The once proud epidemiological J-curve on alcohol intake and cardiovascular outcomes A little flatter With a new analysis based on a cohort of vintage randomized trials. among them, heart failure (HF) Stage B — Characterized by Ventricular dysfunction but no symptoms — those who reported moderate or high alcohol intake showed a four-fold increase in risk of disease progression clinically or continuously. Echocardiography..
In addition, there were no signs of protection at any level of alcohol intake among those who started the study at HF Stage A, which is characterized by the following risk factors: High blood pressure, obesityOr diabetes, but no echo abnormalities.
However, moderate to high alcohol intake, defined here as consumption of 70 g or more. ethanol There was no increased risk of accidental illness in the Stage A (“at risk of HF”) group per week. That is, progression to HF stage B or C (“pre-HF” or “symptomatic HF”, respectively). ).
It also didn’t seem to reduce the risk.And that, along with other findings in the study, contradicts the message that still remains in some guidelines suggesting that alcohol intake may be cardioprotective for some people, Dublin. Bethany Wong of St. Michael’s Hospital, MBBS said theheart.org | Medscape Cardiology..
The analysis was based on 744 adults with HF stage A or B (mean age 66 years, 53% female) and was randomly assigned to either normal care or follow-up with echo and natriuretic peptide assays. .. STOP-HF The trial that created it Primary publication Wong announced the results of a new secondary survey on May 22nd. European Society of Cardiology (HFA-ESC) 2022 Heart Failure Association The session was virtual and live in Madrid.
She pointed to the latest ESC Guideline document For the diagnosis and management of HF Announced last yearAlthough this does not recommend the use of alcohol by people with alcohol-induced cardiomyopathy, it suggests that as a preventive strategy for the general population, either not ingested or only “light” ingestion is “beneficial”. I am. The Corresponding guidelines From North American society Mentions alcohol Only a few times, usually Substance abuse..
“The 2021 ESC guidelines report that for men, up to 140 grams per week is not only safe, but can also protect against heart failure,” Wong said. “On the other hand, it doubles the amount found to be associated with left ventricular dysfunction in this stage B population, and last year’s heart failure guidelines are in conflict with European preventive cardiology. .. Guidelines“She added. Recent push From the World Heart Federation.
If clinicians and the general public are confused by inconsistent messages, they can see Beyond the heart And even to Other corners Of Cardiology for How To Drink Alcohol Can be harmful Not protection.
“It’s not just the heart that is affected. When giving advice, you need to remember that you need to think about other organs as well,” Wong said.
The analysis excluded ex-drinkers and people with symptomatic HF. 484 participants at risk for HF were younger, less likely to be male, had higher LV ejection fraction (LVEF), natriuretic peptide, left, compared to 260 participants before HF. The ventricular (LV) mass index was low. And LV volume index (P <.001 all).
Alcohol intake was not reported in 27% of the total cohort, low use (≤70 g / week) was reported in 47.8%, and moderate to high use was reported in 25.1%. Participants who reported moderate to high alcohol use were younger, more likely to be male, and had a higher classification of obesity index, Wong reported. From a point of view, she explained that a standard wine bottle contains about 70g of ethanol.
Odds ratio (OR) of HF progression in baseline pre-HF patients — defined as a decrease in LVEF of 5 points or an increase in the E / e’ratio above 2, which is an indicator of diastolic function — alcohol intake Medium to high doses were 4.5 (95% CI, 1.7-15.9) compared to no intake. P <.001) After adjusting for age, gender, obesity, blood pressure, diabetes, and other factors known to affect ventricular function. The findings were similar in an analysis comparing moderate and high intake levels separately with no alcohol intake.
Assumptions that the analysis is limited and limits the generalizability of the old “very homogeneous European population” and that “someone explains and self-reports on clinic visits will stabilize through follow-up” Including, Wong observed, we know it is not. “
In contrast, the cohort was conducting clinical trials with baseline and follow-up echocardiography, so “it could be more robust,” she said. “Further research is needed to positively and ideally confirm these findings.”
Wong reports that she has nothing to disclose.
European Society of Cardiology (HFA-ESC) 2022 Heart Failure Association: Moderate alcohol intake is associated with the progression of left ventricular dysfunction in the European stage B heart failure population.. Announced on May 22, 2022.
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