“Alcohol and cardiovascular disease”的意思、由来-开放百科全书

Excessive alcohol intake is associated with an elevated risk of alcoholic liver disease (ALD), heart failure, some cancers, and accidental injury, and is a leading cause of preventable death in industrialized countries.^[2] However, extensive research has shown that moderate alcohol intake is associated with health benefits, including less cardiovascular disease, diabetes, and hypertension.^[3]

An understanding of the inverse relationship between alcohol consumption and atherosclerosis was understood as early as 1904.^[4] The observation of a lower risk of cardiovascular disease (CVD) in France despite a diet rich in saturated fat was labeled the French Paradox.^[5] While much concerning this paradox remains unclear, some have suggested that the higher consumption of red wine in France results in lower CVD. Although the reduced incidence of CVD disease associated with moderate alcohol consumption is well established,^[6]^[7] many physicians have been wary of promoting the use of alcohol for this benefit considering the many negative effects of excessive alcohol consumption.

Possible mechanisms of alcohol cardioprotection

Extensive epidemiological studies have demonstrated the cardioprotective effect of alcohol consumption. However the mechanism by which this occurs is not fully understood. Research has suggested several possible mechanisms,^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]^[17] including the following.

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 itself.^[19]^[20]

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%".^[21]

Heart disease is the largest cause of mortality in the United States and many other countries. Therefore, some physicians have suggested that patients be informed of the potential health benefits of drinking alcohol in moderation, especially if they abstain and alcohol is not contraindicated. Others, however, argue against the practice in fear that it might lead to heavy or abusive alcohol consumption. Heavy drinking is associated with a number of health and safety problems.

Debate over research methods

Ex-drinkers versus never-drinkers

A logical possibility is that some 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. A paper concludes, "In this population of light to moderate drinkers, alcohol consumption in general was associated with decreased MI [myocardial infarction ] risk in women; however, episodic intoxication was related to a substantial increase in risk."^[21]

An analysis by Dr. Kaye Fillmore and colleagues failed to find significant support. Analyzing 54 prospective studies, the authors found that those studies which were free of the potential 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.^[22]

Dr. Arthur Klatsky noted that the flaw pointed out by Fillmore existed in one of his early studies of alcohol consumption, but that his later studies illustrating a protective effect of moderate alcohol consumption did not contain this flaw. 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.^[23]

This question of confusion of abstainers with previously heavy drinkers in epidemiologic studies is overcome with studies showing dose response effects. That is, higher amounts of alcohol consumption seem associated with greater cardiovascular benefit.^[7] Cardiology associations recommend that people who are currently nondrinkers should not start drinking alcohol.^[24]

Studies on possible confounding effects

Some have suggested the cardioprotective effects of alcohol consumption could be explained by confounding variables. For example, moderate drinkers might have more healthful lifestyles, higher economic status, better dietary habits, better healthcare, or higher educational levels, etc. However, when these and other factors are considered, the cardioprotective effects of alcohol are still evident.^[25]

Confirmation of Cardioprotection

Multiple studies on moderate alcohol consumption have now reconfirmed earlier suspected cardioprotection findings. A 2006 study concluded, "Even in men already at low risk on the basis of body mass index, physical activity, smoking, and diet, moderate alcohol intake is associated with lower risk for myocardial infarction."^[26] Another study found that when men increased their alcohol intake from very low to moderate, they significantly reduced their risk of coronary heart disease. The study monitored the health of 18,455 males for a period of seven years.^[27] A multicenter randomized diet study published in 2013 included over 7000 persons at risk to develop cardiovascular disease, and found that a Mediterranean-diet, including an encouragement to daily wine consumption in habitual drinkers, led to decreased cardiovascular events by about 30%. The study was halted prematurely since the health benefits were so dramatic.^[28] Controverse over their randomization lead to a retraction.^[29]

