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Alcohol and Health TABLE OF CONTENTS Alcohol and Health: Current Evidence ALCOHOL AND HEALTH MARCH-APRIL 2005 OUTCOMES Does Alcohol Consumption Increase the Risk of Ischemic ALCOHOL AND HEALTH OUTCOMES Stroke?, 1 Alcohol May Increase Oral Mu- Does Alcohol Consumption Increase the Risk of Ischemic Stroke? cosal Transmission of HIV, 1 Prior studies of the association between alco- beverage types did not significantly Alcohol Intake, Survival, and hol consumption and ischemic stroke have affect risk. Quality of Life, 2 produced inconsistent results and have limita- • The risk of ischemic stroke was low- tions. To address these issues, researchers est, though not statistically significant, Does Alcohol Consumption assessed alcohol intake and prevalence of inci- in people who consumed 1–2 drinks Decrease the Risk of Coronary dent ischemic stroke (412 cases identified) in on 3–4 days each week (RR 0.7 com- Artery Calcification?, 2 38,156 male health professionals, aged 40–75 pared with those who abstained). years, over a 14-year period. Comments: Although this study reported • In analyses adjusted for potential con- some benefit from red wine use, its clearest founders, the risk of ischemic stroke finding was the increase in risk of ischemic INTERVENTIONS among drinkers versus that of nondrinkers stroke with increasing alcohol consumption, increased as alcohol consumption in- starting at 1–2 drinks per day. The com- Disulfiram or Naltrexone for creased (relative risk [RR] 1.0 for <1 drink plexities associated with beverage type and Alcohol Dependence?, 3 per day, RR 1.3 for 1–2 drinks per day, pattern of use, as indicated in these findings, and RR 1.4 for >2 drinks per day, P=0.01 highlight the challenge in making recom- Talking About Alcohol in Pri- for trend). These findings were not signifi- mendations about safer drinking. mary Care: Do Patients Find It cant when analyses were adjusted for hy- Kevin L. Kraemer, MD, MSc Useful?, 3 pertension. • In analyses adjusted for beverage type, the Reference: Mukamal KJ, et al. Alcohol and Brief Alcohol Intervention: risk of ischemic stroke decreased with risk for ischemic stroke in men: the role of Prolonged Benefits?, 3 increasing red wine use, compared with drinking patterns and usual beverage. Ann no red wine use (P=0.02 for trend). This Intern Med. 2005;142(1):11–19. Primary Medical Care Im- finding was not significant when analyses proves Addictive Problems, 4 also adjusted for hypertension. Other SPECIAL POPULATIONS Alcohol May Increase Oral Mucosal Transmission of HIV Older Adults Often Exceed The HIV virus can infect oral mucosal cells. A cell colonies infected) than did POEs not Alcohol Consumption Limits, 4 number of variables determine the likelihood exposed to ethanol. In addition, treated Moderate Alcohol Intake and of infection, such as viral load and host defense POEs had increased HIV RNA levels. mechanisms. To examine whether alcohol Cognitive Decline in Elderly weakens these defenses and facilitates trans- Comments: This in vitro study suggests that Women, 5 mission, researchers measured the effects of alcohol may play a role in oral HIV trans- various concentrations of ethanol (0%–4%) on mission. These results from the laboratory Adolescent Drinking Portends the efficiency of infection of oral epithelial cells may prove useful when counseling patients Early Adult Harms, 5 with HIV. about the risks of oral sex. Joseph Conigliaro, MD, MPH Alcohol, Adolescents, and Brain Primary oral epithelial cells (POEs) treated Damage, 6 with 4% ethanol—similar to the concentration Reference: Zheng J, et al. Ethanol stimula- of alcohol found in most beers—had a 3- to 6- tion of HIV infection of oral epithelial cells. fold higher susceptibility of infection (i.e., more JAIDS. 2004;37(4):1445–1453. Alcohol and Health: Current Evidence is a project of the Boston Medical Center, supported by the National Institute on Alcohol Abuse and Alcoholism, and produced in cooperation with the Boston University Schools of Medicine and Public Health. PAGE 2 Alcohol Intake, Survival, and Quality of Life To determine the relationship between mid- worse among heavy drinkers in ad- Editorial Board life alcohol consumption and later quality of justed analyses that accounted for life and mortality, researchers in Finland deaths during follow-up. Editor collected clinical and questionnaire data from • Nondrinkers did not differ significantly Richard Saitz, MD, MPH, FASAM, FACP 1808 healthy male executives (aged 40–55 from moderate drinkers on mortality Associate Professor of Medicine & Epidemiology years at baseline) and reassessed them at or quality of life. Director, Clinical Addiction Research & Education Unit various intervals over 29 years. Section of General Internal Medicine Comments: While the