Talk:Alcohol and cardiovascular disease

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Thank you.David Justin 16:16, 12 January 2006 (UTC)

Please see Wikipedia:Cite sources. Also, we should consider merging this into Alcohol and health. Kaisershatner 19:41, 30 January 2006 (UTC)

1 Fillmore's meta-analysis
2 Source
3 Source information
4 Important
5 Documentation
6 Debate over research methods
- 6.1 Ex-drinkers versus never-drinkers
- 6.2 Other factors
7 Possible mechanisms of any benefit

[edit] Fillmore's meta-analysis

The following paper was widely cited in the non-scientific press:

Kaye Fillmore et al. "Moderate alcohol use and reduced mortality risk: systematic error in prospective studies." Addiction Research and Theory. Advanced online publication March 30, 2006.

This paper claims that the conclusions were distorted by people who had to abstain from alcohol because of health problems. This seems to disagree with the statement on the article page that the effect remains if one filters for such effects. Maybe someone knowledgeable could say a few words about this. Han-Kwang, 23 April 2006

Actually the Fillmore paper suggests that the conclusions of a causal relationship between the moderate consumption of alcohol and reduced mortality *may* have been distorted because of the non-disaggregation issue in some studies. Unfortunately, Fillmore's analysis omitted a number of important studies, omitted all non-prospective studies, and did not address the fact that many of the physiological mechanisms whereby alcohol leads to improved cardiovascular health and dramatically reduced mortality are now documented and understood. In short, the paper only looks at a part of the total picture.Medical Man 15:50, 23 April 2006 (UTC)

Yes, but it looks at the most important part. The Fillmore paper, now published in Addiction Research & Theory, 14(2) 2006. 101-132, looks at prospective studies (always considered a better research design than retrospective, though typically much more expensive to conduct) specifically to determine if patients had been misclassified as abstainers but really had reduced or stopped previous drinking patterns. Upon analyzing the resulting data, taking into consideration 54 published studies, the authors found that the studies judged to be error-free did not demonstrate significant cardiac protection from alcohol. I'll update the entry. Drgitlow 19:52, 4 July 2006 (UTC)

[edit] Source

Hi Wham- Please note that I created this page (Alcohol and cardiovascular disease) on 30-9-05 using Alcohol and Health as the Source. Therefore, it is not spam. Thanks. David Justin 14:53, 7 March 2007 (UTC)on 30-9-05

[edit] Source information

[edit] Important

[edit] Documentation

Hi Wham- Please note that the materials in bold in the following Wikipedia entry are from “Alcohol and Health” and “Alcohol Protective Against Coronary Heart Disease (CHD).”

The evidence demonstrates that the entry was sourced from those web pages, and indicating that fact does not constitute spam. To the contrary, it is proper documentation and consistent with Wikipedia guidelines. Thanks.David Justin 00:55, 19 March 2007 (UTC)

The subject of alcohol and heart attacks is important because the major cause of death in many countries is heart disease.

Research indicates that moderate drinkers are less likely to suffer heart attacks than are abstainers or heavy drinkers^[1] (Anani et al.; Gaziano et al.; Manson et al‘’’; Mulcamel et al.; National Institute on Alcohol Abuse and Alcoholism; Rimm et al.; Sesso et al.; Simons et al.; Walsh et al.). The first scientific study of the relationship between alcohol consumption and atherosclerosis was published in the Journal of the American Medical Association in 1904^[2]. Public awareness of the French Paradox in the early 1990s stimulated increased interest in the subject of alcohol and heart disease.

An exhaustive review of all major heart disease studies has found that "alcohol consumption is related to total mortality in a U-shaped manner, where moderate consumers have a reduced total mortality compared with total non-consumers and heavy consumers"(La Porte et al .). Research also reportsthat the risk of a heart attack among moderate drinkers with diabetes is 52 percent lower than among nondrinkers and that the risk of dying in the four years after a heart attack is 32 percent lower among those who were moderate drinkers in the year before the attack (Beulens et al.).

[edit] Debate over research methods

[edit] Ex-drinkers versus never-drinkers

A logical possibility is that many of the alcohol abstainers in research studies previously drank excessively and had undermined their health, thus explaining their high levels of risk. To test this hypothesis, some studies have excluded all but those who had avoided alcohol for their entire lives. The conclusion remained the same in some studies: moderate drinkers are less likely to suffer heart disease.^[3] More recently, however, Fillmore et al failed to find significant support: analyzing 54 prospective studies, the authors found that those studies which were free of the error (including former drinkers in the abstaining group) did not demonstrate significant cardiac protection from alcohol, although they continued to exhibit a J-shaped relationship in which moderate drinkers were less likely (but not at a statistically significantly level of confidence) to suffer cardiac disease than lifelong abstainers (Addiction Research & Theory, 14(2) 2006. 101-132). The sociologist says research is needed that looks at the reasons people abstain, which hers did not do. Cardiologist Dr. Arthur Klatsky notes that Fillmore’s study, which she freely acknowledges proves nothing but only raises questions, is itself seriously flawed. To overcome the inherent weaknesses of all epidemiological studies, even when properly conducted, he calls for a randomized trial in which some subjects are assigned to abstain while others are assigned to drink alcohol in moderation and the health of all is monitored for a period of years [1]

[edit] Other factors

Another possibility is that moderate drinkers have more healthful lifestyles (making them healthier), higher economic status (giving them greater access to better foods or better healthcare), higher educational levels (causing them to be more aware of disease symptoms), etc. However, when these and other factors are considered, the conclusion again remains the same: moderate drinkers are less likely to suffer heart disease.^[4]

[edit] Possible mechanisms of any benefit

Given the epidemiological evidence that moderate drinking reduces heart disease, it becomes important to examine how alcohol might confer its cardiovascular benefits. Can alcohol’s protective affects be explained physiologically? Research suggests that moderate consumption of alcohol improves cardiovascular health in a number of ways^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14] (Facchini et al), including the following.

I. Alcohol improves blood lipid profile. A. It increases HDL ("good") cholesterol. B. It decreases LDL ("bad") cholesterol.

II. Alcohol decreases thrombosis (blood clotting). A. It reduces platelet aggregation. B. It reduces fibrinogen (a blood clotter). C. It increases fibrinolysis (the process by which clots dissolve).

III. Alcohol acts through additional ways. A. It reduces coronary artery spasm in response to stress. B. It increases coronary blood flow. C. It reduces blood pressure. D. It reduces blood insulin level. E. 'It increases estrogen levels.

There is a lack of medical consensus about whether moderate consumption of beer, wine, or distilled spirits has a stronger association with heart disease. Studies suggest that each is effective, with none having a clear advantage. Most researchers now believe that the most important ingredient is the alcohol itselfCite error 2; Invalid <ref> tag; refs with no content must have a name (Barefoot et al.).

The American Heart Association has reported that "More than a dozen prospective studies have demonstrated a consistent, strong, dose-response relation between increasing alcohol consumption and decreasing incidence of CHD (coronary heart disease). The data are similar in men and women in a number of different geographic and ethnic groups. Consumption of one or two drinks per day is associated with a reduction in risk of approximately 30% to 50%"^[15]

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