Novartis Foundation Symposium 216 - Alcohol and Cardiovascular Diseases

280 Pages·1998·9.15 MB·English

ALCOHOL AND
CARDIOVASCULAR
DISEASES
The Novartis Foundation is an international scientific and educational
charity (UK Registered Charity No. 313574). Known until September 1997
as the Ciba Foundation, it was established in 1947 by the CIBA company
of Bask, which merged with Sandoz in 1996, to form Novartis. The
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Novartis Foundation Symposium 216
ALCOHOL A N D
CARDIOVASCULAR
DISEASES
1998
JOHN WILEY & SONS
Chichester New York Weinheim Brisbane . Singapore . Toronto
' ,
Copyright 0 Novartis Foundation 1998
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Novartis Foundation Symposium 216
viii+272 pages, 25 figures, 30 tables
I-ibrav ojcongress Cataloging-in-Pu~ficationD ata
Alcohol and cardiovascular diseases / [editors, Derek J. Chadwick
(organizer) and Jamie A. Goode].
p. cm. (Novartis Foundation symposium ;2 16)
-
“Symposium on Alcohol and Cardiovascular Diseases, held at the
Novartis Foundation, London, 7-9 October 1997”-CIP intro.
Includes bibliographical references and index.
ISBN 0-471-97769-1 (hardcover : alk. paper)
1. Heart-Pathophysiology -Congresses. 2. Alcohol -Physiological
effect- Congresses. 3. Alcohol-Pathophysiology -Congresses.
I. Chadwick, Derek. 11. Goode, Jamie. 111. Symposium on Alcohol
and Cardiovascular Diseases (1997 : London) IV Series.
RC6829A42 1998 98-27198
616.1’071-dc21 CIP
British Librav Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 0 471 97769 1
Typeset in 10% on 122 pt Garamond by DobbieTypesetting Limited, Tavistock, Devon.
Printed and bound in Great Britain by Biddles Ltd, Guildford and King’s Lynn.
This book is printed on acid-free paper responsibly manufactured from sustainable forestry,
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Contents
Jjmposium on Alcoholand cardiovasculardiseases,h eld at the Novartis Foundation, London,
7-9 October 1997
Editors: Derek J. Chadwick (OFaniyed and Jamie A. Goode
Thiss_ymposiumi s basedon aproposalmade Gerv Shaper
T. J. Peters Chairman’s introduction 1
A. L. Klatsky Alcohol and cardiovascular diseases: a historical overview 2
Discussion 12
T. J. Peters and \ R. Preedy Metabolic consequences of alcohol ingestion 19
Discussion 24
P. J. Richardson,\ B. Pate1 and \ R. Preedy Alcohol and the myocardium 35
Discussion 45
I. B. Puddey, K. D. Croft, R. Abu-Amsha Caccetta and L. J. Beilin
Alcohol, free radicals and antioxidants 51
Discussion 63
M. Kupari and P. Koskinen Alcohol, cardiac arrhythmias and sudden death 68
Discussion 79
J. M. Gaziano and J. E. Buring Alcohol intake, lipids and risks of myocardial
infarction 86
Discussion 95
H. F. J. Hendriks and M. S. van der Gaag Alcohol, coagulation and
fibrinolysis 111
Discussion 120
U. Keil, A. Liese, B. Filipiak, J. D. Swales and D. E. Grobbee Alcohol, blood
pressure and hypertension 125
Discussion 144
V
vi CONTENTS
General discussion Alcohol and coagulation 152
Alcohol and stress 153
Randomized controlled trials and alcohol 154
M. H. Criqui Do known cardiovascular risk factors mediate the effect
of alcohol on cardiovascular disease? 159
Discussion 167
A. G. Shaper and S. G.Wannamethee The J-shaped curve and changes
in drinking habit 173
Discussion 188
M. Hillbom, S. Juvela and V. Karttunen Mechanisms of alcohol-related
strokes 193
Discussion 204
S. Renaud and R. Gueguen The French paradox and wine drinking 208
Discussion 217
J. Rehm and S. Bondy Alcohol and all-cause mortality: an overview 223
Discussion 232
P. Anderson Alcohol, cardiovascular diseases and public health policy 237
