Wednesday, March 30, 2011

Alcohol consumption and cardiovascular disease outcomes - A systematic review and meta analysis.

The alcohol consumption is now socially accepted in more number of urban cities.The Indian alcoholic beverages market is dominated by whisky, which accounts for more than half of the total spirits consumed in the country.
The total consumption of whisky is estimated to be around 131 million cases in the current year, a rise of 10 per cent from 119 million cases in 2009. After whisky, rum is the most popular alcoholic beverage in India and the total consumption is estimated to be at 42.4 million cases in the current year, a rise of 8.7 per cent from 39 million cases in 2009.According to the IWSR report, consumption of beer — counted as a separate category — is likely to grow by 7 per cent to 195.5 million cases of 7.8 litres each (1.52 crore Hecto Litres) in the current year, as compared to 181.5 cases (1.41 crore Hecto Litres) in 2009.
IWSR is a London-headquartered market research firm that focuses exclusively on the global alcoholic beverage market.

The recent study in British Medical Journal is appealing to all those who are taking alcohol in a controlled manner. Possible cardioprotective effects of alcohol consumption seen in observational studies continue to be hotly debated in the medical literature and popular media. In the absence of clinical trials, clinicians must interpret these data when answering patients’ questions about taking alcohol to reduce their risk of cardiovascular disease. Systematic reviews and meta-analyses have addressed the association of alcohol consumption with cardiovascular disease outcomes but have not uniformly addressed associations between alcohol use and mortality from cardiovascular disease, as well as the incidence and mortality from coronary heart disease and stroke.

In a review of 84 studies of alcohol consumption and cardiovascular disease, alcohol consumption at 2.5–14.9 g/day (about ≤1 drink a day) was consistently associated with a 14–25% reduction in the risk of all outcomes assessed compared with abstaining from alcohol. Such a reduction in risk is potentially of clinical importance, but consumption of larger amounts of alcohol was associated with higher risks for stroke incidence and mortality.

The protective association of alcohol has been consistently observed in diverse patient populations and in both women and men. Fourthly, the association is specific: moderate drinking (up to 1 drink or 12.5 g alcohol per day for women and 2 drinks or 25 g alcohol per day for men is associated with lower rates of cardiovascular disease but is not uniformly protective for other conditions, such as cancer. But one should remember that hemorrhagic stroke in more in the alcoholics.
The focus  trials would shift from assessing the association between alcohol and disease outcomes to evaluating the receptivity of both physicians and patients to the recommended consumption of alcohol for therapeutic purposes and the extent to which it can be successfully and safely implemented. In support of implementation trials, our two papers show that alcohol consumption in moderation has reproducible and plausible effects on markers of coronary heart disease risk.The total consumption of alcoholic beverages in India is expected to touch 217.1 million cases in 2010, marking a growth of 8 per cent from the previous year, according to a report.
The Emerging Ideal
While alcohol consumption is low overall, it's even lower in women than in men in India, as in many countries. Though data is limited, studies through 2000 consistently estimated prevalence of alcohol use among Indian women at less than 5 percent. In addition, there is a persistent belief that women who drink alcohol are either less educated, rural women or members of the upper crust, leading to a stereotype that associates alcohol use with primitivism or privilege.
However, drinking is becoming more commonplace for India's professional women, causing the gap between drinking habits of women and men in India to narrow--a phenomenon also happening around the world. As women become more educated and more economically independent, women's alcohol use in some societies is rising. (And men's alcohol use, interestingly, is falling in some European countries.)
One contributor in India is employment. Though labor force participation dropped between 1999 and 2002 for rural females, rural males, and urban males, it rose for urban females. Contrary to the historical stereotype, these urban females now consume alcohol at twice the rate of their rural counterparts.

  • Sarah Bosa et al (European Jl of cardiovascular prevention and rehabilitation) concluded that moderate alcohol consumption is associated with a reduced risk of CHD among hypertensive women. Light alcohol consumption tended to be related to a lower risk of stroke. Current guidelines for alcohol consumption in the general population also apply to hypertensive women.


  • We can expect changes in the coming years in a country like India and that may depend on the many social  ethical and cultural issues.

    Atorvastatin Linked to Small Increase in Risk for Type 2 Diabetes

    Simvastatin, Atorvastatin, Rosuvastatin are now available in India. They have been found to be very effective in preventing the secondary cardiovascular complications. There are some complications such as reduction of HDL or inability to raise the HDL, new onset Diabetes ( physician reported diabetes). Atorvastatin seems to carry a "slight increase in the risk" for new-onset type 2 diabetes, according to an analysis of three large trials published in the Journal of the American College of Cardiology. (The trials, as well as this analysis, were sponsored by atorvastatin's manufacturer.)
    Researchers were responding to a 2010 Lancet meta-analysis, which found a small but measurable risk for new-onset diabetes after all statin use. The current analysis focuses on atorvastatin's effects in the TNT, IDEAL, and SPARCL trials. It found that atorvastatin, when compared with placebo in the SPARCL trial, carries a higher risk for diabetes. In the other trials, there was a slightly increased risk when an 80-mg dose was compared with lower doses (10-mg atorvastatin in TNT, 20-mg simvastatin in IDEAL), but the differences did not achieve statistical significance.
    The JACC authors conclude (as did the authors of the Lancet meta-analysis) that the benefits of statins "far outweigh the risks."
    DVT awareness Month - March 2011
    Photo: Melanie ( David Bloom NBC reporter) -National spokes person (USA) for Coalition against deep vein thrombosis

    Venous thrombosis and pulmonary embolism are important clinical conditions that occur in the hospitalized patients. The mortality and morbidity associated with them can be prevented by precautions and medical therapies prior to their onset. Hospitals are encouraged to have written protocols to prevent venous thromboembolism in the hospitalized patients. Heparin, oral anticoagulants are regularly used in the prevention and treatment of VTE. The newer oral direct Xa inhibitors are undergoing phase III trials and soon there is a possibility that they are going to be released in to the market 2013. Riveroxaban, Apixaban, Edoxaban are going to be used in the treatment of deep vein thrombosis without much biochemical monitoring. Thrombolytic usage may increase in the coming years with an idea to prevent post thrombotic syndrome which is currently expected to be as high as 50%. During this month we organized many meetings in the hospitals to share the information and educate the hospital staff. DVT Awareness Meetings were conducted in all the major cities by doctors with lot of enthusiasm. The findings of ENDORSE study were discussed and it was stressed that 50% of the patients getting admitted in to the acute care hospitals are at risk of VTE and only 16% of the surgical and 19% of the medical patients who are at risk of the VTE received the thrombosis prophylaxis. More efforts are needed to identify the patients at risk with the help of RAMs ( risk assessment modules) and adequate prophylactic measures should be taken to reduce the DVT, PE related and deaths and post thrombotic syndrome.

    World Health Day – 7 April 2011

    Antimicrobial resistance and its global spread

    • Antimicrobial resistance: no action today no cure tomorrow
      We live in an era of medical breakthroughs with new wonder drugs available to treat conditions that a few decades ago, or even a few years ago in the case of HIV/AIDS, would have proved fatal. For World Health Day 2011, WHO will launch a worldwide campaign to safeguard these medicines for future generations. Antimicrobial resistance and its global spread threaten the continued effectiveness of many medicines used today to treat the sick, while at the same time it risks jeopardizing important advances being made against major infectious killers.