Alcohol consumption patterns across Europe and adherence to the European guidelines in coronary patients : findings from the ESC-EORP EUROASPIRE V survey

Background and aims: Alcohol consumption is an important risk factor for cardiovascular morbidity and mortality worldwide. The highest levels of alcohol consumption are observed in Europe, where alcohol as contributing cause of coronary heart disease (CHD) is also most significant. We aimed to describe alcohol consumption patterns across European regions and adherence to the current guidelines in patients with a recent CHD event. Methods: The ESC-EORP survey (EUROASPIRE V) has been conducted in 2016-2017 at 131 centers in 27 Eu-ropean countries in 7350 patients with a recent CHD. Median alcohol consumption, as well as the proportion of abstainers and excessive drinkers (i.e. >70 g/week for women and >140 for men, as recommended by the European guidelines on cardiovascular prevention), was calculated for each region. To assess adherence to guidelines, proportions of participants who were advised to reduce excessive alcohol consumption and participants who were incorrectly not advised were calculated per region. Results: Mean age was 64 years (SD: 9.5), 75% were male. Abstention rates were 53% in males and 77% in females, whereas excessive drinking was reported by 9% and 5% of them, respectively. Overall, 57% of the participants were advised to reduce alcohol consumption. In the total population, 3% were incorrectly not advised, however, this percentage differed per region (range: 1%-9%). In regions where alcohol consumption was highest, participants were less often advised to reduce their consumption. Conclusion: In this EUROASPIRE V survey, the majority of CHD patients adhere to the current drinking guidelines, but substantial heterogeneity exists between European regions

Urinary Ethyl Glucuronide as Measure of Alcohol Consumption and Risk of Cardiovascular Disease:A Population-Based Cohort Study

Background Moderate alcohol consumption has been associated with a lower risk of cardiovascular disease (CVD) and all-cause mortality compared with heavy drinkers and abstainers. To date, studies have relied on self-reported consumption, which may be prone to misclassification. Urinary ethyl glucuronide (EtG) is an alcohol metabolite and validated biomarker for recent alcohol consumption. We aimed to examine and compare the associations of self-reported alcohol consumption and EtG with CVD and all-cause mortality. Methods and Results In 5676 participants of the PREVEND (Prevention of Renal and Vascular End-Stage Disease) study cohort, EtG was measured in 24-hour urine samples and alcohol consumption questionnaires were administered. Participants were followed up for occurrence of first CVD and all-cause mortality. Cox proportional hazards regression models, adjusted for age, sex, and CVD risk factors, were fitted for self-reported consumption, divided into 5 categories: abstention, 1 to 4 units/month (reference), 2 to 7 units/week, 1 to 3 units/day, and ≥4 units/day. Similar models were fitted for EtG, analyzed as both continuous and categorical variables. Follow-up times differed for CVD (8 years; 385 CVD events) and all-cause mortality (14 years; 724 deaths). For both self-reported alcohol consumption and EtG, nonsignificant trends were found toward J-shaped associations between alcohol consumption and CVD, with higher risk in the lowest (hazard ratio for abstention versus 1-4 units/month, 1.42; 95% CI, 1.02-1.98) and highest drinking categories (hazard ratio for ≥4 units/day versus 1-4 units/month, 1.11; 95% CI, 0.68-1.84). Neither self-report nor EtG was associated with all-cause mortality. Conclusions Comparable associations with CVD events and all-cause mortality were found for self-report and EtG. This argues for the validity of self-reported alcohol consumption in epidemiologic research

Urinary Ethyl Glucuronide Can Be Used as a Biomarker of Habitual Alcohol Consumption in the General Population

BACKGROUND: Alcohol consumption is a frequently studied risk factor for chronic diseases, but many studies are hampered by self-report of alcohol consumption. The urinary metabolite ethyl glucuronide (EtG), reflecting alcohol consumption during the past 72 h, is a promising objective marker, but population data are lacking. OBJECTIVE: The objective of this study was to assess the reliability of EtG as a marker for habitual alcohol consumption compared with self-report and other biomarkers in the general population. METHODS: Among 6211 participants in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) cohort, EtG concentrations were measured in 24-h urine samples. EtG was considered positive when concentrations were ≥100 ng/mL. Habitual alcohol consumption was self-reported by questionnaire (categories: no/almost never, 1-4 units per month, 2-7 units per week, 1-3 units per day or ≥4 units per day). Plasma HDL cholesterol concentration, erythrocyte mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamyltransferase (GGT) were determined as indirect biomarkers of alcohol consumption. Sensitivity, specificity, positive and negative predictive value, and proportions of agreement between reported consumption and EtG were calculated. To test the agreement of EtG concentration and alcohol consumption in categories, linear regression analysis was performed. In addition, the association between EtG concentrations and indirect biomarkers was analyzed. RESULTS: Mean age was 53.7 y, and 52.9% of participants men. Of the self-reported abstainers, 92.3% had an EtG concentration <100 ng/mL. Sensitivity was 66.3%, positive predictive value was 96.3%, and negative predictive value was 47.4%. The proportion of positive agreement was 78.5%, and the proportion of negative agreement was 62.7%. EtG concentrations were linearly associated with higher categories of alcohol consumption (P-trend < 0.001), adjusted for age, sex, and renal function. EtG was positively related to MCV, HDL cholesterol, and GGT but not to AST and ALT concentrations. CONCLUSIONS: This study shows that urinary EtG is in reasonable agreement with self-reported alcohol consumption and therefore can be used as an objective marker of habitual alcohol consumption in the general population