Discussion 248
T. J. Peters Chairman’s summing-up 258
Index of contributors 261
Subject index 263
Participants
Peter Anderson Lifestyles and Health Unit, World Health Organization, Regional
Office for Europe, 8 Scherfigsvej, Copenhagen DK2100, Denmark
Susan J. Bondy (Novartis Foundation Bursar) Addiction Research Foundation,
33 Russell Street, Toronto, Ontario, Canada M5S 2S1
Michael H. Criqui University of California, San Diego, Department of Family &
Preventive Medicine, Clinical Sciences Building, Rm 349,9500 Gilman Drive,
La Jolla, CA 92093-0607, USA
Gin0 Farchi Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore
di Sanith, 00161 Rome, Italy
Michael Farrell Addiction Resource Unit, 6565 Denmark Hill, Camberwell,
London SE5 8RS, UK
Kaye Fillmore Department of Social and Behavioral Science, UCSF, Box 0646,
Laurel Heights, San Francisco, CA 94143-0646, USA
J. Michael Gaziano Veterans Affairs Medical Center, Harvard Medical School,
1440 VFW Parkway,West Roxbury, MA 02132, USA
Philip B. Gorelick Center for Stroke Research, 1645 West Jackson Blvd, Suite 400,
Chicago, IL 60612, USA
Morten Grenbaek Copenhagen Center for Prospective Population Studies,
Danish Epidemiology Science Centre at the Institute of Preventive Medicine,
Copenhagen University Hospital, DK-1399 Copenhagen K, Denmark
Henk F. J. Hendriks TNO Nutrition and Food Research Institute, P 0 Box 360,
3700 AJ Zeist,The Netherlands
Matti Hillbom Department of Neurology, University of Oulu, University Central
Hospital of Oulu, Kajaanintie 50, SF-90220 Oulu, Finland
vii
viii PARTICIPANTS
John F. KeaneyJ r. Boston University School of Medicine,W hitaker Cardiovascular
Institute,W 507,80E Concord Street, Boston, MA 02118, USA
Ulrich Keil Institute of Epidemiology and Social Medicine, University of Munster,
Domagkstr. 3, Munster, D-48129, Germany
Arthur L. Klatsky Kaiser Permanente Medical Center, 280 West MacArthur
Boulevard, Oakland, CA 94611, USA
Marrku Kupari Division of Cardiology, Department of Medicine, Helsinki
University Central Hospital, 00290 Helsinki, Finland
Michael G. Marmot International Centre for Health and Society, University
College London, 1-19 Torrington Place, London WClE BBT, UK
George Miller MRC Epidemiology and Medical Care Unit, St Bartholomew’s and
The Royal London School of Medicine, Charterhouse Square, London EClM BBQ,
UK
Timothy J. Peters (Chairman) Department of Clinical Biochemistry, King’s College
School of Medicine & Dentistry, Bessemer Road, London SE5 9PJ, UK
Ian B. Puddey Department of Medicine, University of Western Australia, Royal
Perth Hospital, GPO Box X2213, Perth, Western Australia
Jiirgen Rehm Addiction Research Foundation, Clinical, Social and Evaluation
Research Department, 33 Russell Street, Toronto, Ontario, Canada M5S 2S1
Serge Renaud INSERM Unit 330, Universiti: Bordeaux 2,146 Rue Leo-Saignat,
33076 Bordeaux Cedex, France
Peter J. Richardson Consultant Cardiologist, King’s College Hospital,
Denmark Hill, London SE5 9RS, UK
A. Gerry Shaper Department of Primary Care and Population Sciences, Royal Free
Hospital School of Medicine, Rowland Hill Street, London NW3 2PF, UK
Alvaro Urbano-Mirquez Alcohol Research Unit, Department of Medicine
Hospital Clinic, University of Barcelona,Villarroell70, Barcelona 08036, Spain
S. Goya Wannamethee Department of Primary Care and Population Sciences,
Royal Free Hospital School of Medicine, Rowland Hill Street, London NW3 2PF,
UK
Novartis Foundation Symposium
Edited by Derek J. Chadwick, Jamie A. Goode
Copyright 0 1998 by Novartis Foundation
Chairman’s introduction
