Relative Risk of Major Risk of Chronic Major Disease Catego ries, by Gender and Gender and verag e Drinkin e Dr g Catego Females Males Disease Disea

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1 38 th IMAG Conference, Amsterdam, October 13-14, 14, 2014 International Meeting on Alcohol and Global Health Overview: All-Cause Mortality Wolfgang Koenig MD, FRCP, FESC, FACC, FAHA Dept. of Internal Medicine II - Cardiology, University of Ulm Medical Center, Ulm, Germany

2 Alcohol Use and Your Health

3 Kiechl et al. Circulation 2014;130: Five-year Changes in Recorded per Capita Alcohol (15+ years) Consumption,

4 Kiechl et al. Circulation 2014;130: Alcohol-attributable Fractions for All-Cause Deaths, 2012

5 Relative Risk of Major Chronic Disease Categories, by Gender and Average Drinking Category Disease ICD-9 code ICD-10 code Malignant neoplasms C00-C97C97 Mouth and oropharynx cancers I 0-20 Females II Drinking Category III 40+ I 0-40 Males II III C00-C14C Esophagus cancer 150 C Liver cancer 155 C Breast cancer Under 45 years of age 174 C years and over Other neoplasms D00-D48D Diabetes mellitus 250 E10-E14E Rehm et al. NIAAA: Understanding the impact of alcohol on human health and well-being, 2003

6 Relative Risk of Major Chronic Disease Categories, by Gender and Average Drinking Category Disease ICD-9 code ICD-10 code Digestive diseases K20-K92K92 I Females II Drinking Category Males III I II Cirrhosis of the liver 571 K70, K III Neuropsychiatric conditions Unipolar major depression , F01-F99, F99, G06-G98G F32-F33F33 RR not available; AF could not be determined otherwise (Rehm et al., in press b) Epilepsy 345 G40-G41G Alcohol use disorders 291, 303, F10 AF 100% AF 100% AF 100% AF 100% AF 100% AF 100% Rehm et al. NIAAA: Understanding the impact of alcohol on human health and well-being, 2003

7 Relative Risk of Major Chronic Disease Categories, by Gender and Average Drinking Category Disease Females Drinking Category Males ICD-9 code ICD-10 code I II III I II III Cardiovascular I00-I99I99 diseases (CVD) Hypertensive disease I10-I13I Coronary heart disease I20-I25I Cerebrovascular disease I60-I69I69 Ischemic stroke Hemorrhagic stroke Other CVD causes , 417, , 424, , 429, , 448, I00, I26- I28, I34- I37, I44- I51, I70- I Rehm et al. NIAAA 2003

8 *Oxid., FMD, Coag., LF and IS, the Heart and Fat Tissue Kiechl et al. Circulation 2014;130: Proposed Mechanistic Insights into Protective* (green) as well as Injurious (red) Effects of Alcohol

9 Di Castelnuovo, A. et al. Arch Intern Med 2006;166: Relative Risk of Total Mortality (95% CI) and Alcohol Intake: Meta-analysis analysis of 34 Prospective Studies Extracted from 56 Curves Using Fixed- and Random-effects Models 6g/d ~1/2 drink 42g/d ~ 4 drinks Max. reduction in women 18% (99%CI 13%-22%) in men 17% (99% CI 15%-19%)

10 Relative Risk of Total Mortality (99% CI) and Alcohol Intake: Meta-analysis analysis of 34 Prospective Studies in - men and women (A) - women (B) - men (C) in the - United States - Europe - other countries (Australia, Japan, and/or China), extracted from adjusted curves Di Castelnuovo, A. et al. Arch Intern Med 2006;166:

11 Ronksley et al. BMJ 2011;342:d671 (84 Studies) WHAT IS ALREADY KNOWN ON THIS TOPIC: Systemic reviews have addressed the association of alcohol consumption with various cardiovascular outcomes However, these reviews are somewhat out of date, and none has comprehensively studied a broad spectrum of relevant cardiovascular end points WHAT THIS STUDY ADDS This meta-analysis analysis provides a summary of current knowledge regarding alcohol associations with six meaningful clinical end points cardiovascular disease mortality, coronary heart disease and mortality, stroke incidence and mortality, and all cause mortality The results confirm the beneficial effects of moderate alcohol consumption and the need to elucidate the underlying pathophysiological mechanisms

12 Ronksley et al. BMJ 2011;342:d671 Forest Plot of Mortality from All Causes Associated with Alcohol Consumption (31 Studies) Lowest Relative Risk of 0.83 ( ) for those consuming g/day

