Understanding the toll of 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.Nygård 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