Timothy J. Peters
Department of Clinical Biochemistry, King’s College Schoolof Medicine and Dentistry, Bessemer
Road, LondonSE59PJ, UK
In most Western countries the production, purveying and pathology of alcohol
beverages is a multibillion dollar business. We have vacillated between its
beneficial and detrimental effects throughout the last century. Of recent interest is
the apparent beneficial effect of modest alcohol consumption, one to three drinks
per day, on mortality and morbidity rates, particularly relating to cardiovascular
disease. The objectives of this symposium were to bring together speakers and
discussants from a wide range of disciplines to evaluate the evidence for the so-
called J-shaped curve and to seek a biological explanation for the apparent
beneficial effects of low levels of consumption. The final aim was to discuss how
the conclusions from the symposium might be translated into effective and
acceptable public health measures.
The physical and intellectual objectives of the programme were clearly achieved:
the participants and readers will clearly have a view as to whether worthwhile
conclusions were reached.
1
Novartis Foundation Symposium
Edited by Derek J. Chadwick, Jamie A. Goode
Copyright 0 1998 by Novartis Foundation
Alcohol and cardiovascular diseases:
a historical overview
Arthur L. Klatsky
Kaiser Permanente Medical Center, 280 West MacA rthur Boulevard, Oakland, CA 9461 1,
USA
Abstract. Evident disparities in relationships make it desirable to consider several
disorders separately. (1) Alcoholic cardiomyopathy was perceived 150 years ago, but
understanding was clouded by recognition of beriberi and of synergistic toxicity from
alcohol with arsenic or cobalt. (2) A report of a link between heavy drinking and
hypertension in WWI French soldiers was apparently ignored for >50 years.
Epidemiological and intervention studies have now firmly established this association,
but a mechanism remains elusive. (3) The ‘holiday heart syndrome’, an increased risk of
supraventricular tachyarrhythmias in alcoholics, has been widely known to clinicians for
25 years; data remain sparse about the total role of heavier drinking in cardiac rhythm
disturbances. (4) Failure of earlier studies to distinguish types of stroke impeded
understanding; it now seems probable that alcohol drinking increases risk of
haemorrhagic stroke but lowers risk of ischaemic stroke. (5) Heberden reported angina
relief by alcohol in 1786, and an inverse alcoholatherosclerosis association was observed
by pathologists early in this century. Recent population studies and plausible mechanisms
support a protective effect of alcohol against coronary disease. International comparisons
dating back to 1819 suggest beverage choice as a factor, but this issue (the ‘French
Paradox’) remains unresolved.
1998 A lcohol and cardiovascular diseases. Wilv, Chichester (Novartis Foundation Symposium
216)p 2-18
Those who cannot remember thepast are condemnedto repeat it.
George Santayana, The Lqe ofaeason, 1905
The effectso f ethyl alcohol upon the cardiovascular system have excited the interest
of clinicians and investigators for well over a century. While much has been
learned, many areas of knowledge remain incomplete. Physiological, clinical and
epidemiological evidence cannot yet be integrated into definitive general concepts.
Past attempts to generalize and simplify have probably had the effect of slowing
progress in understanding this area. Disparity in relations of alcohol drinking to
various cardiovascular conditions (Klatsky 1995a) has become increasingly clear.
n