evidence was rated high only for seven beneficial associations (renal cell carcinoma risk, dementia risk, colorectal cancer mortality, and all-cause mortality in patients with hypertension for low alcohol consumption; renal cell carcinoma risk, cardiovascular disease (CVD) risk in patients with hypertension and all-cause mortality in patients with hypertension for moderate consumption) and four harmful associations (cutaneous basal cell carcinoma risk for low alcohol consumption; cutaneous basal cell carcinoma risk and cutaneous squamous cell carcinoma risk for moderate alcohol consumption; hemorrhagic stroke risk for high alcohol consumption). In this umbrella review, only 11 health outcomes (5 in low alcohol consumption, 5 in moderate alcohol consumption and 1 in high alcohol consumption) with statistically significant showed high quality of epidemiologic evidence. More robust and larger prospective studies are needed to verify our results.
This paper presents a command, glst, for trend estimation across different exposure levels for either single or multiple summarized case-control, incidence-rate, and cumulative incidence data. This approach is based on constructing an approximate covariance estimate for the log relative risks and estimating a corrected linear trend using generalized least squares. For trend analysis of multiple studies, glst can estimate fixed- and random-effects metaregression models. Copyright 2006 by StataCorp LP.
Habitual light to moderate alcohol intake (up to 1 drink per day for women and 1 or 2 drinks per day for men) is associated with decreased risks for total mortality, coronary artery disease, diabetes mellitus, congestive heart failure, and stroke. However, higher levels of alcohol consumption are associated with increased cardiovascular risk. Indeed, behind only smoking and obesity, excessive alcohol consumption is the third leading cause of premature death in the United States. Heavy alcohol use (1) is one of the most common causes of reversible hypertension, (2) accounts for about one-third of all cases of nonischemic dilated cardiomyopathy, (3) is a frequent cause of atrial fibrillation, and (4) markedly increases risks of stroke—both ischemic and hemorrhagic. The risk-to-benefit ratio of drinking appears higher in younger individuals, who also have higher rates of excessive or binge drinking and more frequently have adverse consequences of acute intoxication (for example, accidents, violence, and social strife). In fact, among males aged 15 to 59 years, alcohol abuse is the leading risk factor for premature death. Of the various drinking patterns, daily low- to moderate-dose alcohol intake, ideally red wine before or during the evening meal, is associated with the strongest reduction in adverse cardiovascular outcomes. Health care professionals should not recommend alcohol to nondrinkers because of the paucity of randomized outcome data and the potential for problem drinking even among individuals at apparently low risk. The findings in this review were based on a literature search of PubMed for the 15-year period 1997 through 2012 using the search terms alcohol, ethanol, cardiovascular disease, coronary artery disease, heart failure, hypertension, stroke, and mortality. Studies were considered if they were deemed to be of high quality, objective, and methodologically sound.
Considerable controversy exists regarding the association between coffee consumption and cardiovascular disease (CVD) risk. A meta-analysis was performed to assess the dose-response relationship of long-term coffee consumption with CVD risk.
Pubmed and EMBASE were searched for prospective cohort studies of the relationship between coffee consumption and CVD risk, which included coronary heart disease, stroke, heart failure, and CVD mortality. Thirty-six studies were included with 1,279,804 participants and 36,352 CVD cases. A non-linear relationship of coffee consumption with CVD risk was identified (P for heterogeneity = 0.09, P for trend < 0.001, P for non-linearity < 0.001). Compared with the lowest category of coffee consumption (median: 0 cups/d), the relative risk of CVD was 0.95 (95% CI, 0.87 to 1.03) for the highest (median: 5 cups/d) category, 0.85 (0.80 to 0.90) for the second highest (median: 3.5 cups/d), and 0.89 (0.84 to 0.94) for the third highest category (median: 1.5 cups/d). Looking at separate outcomes, coffee consumption was non-linearly associated with both CHD (P for heterogeneity = 0.001, P for trend < 0.001, P for non-linearity < 0.001) and stroke risks (P for heterogeneity = 0.07, P for trend < 0.001, P for non-linearity< 0.001) (P for trend differences > 0.05).
A non-linear association between coffee consumption with CVD risk was observed in this meta-analysis. Moderate coffee consumption was inversely significantly associated with CVD risk, with the lowest CVD risk at 3 to 5 cups/d, and heavy coffee consumption was not associated with elevated CVD risk.