Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data.

OBJECTIVE: To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease. DESIGN: Mendelian randomisation meta-analysis of 56 epidemiological studies. PARTICIPANTS: 261 991 individuals of European descent, including 20 259 coronary heart disease cases and 10 164 stroke events. Data were available on ADH1B rs1229984 variant, alcohol phenotypes, and cardiovascular biomarkers. MAIN OUTCOME MEASURES: Odds ratio for coronary heart disease and stroke associated with the ADH1B variant in all individuals and by categories of alcohol consumption. RESULTS: Carriers of the A-allele of ADH1B rs1229984 consumed 17.2% fewer units of alcohol per week (95% confidence interval 15.6% to 18.9%), had a lower prevalence of binge drinking (odds ratio 0.78 (95% CI 0.73 to 0.84)), and had higher abstention (odds ratio 1.27 (1.21 to 1.34)) than non-carriers. Rs1229984 A-allele carriers had lower systolic blood pressure (-0.88 (-1.19 to -0.56) mm Hg), interleukin-6 levels (-5.2% (-7.8 to -2.4%)), waist circumference (-0.3 (-0.6 to -0.1) cm), and body mass index (-0.17 (-0.24 to -0.10) kg/m(2)). Rs1229984 A-allele carriers had lower odds of coronary heart disease (odds ratio 0.90 (0.84 to 0.96)). The protective association of the ADH1B rs1229984 A-allele variant remained the same across all categories of alcohol consumption (P=0.83 for heterogeneity). Although no association of rs1229984 was identified with the combined subtypes of stroke, carriers of the A-allele had lower odds of ischaemic stroke (odds ratio 0.83 (0.72 to 0.95)). CONCLUSIONS: Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health

New advances in treating patients with arterial hypertension and diabetes mellitus

The authors present literature review on the important clinical issue – arterial hypertension (AH) management in patients with Type 2 diabetes mellitus (DM-2). In DM-2 individuals, AH prevalence triples, and dangerous combination of AH and DM-2 substantially increases target organ damage (TOD) risk. Analyzing various studies on causes of additional TOD risk increase, the authors conclude that blood pressure control is most important in DM-2 treatment. Clinical importance of antihypertensive agents’ metabolic effects in regard to long-term cardiovascular prognosis is discussed

TOBACCO DEPENDENCE TREATMENT WITH NICOTINE REPLACEMENT THERAPY AS ONE OF THE METHODS FOR CARDIOVASCULAR DISEASE RISK REDUCTION

Aim. To investigate efficacy and safety of nicotine chewing gum and inhaler in individuals trying to quit smoking. To assess expected reduction of cardiovascular disease (CVD) and total mortality relative risks (RR).Material and methods. In this open, parallel study, 169 relatively healthy male smokers aged 18-60 years were randomly assigned to free choice vs admission of Nicorette gum (2/4 mg) or inhaler (10 mg). At baseline, all participants smoked ≥15 cig/d, for ≥3 years. The intervention phase lasted 3 months; follow-up evaluations were made at 3, 6 and 12 months after nicotine replacement therapy (NRT) initiation.Results. Twelve-month results were obtained for 152 subjects (response rate 89.9%). Point prevalence abstinence and reduction (smoking ≤50% of basic daily cigarette amount) rates were 19.7% and 35.5%, respectively. Neither abstinence, nor reduction rates depended on Nicorette form (gum vs inhaler), or on choice vs admission factor. The main predictors of long-term efficacy were nicotine dependence severity and contacts with other smokers.NRT was not associated with negative dynamics in objective health parameters (blood pressure, heart rate, ECG parameters, body weight, and body mass index) or self-evaluation of health. Both Nicorette forms seemed to be safe and well-tolerated.At 12 months, the expected mean RR reduction for CVD mortality reached 19%, for total mortality – 21%.Conclusion. In Russian clinical settings, NRT efficacy and safety are similar to that demonstrated in numerous international trials. NRT can be recommended as one of the methods of assistance to quit smoking and, therefore, for CVD risk reduction.</p

Arterial hypertension: ambulatory patients’ point of view. First results of GARANT Study

Aim. To study patients’ awareness on arterial hypertension (AH), its treatment and prevention, as well as to investigate AH therapy compliance, the GARANT Study (PharmacoepidemioloGy of ARteriAl HyperteNsion in Real-World Ambulatory PracTice) was performed, supported by KRKA company. Material and methods. Doctors and patients from 99 clinics in 63 Russian cities participated in the study. In total, 9214 patients (3189 men, 6025 women; mean age 54,7 years) responded to this doctor-performed survey. Results. AH awareness was high enough, with as many as 86,8% of the patients knowing their blood pressure (BP) level. At the same time, only every third participant knew his or her cholesterol (CH) level. More than 70% of men and 80% of women knew that AH is a risk factor (RF). From the patients’ point of view, AH was the leading RF. Awareness on the other RF was below 33%, with only two exceptions: alcohol (42,2% for men, 35,8% for women) and smoking (38,4% and 30,9%, respectively). Conclusion. While doctors are fully responsible for high BP diagnostics and explanation of pharmaceutical and non-pharmaceutical therapy benefits and risks to their patients, treatment compliance and lifestyle modification should be supported by patients themselves, their families, and society as a whole

TOBACCO DEPENDENCE TREATMENT WITH NICOTINE REPLACEMENT THERAPY AS ONE OF THE METHODS FOR CARDIOVASCULAR DISEASE RISK REDUCTION

Aim. To investigate efficacy and safety of nicotine chewing gum and inhaler in individuals trying to quit smoking. To assess expected reduction of cardiovascular disease (CVD) and total mortality relative risks (RR).Material and methods. In this open, parallel study, 169 relatively healthy male smokers aged 18-60 years were randomly assigned to free choice vs admission of Nicorette gum (2/4 mg) or inhaler (10 mg). At baseline, all participants smoked ≥15 cig/d, for ≥3 years. The intervention phase lasted 3 months; follow-up evaluations were made at 3, 6 and 12 months after nicotine replacement therapy (NRT) initiation.Results. Twelve-month results were obtained for 152 subjects (response rate 89.9%). Point prevalence abstinence and reduction (smoking ≤50% of basic daily cigarette amount) rates were 19.7% and 35.5%, respectively. Neither abstinence, nor reduction rates depended on Nicorette form (gum vs inhaler), or on choice vs admission factor. The main predictors of long-term efficacy were nicotine dependence severity and contacts with other smokers.NRT was not associated with negative dynamics in objective health parameters (blood pressure, heart rate, ECG parameters, body weight, and body mass index) or self-evaluation of health. Both Nicorette forms seemed to be safe and well-tolerated.At 12 months, the expected mean RR reduction for CVD mortality reached 19%, for total mortality – 21%.Conclusion. In Russian clinical settings, NRT efficacy and safety are similar to that demonstrated in numerous international trials. NRT can be recommended as one of the methods of assistance to quit smoking and, therefore, for CVD risk reduction