13 Association of Alcohol Consumption With CV or Total Mortality in CVD Patients Study Country No. Sex Follow-up, y Primary Event Secondary Event Doll, UK 5402 Men 13.0 CVD+CV-RF Thun, USA Both 9.0 CVD+CV-RF Janszky, Sweden 1346 Both 8.6 AMI Masunaga, Japan 3845 Men 1.1 AMI Aguilar, USA 2036 Both 3.5 AMI Jackson, USA 1320 Men 4.5 Stroke Mukamal, USA 1913 Both 3.8 AMI Shaper, UK 596 Men 12.8 CHD Valmadrid, USA 262 Both 12.3 ACS Muntwyler, USA 5356 Men 5.0 AMI AC-M, CV-M AC-M, CV-M AC-M,CV-M, CV-M+CVD AC-M, CV-M+CVD AC-M, CV-M, CV-M+CVD AC-M, CV-M AC-M, CV-M AC-M, CV-M CV-M AC-M, CV-M UK indicates United Kingdom; CV-RF, cardiovascular risk factors; AC-M, all-cause mortality; CV-M, cardiovascular mortality; USA, United States of America; and ACS, acute coronary syndrome. Funded by ERAB Costanzo et al. Circulation 2010;121:

14 Relative Risk of Cardiovascular Mortality Relative Risks of Cardiovascular Mortality with 1.4 Different Intakes of Alcohol in CVD Patients Funded by ERAB Alcohol Consumption (grams/day) Janszky, 2008 Aguilar, 2006 Jackson, 2003 Mukamal, 2001 Shaper, 2000 Valmadrid, 1999 Muntwyler, 1998 Costanzo et al. Circulation 2010;121:

15 Relative Risk of All-Cause Mortality Relative Risks of Total Mortality with Different 1.4 Intakes of Alcohol in Studies of CVD Patients Funded by ERAB Alcohol Consumption (grams/day) Janszky, 2008 Masunaga, 2006 (age <65yr) Masunaga, 2006 (age 65yr) Aguilar, 2006 Jackson, 2003 Mukamal, 2001 Shaper, 2000 Muntwyler, 1998 (age <65yr) Muntwyler, 1998 (age 65yr) Costanzo et al. Circulation 2010;121:

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17 Mukamal et al. JAMA 2001;285: Survival Following Acute Myocardial Infarction (AMI) According to Average Alcohol Consumption

18 Mukamal et al. JAMA 2001;285: Hazard Ratios for Mortality Following Acute Myocardial Infarction According to Alcohol Consumption

19 Mukamal et al. JAMA 2001;285: Hazard Ratios for All-Cause Mortality According to Alcohol Consumption by Predominant Beverage Type*

20 Pai et al. Eur Heart J 2012;33:

21 Pai et al. Eur Heart J 2012;33: Baseline Lifestyle and Clinical Characteristics of 1818 Men with Incident Non-Fatal MI in the HPFU Study

22 Pai et al. Eur Heart J 2012;33: Long-term Alcohol Intake and Risks for Total Death and CVD Death Among 1818 Men with Incident Non-Fatal MI

23 Pai et al. Eur Heart J 2012;33: Beverage-specific Long-term Alcohol Consumption and Risks of Total Death Among 1818 Men with Incident Non-Fatal MI

24 Zaridze et al. Lancet 2014;383: All-Cause Mortality, Males Aged Years, in Russia From and in the UK From

25 Alcohol and Cardiovascular Mortality Common Sense and Scientific Truth*...The risks of moderate drinking differ by sex, age, personal history, and family history. As is often the case in medical practice, advice about life-style must be based on something less than certainty. There is no substitute for balanced judgement by a knowledgeable, objective health professional. What is required is a synthesis of common sense and the best available scientific facts. *Editorial by A.L. Klatsky JACC 2010;55:

26 Department of Cardiology University of Ulm Medical Center The New York Times, Sunday May 8, 2005 University of Ulm Medical Center

27 Alcohol Consumption in Relation to MI Diagnosis Pai et al. Eur Heart J 2012;33:

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29 Kaplan-Meier Estimates of Survival After Acute MI Among Binge Drinkers and Nonbinge Drinkers* *matched by Propensity Score Mukamal et al. Circulation 2005;112:

30 Mukamal et al. Circulation 2005;112: Adjusted HRs for Mortality After Acute MI According to Binge Drinking and Usual Alcohol Intake

31 Mukamal et al. Circulation 2005;112: HRs and 95% CIs for All-Cause, Cardiovascular, and Noncardiovascular Mortality After Acute MI According to Drinking Among Onset Study Participants

32 Mukamal et al. Circulation 2005;112: Additional Adjusted Analyses of Binge Drinking and Total Mortality Among Onset Study Participants

33 Pai et al. Eur Heart J 2012;33: Change in Alcohol Consumption Pattern and Risks for Total Death and Death due to CVD Among the 1633 Men who Reported Alcohol Consumption on the Questionnaires Immediately Before and After MI Diagnosis