{"id":605,"date":"2015-02-20T11:00:33","date_gmt":"2015-02-20T11:00:33","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=605"},"modified":"2017-08-21T11:54:06","modified_gmt":"2017-08-21T11:54:06","slug":"primary-care-corner-with-geoffrey-modest-md-moderate-alcohol-and-cardioprotection","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/02\/20\/primary-care-corner-with-geoffrey-modest-md-moderate-alcohol-and-cardioprotection\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Moderate alcohol and cardioprotection????"},"content":{"rendered":"

By: Dr. Geoffrey Modest<\/strong><\/p>\n

\"alcohol\"I have been one of those occasionally\u00a0advocating small amounts of alcohol to some of my patients (ie, those with no personal or family\u00a0history of addictions \u00a0and who\u00a0were resistant to taking statins despite their increased cardiovascular risk) for several reasons. There have been\u00a0large meta-analyses (for example,\u00a0see\u00a0Ronksley P E et al. BMJ 2011;342:bmj.d671<\/strong> \u00a0— meta-analysis of 84 studies with 11 years followup) finding 25% decrease in CAD incidence and mortality\u00a0and 13% decrease in total mortality in moderate alcohol consumers. And, there was reasonable biological plausibility (reviewed by Brien, et al BMJ 2011) finding increased HDL, slightly\u00a0decreased LDL, increased apolipoprotein A1, decreased fibrinogen, and increased adiponectin (which is decreased in the\u00a0setting of insulin resistance\/diabetes and negatively correlates with insulin resistance) — all of which should decrease CAD. \u00a0There are many clinicians\u00a0strongly against our promoting a glass of wine with meals, partly because of the overall devastating effects of excessive alcohol intake (and that we as providers should not suggest a toxic chemical)\u00a0and partly because of very likely biases in the retrospective and uncontrolled\u00a0studies on moderate alcohol consumption. Some of these biases, for example, include the fact that “non-drinkers” in many of the studies\u00a0included\u00a0former\u00a0drinkers (who from several other studies have more depression and increased mortality than “never drinkers”); in addition, those who drink small amounts of wine with dinner might well take care of themselves better (healthier diet, more exercise, other factors??) than those who either drink much more or do not drink at all. In this light, a new BMJ article\u00a0found minimal benefit of alcohol\u00a0(see\u00a0BMJ 2015;350:h384<\/strong>).<\/p>\n

Details:<\/p>\n

–analyses were done of 10 waves of the Health Survey for England from\u00a01998-2008, in adults >50 yo\u200b.<\/p>\n

–the Health Survey is an annual cross sectional survey of the\u00a0non-institutionalized general English population, which included questions about self-reported average weekly alcohol consumption and consumption on the heaviest day in the past week. the survey assessed “former drinkers” as well as\u00a0“never drinkers”<\/p>\n

–all-cause mortality was\u00a0based on recorded\u00a0deaths, with prior\u00a0consent by the patient to link to the Health Survey database (n=18,368)<\/p>\n

Results:<\/p>\n

–controlling for age (their Model 1), weekly use and use on heaviest day were protective at all levels of consumption and in all age groups except\u00a0women 50-64 yo (where consumption of >20 units\/week was insignificant)<\/p>\n

–controlling for age, BMI, economic activity, education, ethnicity, country\u00a0region, marital status, smoking status, and social class (their Model 2), and not including “former drinkers”, the only groups\u00a0with protection from alcohol were\u00a0women\u00a0>65 yo\u00a0consuming <=10 units\/week or up to 3 units on their heaviest consumption day\u00a0as well as those who consumed at a frequency of <=2 drinking occasions\/month, and men 50-64 yo consuming 15-20 units\/week or drinking up to 1.5 units on their heaviest consumption day (though the magnitude of protection in men was “minimal”).<\/p>\n

So, this study adds to others which have found that when “former drinkers” are removed from the non-drinker category, the protective effect of alcohol is either attenuated or nullified.<\/p>\n

__<\/p>\n

Tim Naimi published an editorial in the journal Addiction, which argues strongly that moderate alcohol consumption should not be considered cardioprotective at this point and that we should not be recommending that patients drink (see doi:10.1111\/add.12828<\/strong>). He (and coauthors) cite impressive data from several Mandelian randomization studies (which decreases the likelihood of confounding) which seem to contradict a direct role of alcohol in decreasing both CAD biomarkers as well as several of the attributed \u201chealth-promoting\u201d effects of moderate alcohol (cardiac, but also cognitive function, blood pressure, and prenatal exposure with both balance and academic achievement in kids).<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Moderate alcohol and cardioprotection???? […]<\/p>\n

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