Alcohol consumption patterns across Europe and adherence to the European guidelines in coronary patients: Findings from the ESC-EORP EUROASPIRE V survey

Background and aims: Alcohol consumption is an important risk factor for cardiovascular morbidity and mortality worldwide. The highest levels of alcohol consumption are observed in Europe, where alcohol as contributing cause of coronary heart disease (CHD) is also most significant. We aimed to describe alcohol consumption patterns across European regions and adherence to the current guidelines in patients with a recent CHD event. Methods: The ESC-EORP survey (EUROASPIRE V) has been conducted in 2016–2017 at 131 centers in 27 European countries in 7350 patients with a recent CHD. Median alcohol consumption, as well as the proportion of abstainers and excessive drinkers (i.e. >70 g/week for women and >140 for men, as recommended by the European guidelines on cardiovascular prevention), was calculated for each region. To assess adherence to guidelines, proportions of participants who were advised to reduce excessive alcohol consumption and participants who were incorrectly not advised were calculated per region. Results: Mean age was 64 years (SD: 9.5), 75% were male. Abstention rates were 53% in males and 77% in females, whereas excessive drinking was reported by 9% and 5% of them, respectively. Overall, 57% of the participants were advised to reduce alcohol consumption. In the total population, 3% were incorrectly not advised, however, this percentage differed per region (range: 1%–9%). In regions where alcohol consumption was highest, participants were less often advised to reduce their consumption. Conclusion: In this EUROASPIRE V survey, the majority of CHD patients adhere to the current drinking guidelines, but substantial heterogeneity exists between European regions

Modifiable cardiovascular risk factors and lifestyle behaviours in relation to cardiometabolic health: Opportunities for prevention

The research described in this thesis addresses the association of several traditional and novel cardiovascular risk factors and lifestyle behaviours with cardiometabolic diseases. This was further specified into two research objectives: I. What are potential mechanisms of the relationship between the modifiable lifestyle factor alcohol consumption and cardiometabolic diseases? II. What is the causal role of modifiable cardiovascular and lifestyle-related risk factors in the development of cardiometabolic diseases? Potential mechanisms of the relation between alcohol consumption and cardiometabolic diseases In Chapters 2 and 3, cardiac function and structure, insulin sensitivity and adiposity were investigated as potential underlying mechanisms in the relation of alcohol consumption with cardiometabolic diseases. Chapter 2 showed that higher levels of alcohol consumption were linearly associated with a decrease in left ventricular ejection fraction, a measure of systolic function, in a prospective study of 404 participants. No association was observed between alcohol consumption and left atrial volume index, which is a measure of diastolic function, or left ventricular mass index, a measure of cardiac structure. These findings suggest that alcohol consumption might play a role in the pathophysiology of heart failure with reduced ejection fraction. Chapter 3 showed that heavy drinking was associated with higher liver fat in a cross-sectional study on 787 men with prediabetes, and central adiposity seemed to explain part of this association. Moderate amounts of alcohol consumption appeared to be associated with a decrease in liver fat in the prospective analysis, but the definitive shape of this association warrants investigation in larger and more long-term follow-up studies. Altogether, heavy alcohol consumption is harmful for preclinical aspects of cardiometabolic health, but whether there is a safe drinking threshold for moderate amounts of alcohol consumption remains a point of discussion. The causal role of modifiable cardiovascular and lifestyle-related risk factors in the development of cardiometabolic diseases In Chapter 4, a systematic review of the current evidence from Mendelian randomization (MR) studies on the association between alcohol consumption and cardiometabolic diseases, mortality and cardiovascular risk factors was conducted. There was large heterogeneity in the methodological quality of the MR studies on this topic so far. It was not possible to draw conclusions on the causal role of moderate alcohol consumption on cardiometabolic health. Recent developments in MR reporting guidelines and methodology including instrument selection and non-linearity are expected to improve evidence from future MR studies. In Chapters 5, 6 and 7, the two-sample MR method was used to investigate the potential causal association of several cardiovascular risk factors and lifestyle behaviours with risk of hypertension, heart failure and longevity, respectively. These MR studies confirmed the causal role of several traditional risk factors in the development of cardiometabolic diseases, with for example genetically predicted smoking initiation being detrimentally associated with hypertension, heart failure and longevity, and genetically predicted higher body mass index being harmful for hypertension and longevity. A genetically predicted higher educational level was associated with a reduced risk of hypertension and increased life expectancy. The MR studies implied that sleep might be an important novel risk factor for cardiometabolic health, with a genetically predicted longer sleep duration being associated with a lower heart failure risk en a potentially lower hypertension risk, and genetically predicted insomnia increasing the risk of hypertension and possibly reducing life expectancy. For lifestyle factors including physical activity, sedentary behaviour and coffee consumption, the precision was low in the majority of the MR analyses, making it not possible to draw causal conclusions for these factors

