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Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j909 (Published 22 March 2017) Cite this as: BMJ 2017;356:j909

Re: Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records

One of the clinical and public health implications of the article by Dr. Bell and co-authors is that “if a patient reports heavy drinking they can be informed that if they continue to do so they have an increased risk of initial presentation withischaemic stroke, heart failure, cardiac arrest, transient ischaemic attack, intracerebral haemorrhage, or peripheral arterial disease, as well coronary death with no previous symptoms” [1]. It is very important as some middle-age people face an everyday dilemma “to drink or not to drink”, supposed health benefits from drinking being a weighty argument. There may be international differences. Autopsy has been obligatory in Russian hospitals; and anatomic pathologists generally perform many autopsies of alcoholics. There is a broadly accepted opinion among pathologists here that heavy drinkers and alcoholics tend to have smooth aorta and large arteries i.e. less pronounced atherosclerosis than it can be expected at the given age. Admittedly, such statements are difficult to find in Russian literature probably because the literature is influenced by anti-alcohol policies [2]. This phenomenon can be mechanistically explained by poor diets of many alcoholics and heavy drinkers i.e. below average consumption of animal fat.

Conclusion for further research: studies of cardiovascular effects of heavy drinking should take into account the diet. It can be reasonably assumed that in a study, where cases (heavy drinkers) and controls would be matched by animal fat consumption, alcohol-related cardiovascular risks would turn out to be higher.

References
1. Bell S, Daskalopoulou M, Rapsomaniki E, George J, Britton A, Bobak M, Casas JP, Dale CE, Denaxas S, Shah A4, Hemingway H. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ. 2017;356:j909. doi: 10.1136/bmj.j909.
2. Jargin, S. Alcohol and alcoholism in Russia: Policies and their effects. Archives Medical Review Journal 2017;26:207-22. doi: 10.17827/aktd.280541

Competing interests: No competing interests

11 April 2017
Sergei Jargin
medical reviewer
Clementovski per 6-82