See also

References

1. ^{{cite book |author =World Health Organization |title=Global Status Report on Alcohol 2004 |location=Geneva |year=2004 |isbn=978-92-4-156272-0 |url=http://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf}}
2. ^{{cite journal | author = Centers for Disease Control and Prevention (CDC) | title = Alcohol-attributable deaths and years of potential life lost--United States, 2001 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 53 | issue = 37 | pages = 866–70 | date = September 2004 | pmid = 15385917 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5337a2.htm }}
3. ^{{cite journal | vauthors = O'Keefe JH, Bybee KA, Lavie CJ | title = Alcohol and cardiovascular health: the razor-sharp double-edged sword | journal = Journal of the American College of Cardiology | volume = 50 | issue = 11 | pages = 1009–14 | date = September 2007 | pmid = 17825708 | doi = 10.1016/j.jacc.2007.04.089 }}
4. ^{{cite journal |author =Cabot, R.C. |title=The relation of alcohol to arterioscleroisis |journal=Journal of the American Medical Association |year=1904 |volume=43 |issue=12 |pages=774–775| doi = 10.1001/jama.1904.92500120002a }}
5. ^{{cite journal | vauthors = Simini B | title = Serge Renaud: from French paradox to Cretan miracle | journal = Lancet | volume = 355 | issue = 9197 | pages = 48 | date = January 2000 | pmid = 10615898 | doi = 10.1016/S0140-6736(05)71990-5 }}
6. ^{{cite journal | vauthors = Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA | title = Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis | journal = BMJ | volume = 342 | issue = feb22 1 | pages = d671 | date = February 2011 | pmid = 21343207 | pmc = 3043109 | doi = 10.1136/bmj.d671 }}
7. ^¹{{cite journal | vauthors = Tolstrup J, Jensen MK, Tjønneland A, Overvad K, Mukamal KJ, Grønbaek M | title = Prospective study of alcohol drinking patterns and coronary heart disease in women and men | journal = BMJ | volume = 332 | issue = 7552 | pages = 1244–8 | date = May 2006 | pmid = 16672312 | pmc = 1471902 | doi = 10.1136/bmj.38831.503113.7c }}
8. ^{{cite journal | vauthors = Davidson DM | title = Cardiovascular effects of alcohol | journal = The Western Journal of Medicine | volume = 151 | issue = 4 | pages = 430–9 | date = October 1989 | pmid = 2686174 | pmc = 1026830 }}
9. ^{{cite journal | vauthors = Facchini F, Chen YD, Reaven GM | title = Light-to-moderate alcohol intake is associated with enhanced insulin sensitivity | journal = Diabetes Care | volume = 17 | issue = 2 | pages = 115–9 | date = February 1994 | pmid = 7907975 | doi = 10.2337/diacare.17.2.115 }}
10. ^{{cite journal | vauthors = Langer RD, Criqui MH, Reed DM | title = Lipoproteins and blood pressure as biological pathways for effect of moderate alcohol consumption on coronary heart disease | journal = Circulation | volume = 85 | issue = 3 | pages = 910–5 | date = March 1992 | pmid = 1537127 | doi = 10.1161/01.cir.85.3.910 }}
11. ^{{cite journal | vauthors = Mennen LI, Balkau B, Vol S, Cacès E, Eschwège E | title = Fibrinogen: a possible link between alcohol consumption and cardiovascular disease? DESIR Study Group | journal = Arteriosclerosis, Thrombosis, and Vascular Biology | volume = 19 | issue = 4 | pages = 887–92 | date = April 1999 | pmid = 10195914 | doi = 10.1161/01.atv.19.4.887 }}
12. ^{{cite journal | vauthors = Paassilta M, Kervinen K, Rantala AO, Savolainen MJ, Lilja M, Reunanen A, Kesäniemi YA | title = Social alcohol consumption and low Lp(a) lipoprotein concentrations in middle aged Finnish men: population based study | journal = BMJ | volume = 316 | issue = 7131 | pages = 594–5 | date = February 1998 | pmid = 9518912 | pmc = 28464 | doi = 10.1136/bmj.316.7131.594 }}
13. ^{{cite journal | vauthors = Rimm EB, Williams P, Fosher K, Criqui M, Stampfer MJ | title = Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors | journal = BMJ | volume = 319 | issue = 7224 | pages = 1523–8 | date = December 1999 | pmid = 10591709 | pmc = 28294 | doi = 10.1136/bmj.319.7224.1523 }}
14. ^{{cite journal | vauthors = Thun MJ, Peto R, Lopez AD, Monaco JH, Henley SJ, Heath CW, Doll R | title = Alcohol consumption and mortality among middle-aged and elderly U.S. adults | journal = The New England Journal of Medicine | volume = 337 | issue = 24 | pages = 1705–14 | date = December 1997 | pmid = 9392695 | doi = 10.1056/NEJM199712113372401 }}
