Alcohol and chronic diseases: complex relations

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Alcohol and chronic diseases: complex relations. Guillemont J. Conference on Cardiovascular Diseases (Madrid: Ministry of Health and Social Policy; 2010).

Alcohol and chronic diseases: complex relations. Guillemont J. Conference on Cardiovascular Diseases (Madrid: Ministry of Health and Social Policy; 2010).

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  • 1. Alcohol and chronic diseases: complex relations Juliette Guillemont, Alcohol Programme Coordinator National Institute for Prevention and Health Education (Inpes, France) Conference on cardiovascular diseases Madrid, 18 February 2010
  • 2. 2 • Alcohol and cancer • Alcohol and CVD • Alcohol and chronic diseases in public health policies
  • 3. 3 Alcohol and cancer: the fruit of collective expertise (1/2) • WHO International Agency for Research on Cancer (IARC) monographs: – 1988: Alcohol drinking – 1999: Acetaldehyde – 2007: Ethanol in alcoholic beverages • World Cancer Research Fund (WCRF) and American Institute for Cancer Research (IARC): – 1st report on food, nutrition and the prevention of cancer in 1997 – 2nd report in 2007
  • 4. 4 Alcohol and cancer: the fruit of collective expertise (2/2) • IARC (Monograph n°96, to be published) – Alcoholic beverages and ethanol in alcoholic beverages are carcinogenic to humans (Group 1) – Causal link between alcohol consumption and the occurrence of malignant tumours of the oral cavity, pharynx, larynx, oesophagus, liver, colorectum, and female breast • WCRF/AICR: – Increase of the risk of several cancers: UADT (mouth, pharynx, larynx, oesophagus), colon- rectum, breast, liver – No threshold observed – No significant difference depending on the type of drink
  • 5. 5 Alcohol and CVD: what we know about harmful effects • Alcohol: – raises blood pressure and increases the risk of hypertension in a dose dependent manner – increases the risk of haemorrhagic stroke • Episodic heavy drinking: – is an important risk factor for both ischaemic and haemorrhagic stroke – increases the risk of heart arrhythmias and of sudden coronary death Anderson & Baumberg, 2006
  • 6. 6 Alcohol and hypertension Relative risks of hypertension by alcohol intake (Corrao et al., 1999 in Anderson & Baumberg, 2006)
  • 7. 8 Alcohol and coronary heart disease (1/2) • J curve: – Alcohol in low doses (< 20g/day) reduces the risk of coronary heart disease – High doses increase the risk • Plausible biochemical basis: – Alcohol consumption raises levels of HDL cholesterol, which removes fatty deposits in blood vessels – Moderate alcohol intake favourably affects blood clotting profiles – Independant of beverage type Anderson & Baumberg, 2006
  • 8. 9 Alcohol and coronary heart disease (2/2) Dose response relationship between reported alcohol consumption and the relative risk of CHD obtained by pooling 28 higher quality cohort studies (Corrao et al., 2000 in Anderson & Baumberg, 2006)
  • 9. 10 Alcohol and coronary heart disease Alternative explanations • Abstainers include people who have reduced or stopped drinking, due to ageing and ill health – Error-free studies find no significant protection • Unhealthier lifestyle in abstainers – Diet, physical activity, smoking – Education, income, mental health etc. Anderson & Baumberg, 2006
  • 10. 11 Alcohol and coronary heart disease Alternative explanations Risk of death from CHD according to reference groups Stockwell et al., 2007 Type of study Number OR p Men ≤ 44 g/day All studies together 32 0.845 < 0.0001 Lifelong abstainers + ex-drinkers + occasional drinkers 24 0.792 < 0.0001 Lifelong abstainers + ex-drinkers 6 0.892 NS Lifelong abstainers 2 1.11 NS Women ≤ 24 g/day All studies together 13 0.792 < 0.0001 Lifelong abstainers + ex-drinkers + occasional drinkers 9 0.888 < 0.02 Lifelong abstainers + ex-drinkers 3 0.749 < 0.05 Lifelong abstainers 1 0.779 NS