Modifiable cardiovascular risk factors and lifestyle behaviours in relation to cardiometabolic health: Opportunities for prevention

The research described in this thesis addresses the association of several traditional and novel cardiovascular risk factors and lifestyle behaviours with cardiometabolic diseases. This was further specified into two research objectives: I. What are potential mechanisms of the relationship between the modifiable lifestyle factor alcohol consumption and cardiometabolic diseases? II. What is the causal role of modifiable cardiovascular and lifestyle-related risk factors in the development of cardiometabolic diseases? Potential mechanisms of the relation between alcohol consumption and cardiometabolic diseases In Chapters 2 and 3, cardiac function and structure, insulin sensitivity and adiposity were investigated as potential underlying mechanisms in the relation of alcohol consumption with cardiometabolic diseases. Chapter 2 showed that higher levels of alcohol consumption were linearly associated with a decrease in left ventricular ejection fraction, a measure of systolic function, in a prospective study of 404 participants. No association was observed between alcohol consumption and left atrial volume index, which is a measure of diastolic function, or left ventricular mass index, a measure of cardiac structure. These findings suggest that alcohol consumption might play a role in the pathophysiology of heart failure with reduced ejection fraction. Chapter 3 showed that heavy drinking was associated with higher liver fat in a cross-sectional study on 787 men with prediabetes, and central adiposity seemed to explain part of this association. Moderate amounts of alcohol consumption appeared to be associated with a decrease in liver fat in the prospective analysis, but the definitive shape of this association warrants investigation in larger and more long-term follow-up studies. Altogether, heavy alcohol consumption is harmful for preclinical aspects of cardiometabolic health, but whether there is a safe drinking threshold for moderate amounts of alcohol consumption remains a point of discussion. The causal role of modifiable cardiovascular and lifestyle-related risk factors in the development of cardiometabolic diseases In Chapter 4, a systematic review of the current evidence from Mendelian randomization (MR) studies on the association between alcohol consumption and cardiometabolic diseases, mortality and cardiovascular risk factors was conducted. There was large heterogeneity in the methodological quality of the MR studies on this topic so far. It was not possible to draw conclusions on the causal role of moderate alcohol consumption on cardiometabolic health. Recent developments in MR reporting guidelines and methodology including instrument selection and non-linearity are expected to improve evidence from future MR studies. In Chapters 5, 6 and 7, the two-sample MR method was used to investigate the potential causal association of several cardiovascular risk factors and lifestyle behaviours with risk of hypertension, heart failure and longevity, respectively. These MR studies confirmed the causal role of several traditional risk factors in the development of cardiometabolic diseases, with for example genetically predicted smoking initiation being detrimentally associated with hypertension, heart failure and longevity, and genetically predicted higher body mass index being harmful for hypertension and longevity. A genetically predicted higher educational level was associated with a reduced risk of hypertension and increased life expectancy. The MR studies implied that sleep might be an important novel risk factor for cardiometabolic health, with a genetically predicted longer sleep duration being associated with a lower heart failure risk en a potentially lower hypertension risk, and genetically predicted insomnia increasing the risk of hypertension and possibly reducing life expectancy. For lifestyle factors including physical activity, sedentary behaviour and coffee consumption, the precision was low in the majority of the MR analyses, making it not possible to draw causal conclusions for these factors

Alcohol Consumption and Cardiovascular Disease Risk: Placing New Data in Context

Purpose of Review: A clear link between excessive alcohol consumption and cardiovascular disease (CVD) has been established, but no consensus exists on the effects of moderate alcohol consumption on CVD. Recent Findings: A lower risk of coronary heart disease and myocardial infarction among moderate drinkers compared to abstainers has been consistently observed in epidemiological studies and meta-analyses of these studies. However, ambiguity remains on the effect of alcohol on other CVDs and all-cause mortality. Short-term randomized controlled trials (RCT) have identified potentially beneficial effects of alcohol consumption on cardiovascular risk factors, but studies investigating genetic polymorphisms that influence alcohol consumption (i.e., Mendelian randomization) have yielded inconclusive results. To date, a long-term RCT providing causal evidence is lacking but urgently needed. Summary: Triangulation of evidence from different study designs, including long-term RCTs, pragmatic trials and the evaluation of policy measures, combined will lead to the best available evidence