15. ^{{cite journal | vauthors = Zhang QH, Das K, Siddiqui S, Myers AK | title = Effects of acute, moderate ethanol consumption on human platelet aggregation in platelet-rich plasma and whole blood | journal = Alcoholism, Clinical and Experimental Research | volume = 24 | issue = 4 | pages = 528–34 | date = April 2000 | pmid = 10798590 | doi = 10.1111/j.1530-0277.2000.tb02021.x }}
16. ^{{cite journal | vauthors = Wang Z, Barker TH, Fuller GM | title = Alcohol at moderate levels decreases fibrinogen expression in vivo and in vitro | journal = Alcoholism, Clinical and Experimental Research | volume = 23 | issue = 12 | pages = 1927–32 | date = December 1999 | pmid = 10630612 | doi = 10.1111/j.1530-0277.1999.tb04093.x }}
17. ^{{cite journal | vauthors = Steinberg D, Pearson TA, Kuller LH | title = Alcohol and atherosclerosis | journal = Annals of Internal Medicine | volume = 114 | issue = 11 | pages = 967–76 | date = June 1991 | pmid = 2024865 | doi = 10.7326/0003-4819-114-11-967 }}
18. ^{{cite journal | vauthors = Mukamal KJ, Mackey RH, Kuller LH, Tracy RP, Kronmal RA, Mittleman MA, Siscovick DS | title = Alcohol consumption and lipoprotein subclasses in older adults | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 92 | issue = 7 | pages = 2559–66 | date = July 2007 | pmid = 17440017 | doi = 10.1210/jc.2006-2422 }}
19. ^{{cite journal | vauthors = Rimm EB, Klatsky A, Grobbee D, Stampfer MJ | title = Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits | journal = BMJ | volume = 312 | issue = 7033 | pages = 731–6 | date = March 1996 | pmid = 8605457 | pmc = 2350477 | doi = 10.1136/bmj.312.7033.731 }}
20. ^{{cite journal | vauthors = Barefoot JC, Grønbaek M, Feaganes JR, McPherson RS, Williams RB, Siegler IC | title = Alcoholic beverage preference, diet, and health habits in the UNC Alumni Heart Study | journal = The American Journal of Clinical Nutrition | volume = 76 | issue = 2 | pages = 466–72 | date = August 2002 | pmid = 12145024 | doi = 10.1093/ajcn/76.2.466 }}
21. ^{{cite journal | vauthors = Dorn JM, Hovey K, Williams BA, Freudenheim JL, Russell M, Nochajski TH, Trevisan M | title = Alcohol drinking pattern and non-fatal myocardial infarction in women | journal = Addiction | volume = 102 | issue = 5 | pages = 730–9 | date = May 2007 | pmid = 17506150 | doi = 10.1111/j.1360-0443.2007.01765.x }}
22. ^{{cite journal |vauthors=Fillmore KM, Kerr WC, Stockwell T, Chikritzhs T, Bostrom A |title=Moderate alcohol use and reduced mortality risk: Systematic error in prospective studies |journal=Addict Res Theory |volume=14 |issue=2 |pages=101–132 |date=April 2006 |doi=10.1080/16066350500497983 }}
23. ^{{cite news |url=http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/03/30/MNGMTI0B3U1.DTL |title=UCSF points out flaw in studies tying alcohol to heart health | work=The San Francisco Chronicle | first=Sabin | last=Russell | date=2010-08-28}}
24. ^{{cite web |url=https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/alcohol-and-heart-health |title=Alcohol and Heart Health |publisher=American Heart Association |date=August 15, 2014 }}
25. ^¹{{cite journal |last1=Pearson |first1=Thomas A. |title=Alcohol and Heart Disease |journal=Circulation |date=December 1996 |volume=94 |issue=11 |pages=3023–3025 |doi=10.1161/01.cir.94.11.3023 }}
26. ^{{cite journal | vauthors = Mukamal KJ, Chiuve SE, Rimm EB | title = Alcohol consumption and risk for coronary heart disease in men with healthy lifestyles | journal = Archives of Internal Medicine | volume = 166 | issue = 19 | pages = 2145–50 | date = October 2006 | pmid = 17060546 | doi = 10.1001/archinte.166.19.2145 }}
27. ^{{cite journal | vauthors = Sesso HD, Stampfer MJ, Rosner B, Hennekens CH, Manson JE, Gaziano JM | title = Seven-year changes in alcohol consumption and subsequent risk of cardiovascular disease in men | journal = Archives of Internal Medicine | volume = 160 | issue = 17 | pages = 2605–12 | date = September 2000 | pmid = 10999974 | doi = 10.1001/archinte.160.17.2605 }}
28. ^{{cite journal | vauthors = Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA | display-authors = 6 | title = Primary prevention of cardiovascular disease with a Mediterranean diet | journal = The New England Journal of Medicine | volume = 368 | issue = 14 | pages = 1279–90 | date = April 2013 | pmid = 23432189 | doi = 10.1056/NEJMoa1200303 }}
29. ^{{cite journal | vauthors = Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA | display-authors = 6 | title = Retraction and Republication: Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl J Med 2013;368:1279-90 | journal = The New England Journal of Medicine | volume = 378 | issue = 25 | pages = 2441–2442 | date = June 2018 | pmid = 29897867 | doi = 10.1056/NEJMc1806491 }}