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
Alcohol Use and Your Health http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
Kiechl et al. Circulation 2014;130:383-386386 Five-year Changes in Recorded per Capita Alcohol (15+ years) Consumption, 2006-20102010
Kiechl et al. Circulation 2014;130:383-386386 Alcohol-attributable Fractions for All-Cause Deaths, 2012
Relative Risk of Major Chronic Disease Categories, by Gender and Average Drinking Category Disease ICD-9 code ICD-10 code Malignant neoplasms 140-208 C00-C97C97 Mouth and oropharynx cancers I 0-20 Females II 20-40 Drinking Category III 40+ I 0-40 Males II 40-60 III 60+ 140-149149 C00-C14C14 1.45 1.85 5.39 1.45 1.85 5.39 Esophagus cancer 150 C15 1.80 2.38 4.36 1.80 2.38 4.36 Liver cancer 155 C22 1.45 3.03 3.60 1.45 3.03 3.60 Breast cancer 1.14 1.41 1.59 Under 45 years of age 174 C50 1.15 1.41 1.46 45 years and over 1.14 1.38 1.62 Other neoplasms 210-239239 D00-D48D48 1.10 1.30 1.70 1.10 1.30 1.70 Diabetes mellitus 250 E10-E14E14 0.92 0.87 1.13 1.00 0.57 0.73 Rehm et al. NIAAA: Understanding the impact of alcohol on human health and well-being, 2003
Relative Risk of Major Chronic Disease Categories, by Gender and Average Drinking Category Disease ICD-9 code ICD-10 code Digestive diseases 530-579579 K20-K92K92 I Females II Drinking Category Males III I II Cirrhosis of the liver 571 K70, K74 1.26 9.54 9.54 1.26 9.54 9.54 III Neuropsychiatric conditions Unipolar major depression 290-319, 324-359359 F01-F99, F99, G06-G98G98 300.4 F32-F33F33 RR not available; AF could not be determined otherwise (Rehm et al., in press b) Epilepsy 345 G40-G41G41 1.34 7.22 7.52 1.23 7.52 6.83 Alcohol use disorders 291, 303, 305.0 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
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 390-459 I00-I99I99 diseases (CVD) Hypertensive disease 401-405405 I10-I13I13 1.40 2.00 2.00 1.40 2.00 4.10 Coronary heart disease 410-414414 I20-I25I25 0.82 0.83 1.12 0.82 0.83 1.00 Cerebrovascular disease 430-438438 I60-I69I69 Ischemic stroke 0.52 0.64 1.06 0.94 1.33 1.65 Hemorrhagic stroke 0.59 0.65 7.98 1.27 2.19 2.38 Other CVD causes 415-417, 417, 423-424, 424, 426-429, 429, 440-448, 448, 451-459459 I00, I26- I28, I34- I37, I44- I51, I70- I99 1.50 2.20 2.20 1.50 2.20 2.20 Rehm et al. NIAAA 2003
*Oxid., FMD, Coag., LF and IS, the Heart and Fat Tissue Kiechl et al. Circulation 2014;130:383-386386 Proposed Mechanistic Insights into Protective* (green) as well as Injurious (red) Effects of Alcohol
Di Castelnuovo, A. et al. Arch Intern Med 2006;166:2437-24452445 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%)
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;166:2437-2445.
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
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 (0.80-0.86) for those consuming 2.5-14.9 g/day
Association of Alcohol Consumption With CV or Total Mortality in CVD Patients Study Country No. Sex Follow-up, y Primary Event Secondary Event Doll, 1994 18 UK 5402 Men 13.0 CVD+CV-RF Thun, 1997 19 USA 152240 Both 9.0 CVD+CV-RF Janszky, 2008 20 Sweden 1346 Both 8.6 AMI Masunaga, 2006 21 Japan 3845 Men 1.1 AMI Aguilar, 2004 22 USA 2036 Both 3.5 AMI Jackson, 2003 23 USA 1320 Men 4.5 Stroke Mukamal, 2001 25 USA 1913 Both 3.8 AMI Shaper, 2000 25 UK 596 Men 12.8 CHD Valmadrid, 1999 26 USA 262 Both 12.3 ACS Muntwyler, 1998 27 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;121:1951-19591959
Relative Risk of Cardiovascular Mortality Relative Risks of Cardiovascular Mortality with 1.4 Different Intakes of Alcohol in CVD Patients 1.2 1 0.8 0.6 0.4 0.2 0 5 Funded by ERAB 10 15 20 25 30 35 40 Alcohol Consumption (grams/day) Janszky, 2008 Aguilar, 2006 Jackson, 2003 Mukamal, 2001 Shaper, 2000 Valmadrid, 1999 Muntwyler, 1998 Costanzo et al. Circulation 2010;121:1951-19591959
Relative Risk of All-Cause Mortality Relative Risks of Total Mortality with Different 1.4 Intakes of Alcohol in Studies of CVD Patients 1.2 1 0.8 0.6 0.4 0.2 0 5 10 15 20 25 30 35 40 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;121:1951-19591959
Mukamal et al. JAMA 2001;285:1965-19701970 Survival Following Acute Myocardial Infarction (AMI) According to Average Alcohol Consumption
Mukamal et al. JAMA 2001;285:1965-19701970 Hazard Ratios for Mortality Following Acute Myocardial Infarction According to Alcohol Consumption
Mukamal et al. JAMA 2001;285:1965-19701970 Hazard Ratios for All-Cause Mortality According to Alcohol Consumption by Predominant Beverage Type*
Pai et al. Eur Heart J 2012;33:1598-16051605
Pai et al. Eur Heart J 2012;33:1598-16051605 Baseline Lifestyle and Clinical Characteristics of 1818 Men with Incident Non-Fatal MI in the HPFU Study
Pai et al. Eur Heart J 2012;33:1598-16051605 Long-term Alcohol Intake and Risks for Total Death and CVD Death Among 1818 Men with Incident Non-Fatal MI
Pai et al. Eur Heart J 2012;33:1598-16051605 Beverage-specific Long-term Alcohol Consumption and Risks of Total Death Among 1818 Men with Incident Non-Fatal MI
Zaridze et al. Lancet 2014;383:1465-14731473 All-Cause Mortality, Males Aged 15-5454 Years, in Russia From 1980-2012 and in the UK From 1980-2010
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;55:1336-13391339
Department of Cardiology University of Ulm Medical Center The New York Times, Sunday May 8, 2005 University of Ulm Medical Center
Alcohol Consumption in Relation to MI Diagnosis Pai et al. Eur Heart J 2012;33:1598-16051605
Kaplan-Meier Estimates of Survival After Acute MI Among Binge Drinkers and Nonbinge Drinkers* *matched by Propensity Score Mukamal et al. Circulation 2005;112:3839-38453845
Mukamal et al. Circulation 2005;112:3839-38453845 Adjusted HRs for Mortality After Acute MI According to Binge Drinking and Usual Alcohol Intake
Mukamal et al. Circulation 2005;112:3839-38453845 HRs and 95% CIs for All-Cause, Cardiovascular, and Noncardiovascular Mortality After Acute MI According to Drinking Among Onset Study Participants
Mukamal et al. Circulation 2005;112:3839-38453845 Additional Adjusted Analyses of Binge Drinking and Total Mortality Among Onset Study Participants
Pai et al. Eur Heart J 2012;33:1598-16051605 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