Rapid Responses to:

EDITORIALS: Annie Britton How much and how often should we drink? BMJ 2006; 332: 1224-1225 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Why Legislation?

Aidan P Gill   (26 May 2006)

Protecting the heart may not protect public health

Rahul Rao   (26 May 2006)

Alcohol intake to reduce cardiovascular risks

Dietmar Fuchs, Katharina Schroecksnadel   (2 June 2006)

Good prospects for Russia?

Bjarne H Wik   (27 June 2006)

Why Legislation? 26 May 2006
Aidan P Gill, Medical Director Omnicare Clinical Research, SN14 6NQ Send response to journal: Re: Why Legislation?	We drink 76% of the amount of alcohol as the French and correspondingly we suffer 70% of the amount of Liver Cirrhosis. Unfortunately the rest of the statistics don't follow with the same equality. We only have half the rate of Mouth and Oropharynx Cancer and 40% of the Traffic casualities due to alcohol. Furthermore we suffer 2.8 times the rate of Ischaemic Heart Disease, yet, as men, we live, on average, a year longer, sadly our women live 2 years less than our French cousins. Annie Britton rightly suggests that people need educating on the potential benefits and potential risks to health of drinking alochol, but why do we need the 'Nanny State' legislating to force us to adhere to guidelines on 'Safe limits' when the research cannot agree on what is a safe limit. APG Competing interests: None declared
Protecting the heart may not protect public health 26 May 2006
Rahul Rao, Consultant/Senior Lecturer in Old Age Psychiatry York Clinic, Guy's Hospital, London SE1 3RR Send response to journal: Re: Protecting the heart may not protect public health	Editor Dr Britton raises the profile of what will continue to be an informed debate over the role of alcohol in protecting the heart from vascular disease. However, the picture is not complete and, as she points out, there is the potential for the media to take a rather skewed view of the benefits of drinking. In older people, the harmful effects of alcohol may be manifest in ways other than cardiac events. For example, 50% of older people with alcohol misuse present to secondary care services with falls [1]. The cardioprotective message is also clouded by the lack of any clear evidence that alcohol is beneficial to older people's health in general. There has been a steep increase in the prevalance of alcohol misuse in older people in the UK over the past 20 years, with a rise of 50% in men and a staggering 100% rise in women. Coupled with a projected rise in over 65s of 50% between 2001 and 2031, there is a risk of a greater public health burden in years to come There may be alternatives to reducing cardiovascular risk, other than the use of a psychoactive drug with the potential for adverse non-cardiac effects. Futhermore, on a public health level, the 'prevention paradox' suggests that it is those older people drinking at moderate levels who may pose the greatest public health burden [2]. The media, government and drinks industry would do well to consider the bigger picture of alcohol- related burden in people approaching their 60s, before potentially misinforming the public of the benefits of alcohol. REFERENCES [1] Mulinga JD. Elderly people with alcohol-related problems: where do they go? Int J Geriatr Psychiatry 2000;14:564-66. [2] Kreitman N. Alcohol consumption and the preventive paradox. Br J Addict 1986;81:353–63. Competing interests: None declared
Alcohol intake to reduce cardiovascular risks 2 June 2006
Dietmar Fuchs, Innsbruck Medical University 6020 Innsbruck, Austria, Katharina Schroecksnadel Send response to journal: Re: Alcohol intake to reduce cardiovascular risks	This study confirms and extends earlier observations that intake of alcoholic beverages is associated with reduction of coronary heart disease (1). The conclusion that alcohol is the primary denominator of outcome deserves some further comment. It is obvious that individuals do not drink diluted alcohol, rather they drink alcoholic beverages like beer or wine. These beverages contain huge amounts of compounds which are suspected to possess anti-inflammatory potential, e.g. flavonoids or stilbenes. Recently it has been found in vitro that extracts of these beverages inhibit biochemical pathways related to Th1- type immune response and pro- inflammatory cytokine interferon-gamma (2, 3). In the same studies it was also demonstrated that grape juice and alcohol-free beer have almost identical potential to interrupt inflammatory cascades like beer or wine, whereas ethanol was effective only at much higher concentrations. Inflammation is an important driving force for coronary heart disease, as it is for neurodegenerative diseases like dementias. Not surprisingly, alcohol consumption was also found to reduce development and progression of dementia (4). Putting these different aspects together, it seems that it is not the intake of alcohol but the intake of compounds which are preserved in alcoholic beverages and reduce the risk of coronary heart disease. In adults, alcoholic beverages are more popular than non- alcoholics. From available scientific pilot studies (5-7), it rather appears that there is no need to recommend the intake of alcohol. Once non -alcoholic beverages are adequately advertised they could easily replace alcoholics. However, this hypothesis should of course first be tested in longitudinal studies. Even though in ancient times, alcohol content of beverages was the only way to preserve them from decay, new substances might prove as effective as alcohol without severe side effects on over- dosage. Katharina Schroecksnadel, Dietmar Fuchs Department of Internal Medicine and Division of Biological Chemistry, Biocentre Innsbruck Medical University, 6020 Innsbruck, Austria 1. Rimm EB, Giovannucci EL, Willett WC, Colditz GA, Ascherio A, Rosner B, et al. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet 1991;338:464-8. 2. Neurauter G, Wirleitner B, Schroecksnadel K, Schennach H, Fuchs D. Wine and grape juice modulate interferon-gamma-induced neopterin production and tryptophan degradation in human PBMC. Pteridines 2004;15:1- 9. 3. Winkler C, Wirleitner B, Schroecksnadel K, Schennach H, Fuchs D. Beer down-regulates activated peripheral blood mononuclear cells in vitro. Intern Immunopharmacol 2006;6:390- 395. 4. Ruitenberg A, van Swieten JC, Witteman JC, Mehta KM, van Duijn CM, Hofman A, et al. Alcohol consumption and risk of dementia: the Rotterdam Study. Lancet 2002;359:281-6. 5. Stein JH, Keevil JG, Wiebe DA, Aeschlimann S, Folts JD. Purple grape juice improves endothelial function and reduces the susceptibility of LDL cholesterol to oxidation in patients with coronary artery disease. Circulation 1999;100:1050-5. 6. Folts JD. Potential health benefits from the flavonoids in grape products on vascular disease. Adv Exp Med Biol 2002;505:95-111. 7. Karatzi K, Papamichael C, Aznaouridis K, Karatzis E, Lekakis J, Matsouka C, et al. Constituents of red wine other than alcohol improve endothelial function in patients with coronary artery disease. Coron Artery Dis 2004 ;15:485-90. Competing interests: None declared
Good prospects for Russia? 27 June 2006
Bjarne H Wik, Retired researcher Chr. Tommtersveg 3B 2005 Rælingen, NORWAY Send response to journal: Re: Good prospects for Russia?	When looking to the drastic decrease in aging of Russian men during the last 10 to 20 years, and to the rise in alcohol consumption in the male part of the population during the same period, we should now have hope for less cardiac diseases among elderly men in this country. But will this be due to the intake of alcohol among these men, or to the fact that there are less and less men becoming older than 50 years in Russia? With regards Bjarne Wik Competing interests: None declared