poorer outcomes Boston Medical Center • A significantly greater proportion of experienced by heavy drinkers are not sur- Boston University Schools of Medicine & Public Health heavy drinkers (consumed >349 g of prising, the lack of differences between alcohol per week) than moderate drink- nondrinkers and moderate drinkers in this Co-Editor ers (consumed 1–349 g per week) or population of high socioeconomic status is R. Curtis Ellison, MD nondrinkers died (38%, 25%, and 27%, notable. Unfortunately, this study has sev- Professor of Medicine & Public Health respectively). eral substantial limitations, including not Chief, Section of Preventive Medicine & Epidemiology • In analyses adjusted for age, smoking, adequately adjusting for potential confound- Evans Department of Medicine cholesterol, and glucose levels, heavy ers and defining moderate drinking broadly Director, Institute on Lifestyle & Health drinkers (compared with moderate (e.g., included amounts often considered as Boston University School of Medicine drinkers) had a borderline significant heavy drinking). Nonetheless, future studies increased risk of death from all causes investigating how social factors, like socio- Associate Editors (hazard ratio [HR] 1.3) and a signifi- economic status, may influence drinking Joseph Conigliaro, MD, MPH, FACP cantly greater risk of noncardiovascular, outcomes should be encouraged. R. Curtis Ellison, MD Associate Professor of Medicine & Epidemiology noncancer, and nonviolent deaths (HR Director, Substance Abuse Assessment Team 2.8). Section of General Internal Medicine • Alcohol consumption was not signifi- Reference: Strandberg AY, et al. Alcohol VA Pittsburgh Healthcare System cantly associated with quality of life consumption, 29-y total mortality, and University of Pittsburgh Schools of Medicine & Public (determined by the RAND 36, a vali- quality of life in men. Am J Clin Nutr. Health dated survey measure) at follow-up 2004;80(5):1366–1371. among survivors. However, it was Peter D. Friedmann, MD, MPH Associate Professor of Medicine & Community Health Division of General Internal Medicine Does Alcohol Consumption Decrease the Risk of Coronary Artery Calcification? Rhode Island Hospital Decreased coronary atherosclerosis is one compared with those who did not Brown Medical School possible mechanism to explain the lower drink liquor rates of coronary artery disease (CAD) out- Kevin L. Kraemer, MD, MSc comes observed in light-to-moderate drink- Results did not differ between men and Associate Professor of Medicine & Health Policy & ers. To study this further, researchers meas- women. Management ured coronary artery calcification (using Director, General Internal Medicine Fellowship Program electron beam computed tomography) and Comments: According to this study, light- Division of General Internal Medicine University of Pittsburgh Schools of Medicine & Public alcohol consumption in 1795 adults aged 55 to-moderate alcohol consumption de- Health and older without known CAD. creases odds of extensive coronary calcifi- cation in a population of asymptomatic Jeffrey H. Samet, MD, MA, MPH In analyses controlling for various cardiovas- adults. This finding suggests a lower burden cular risk factors, the odds of extensive of coronary atherosclerosis in light-to- Professor of Medicine & Public Health Chief, Section of General Internal Medicine coronary calcification (calcium score of moderate drinkers and is consistent with Boston Medical Center >=400, a score associated with proven current public health recommendations on Boston University Schools of Medicine & Public Health CAD) were significantly lower in people who lower-risk drinking. The influence of longi- consumed the following: tudinal changes in drinking patterns and of Managing Editor • <1 drink per day (odds ratio [OR] 0.5) heavy drinking on coronary calcification or 1–2 drinks per day (OR 0.4) com- was not ascertained. Rosanne T. Guerriero, MPH pared with those who did not drink Kevin L. Kraemer, MD, MSc Boston Medical Center • <1 drink of wine per day (OR 0.7) or 1– Boston University Schools of Medicine & Public Health Reference: Vliegenthart R, et al. Alcohol 2 drinks of wine per day (OR 0.5) com- pared with those who did not drink consumption and coronary calcification in a wine general population. Arch Int Med. • <1 drink of liquor per day (OR 0.6) 2004;164(21):2355–2360. Alcohol and Health: Current Evidence, March-April 2005 PAGE 3 INTERVENTIONS Disulfiram or Naltrexone for Alcohol Dependence? Both disulfiram and naltrexone have proven efficacy for treating Patients in the naltrexone group had less craving. alcohol dependence. However, few studies have compared these treatments. In an open-label trial, researchers in India randomized Comments: The primary limitations
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