  • 11. 12 What about the French paradox? • The French paradox was born in 1981 • France vs. Nordic countries: – Lower coronary heart mortality – Similar levels of saturated fat intake • Proposed explanation: high wine consumption
  • 12. 13 What about the French paradox? Alternative explanations • Underestimate of coronary heart disease – Coronary heart death in MONICA study >> national statistics – No French specificity: rates of coronary events in French regions are similar to those in regions of other countries but of similar latitude (North-South gradient) • Misestimate of lipid intake – MONICA study: eating habits in France are healthier than in Nordic countries
  • 13. 14 What about the French paradox? Alternative explanations Mean standard rates of coronary events and coronary deaths in MONICA and coronary deaths according to national satistics in 8 countries (men 35-64; 1985-1994). Source: MONICA Coronary mortality Coronary events national (MONICA) MONICA statistics UK (Belfast + Glasgow) 736 322 306 Finland (Kuopio + Karelia + Turku) 701 329 319 Belgium (Ghent + Charleroi) 417 199 117 Germany (Augsburg + Bremen + East) 339 174 139 France (Lille + Strasbourg + Toulouse) 274 134 74 Italy (Brianza + Friuli) 266 112 101 Switzerland (Vaud/Fribourg + Ticino) 261 91 89 Spain (Barcelona) 210 76 63
  • 14. 17 Disease burden attributable to alcohol Deaths attributable to alcohol consumption in the world in 2002 (WHO, 2007) % of deaths as a proportion of the Number of deaths (thousands) deaths attributable to the disease Disease category categories listed Males Females Total Males Females Total Deaths caused Maternal and perinatal conditions (low birth weight) 1 1 3 0,1 0,3 0,1 Cancer 361 105 466 18,7 25,0 19,8 Diabetes mellitus 0 1 1 0,0 0,2 0,0 Neuropsychiatric disorders 106 25 130 5,5 5,9 5,5 Cardiovascular diseases 452 77 528 23,3 18,2 22,4 Cirrhosis of the liver 293 77 370 15,2 18,2 15,7 Unintentional injuries 501 96 597 25,9 22,7 25,3 Intentional injuries 220 40 260 11,4 9,6 11,1 Total “detrimental effects” attributable to alcohol 1 934 421 2 355 100,0 100,0 100,0 Deaths prevented Diabetes mellitus -8 -5 -12 7,7 3,5 5,3 Cardiovascular diseases -90 -130 -220 92,3 96,5 94,7 Total “beneficial effects" attributable to alcohol -98 -135 -232 100,0 100,0 100,0 All alcohol-attributable net deaths 1 836 287 2 123 100,0 100,0 100,0 All deaths 29 891 27 138 57 029 Net deaths attributable to alcohol as a percentage of all deaths 6,1% 1,1% 3,7%
  • 15. 18 Who would like to take care of their heart with a carcinogenic product?
  • 16. 19 Chronic diseases in French public health policies • Action plan to enhance quality of life in patients with chronic diseases • Action plans for specific chronic diseases: cancer, Alzheimer disease, rare diseases etc. • No specific strategy for CVD: – Actions plans on CVD determinants: nutrition & physical activity, addictions etc. – Generate less fear than other diseases? – Alleged low level of cardiovascular mortality
  • 17. 20 Alcohol in French public health policies • Alcohol is addressed in various action plans: – Prevention and treatment of addictions – Government plan against drug and drug addiction – Youth health – Cancer – National Nutrition & Health Programme • No comprehensive strategy on alcohol but 2 objectives: – To decrease mean alcohol consumption – To decrease the incidence of hazardous and harmful drinking
  • 18. Effectiveness of alcohol policies Adapted from Babor et al., 2003