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EDUCATION AND DEBATE: Martin McKee and Vladimir Shkolnikov Understanding the toll of premature death among men in eastern Europe BMJ 2001; 323: 1051-1055 [Full text]

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Life expectancy in Russia may be bad, but...

Josh Kurutz   (3 November 2001)

Alcohol consumption, homocysteine and premature death among men in eastern Europe

Stefan Bleich, Kirsten Bleich, Detlef Degner, Wolfgang Sperling, Johannes Kornhuber   (3 November 2001)

Graph was mislabelled

Martin McKee   (5 November 2001)

Life expectancy in Russia may be bad, but... 3 November 2001
Josh Kurutz, Postdoctoral associate University of Chicago, Chemistry Department Send response to journal: Re: Life expectancy in Russia may be bad, but...	The article by McKee and Shkolnikov is certainly effective at conveying the idea that life expectancy for men in the former Soviet Union is very low, but I suspect they are exaggerating the point. I do not know exactly how many Russian infants in 1994 survived their first year, but I reckon that at least a few managed to get to 1995, contrary to Figure 1. Rather than announcing a tragedy for male babies on Biblical proportions, I propose that the authors probably intended the bottom of the y-axis to read "60," not "0." Please print a correction soon. Russian mothers will thank you for it.
Alcohol consumption, homocysteine and premature death among men in eastern Europe 3 November 2001
Stefan Bleich, medical doctor, postdoctorade research Department of Psychiatry and Psychotherapy,University of Erlangen-Nuremberg,Germany, Kirsten Bleich, Detlef Degner, Wolfgang Sperling, Johannes Kornhuber Send response to journal: Re: Alcohol consumption, homocysteine and premature death among men in eastern Europe	Stefan Bleich, M.D., Kirsten Bleich M.D., *Detlef Degner, M.D., Wolfgang Sperling, M.D., Johannes Kornhuber, M.D. Departments of Psychiatry and Psychotherapy, Friedrich-Alexander- University of Erlangen-Nuremberg, *Georg-August-University of Göttingen Germany EDITOR - We read with interest the study reported by McKee and Shkolnikov in the November 2001 issue of the BMJ (1). The authors concluded that the leading causes of the high mortality of premature death among men in eastern Europe were injuries, violence and cardiovascular diseases. Furthermore, high levels of alcohol consumption, especially binge drinking, were an important underlying factor. In addition to the article we would like to emphasize the influence of alcohol consumption on the level of plasma homocysteine. Pathologically raised levels of plasma homocysteine have been reported in patients suffering from chronic alcoholism (2), during the withdrawal state (3), and in social drinkers (4), whereas normal levels were found in patients with alcohol intoxication who where not alcohol-dependent (5). As reported lately (4) we found abstinent individuals to have significantly lower levels of endogenous homocysteine when compared with consumers of beer, red wine or spirits daily. It has been proposed that ethanol-induced hyperhomocysteinemia could be a significant risk factor for the increased incidence of coronary artery disease and stroke related to high alcohol consumption (6), since evidence from observational studies suggests that elevated levels of homocysteine are associated with an increased risk of cardiovascular and cerebrovascular diseases including acute myocardial infarction, thrombosis and stroke (7). We think hyperhomocysteinemia should be considered as an important risk factor for cardiovascular diseases leading to premature death among men in eastern Europe, especially taking into account the high incidence of alcohol dependence in these countries. References 1.McKee M, Shkolnikov V. Understanding the toll of premature death among men in eastern Europe. BMJ 2001; 323: 1051-55. 2.Cravo ML, Glória LM, Selhub J, Nadeau MR, Camilo ME, Resende MP, Cardoso JN, Leitao CN, Mira C. Hyperhomocysteinemia in chronic alcoholism: correlation with folate, vitamin B-12, and vitamin B-6 status. Am J Clin Nutr 1996; 63:220-24. 3.Bleich S, Degner D, Wiltfang J, Maler JM, Niedmann P, Cohrs S, Mangholz A, Porzig J, Sprung R, Rüther E, Kornhuber J. Elevated homocysteine levels in alcohol withdrawal. Alcohol Alcohol 2000; 35:351-54. 4.Bleich S, Bleich K, Kropp S, Degner D, Bittermann, HJ, Sperling W, Rüther E, Kornhuber J. Moderate alcohol consumption in social drinkers raises plasma homocysteine levels: a contradiction to the "French paradox"? Alcohol Alcohol 2001; 36: 189-192. 5.Bleich S, Degner D, Kropp S, Rüther E, Kornhuber J. Red wine, spirits, beer and serum homocysteine. Lancet 2000; 356 (9228):512. 6.Bleich S, Degner D. Whole blood folate, homocysteine in serum, and risk of first acute myocardial infarction. Atherosclerosis 2000; 150:441-42. 7.Nygĺrd O, Nordrehaug JE, Refsum H, Ueland PM, Farstad PM, Vollset, SE. Plasma homocysteine levels and mortality in patients with coronary artery disease. New Eng J Med 1997; 337:230-36. Corresponding author: Dr. Stefan Bleich, M.D Department of Psychiatry and Psychotherapy Friedrich-Alexander-University of Erlangen-Nuremberg Schwabachanlage 6-10 91054 Erlangen/ Germany Tel: ++49-9131-853-4612 Fax: ++49-9131-853-6592 Email: stefan.bleich@t-online.de
Graph was mislabelled 5 November 2001
Martin McKee, Professor of European Public Health London School of Hygiene and Tropical Medicine Send response to journal: Re: Graph was mislabelled	Dr Kurutz is, of course, correct in assuming that the Y axis in figure 1 has been mislabelled. Having just checked the original file, I can confirm that the graph sent to the BMJ began at 60 and went to 80, not 0 to 80 as it appeared in the final version. Unfortunately we only saw the text, not the graphs at the proof stage. In posting this, perhaps the BMJ could make the necessary erratum. Martin McKee