Easiest Way To Quit Alcohol

Alcohol Free Forever

This powerful guide walks you step-by-step through exactly what you need to do to free yourself from your alcohol addiction without going through AA meetings or expensive sessions. There are three main types of relaxation techniques you can practice when you feel upset and stressed. If you practice regularly, they will become part of your lifestyle and you may find yourself habitually more relaxed as a result. Part 2 will exercise Neuro Linguistic Programming to release thoughts and a technique of progressive muscle relaxation also negative situations. Because of the mind body connection, exercises to relax the body will also flow through the mind. Much of the stress we feel is because of our resistance to certain feelings or emotions. Alcohol Free Forever is a lifesaver ebook. This guide was extremely eye-opening and the daily emails make it extremely easy to quit and to establish a routine that did not involve alcohol. Read more here...

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Measurements ofalcohol intake

Alcohol consumption based on self-reported data consistently account for only 40-60 of alcohol purchases 43 , The greatest problem facing alcohol research is the lack of a reference standard with which to validate self-reported drinking. Collateral reports by significant others do not necessarily provide better information 43 , Biochemical markers, which are useful in the diagnosis of alcoholism and recent drinking, cannot be used to estimate absolute alcohol intake at an individual level. Most observational studies ask the respondents to recall their usual intake over a long period of time, say 1 month or 1 year. This approach is likely to yield information about modal frequencies and quantities and thus underestimate average intake. On the other hand, recalling the actual intake during all actual drinking occasions over a short period of time (e.g., 24 hours) ignores the day-to-day variations in alcohol consumption. Among the five main methods used to assess alcohol intake i.e.,...

Are Female Animal Models Of Alcoholism Helpful In Evaluating The Adverse Effects Of Alcohol

Female animal models of alcoholism should be used to study the effects oflong-term alcohol exposure. However, investigators need to consider variables such as the level concentration of ethanol intake, the pattern of weight gain as well as the absolute weight gain, and hormone levels. As noted above, we have found that female rodents drink less alcohol than male rodents (Table 4.6). Our findings differ from those of others, who have reported that female rodents drink more than male rodents 38,39 , In addition, the pattern of drinking appears to be different between cohorts of female animals (Figure 4.4). Lieber DeCarli liquid diet intake is shown in Figure 4.4 for two different cohorts of female rats one group drank for 5 months (preliminary data above) and another drank for 8 months (ongoing studies). Similar to others, we found that in both cohorts of female rats the average daily amount of diet consumed was variable 39 , However, the average daily ethanol intake (gm day) in the...

Alcohol Consumption And The Risk Of Stroke

There is plenty of evidence that heavy drinking (> 60 g day) is related to increased risk ofboth hemorrhagic 19 and ischemic strokes 1,3,7,8,10-12 . In contrast, light ( 24 g day for men and 12 g day for women) and moderate (25-60 g day for men and 13-48 g day for women) drinking does not seem to increase and may even decrease the risk of stroke compared with non-drinking 7,13,14 . However, in order to understand the relationship between alcohol and the risk of stroke, one has to separately examine the effects of alcohol on each stroke subtype (i.e., subarachnoid and intracerebral hemorrhage, and cerebral infarction), the dose-response curve most probably differing from one subtype to another. The risk of subarachnoid hemorrhage seems to increase steeply with increasing alcohol consumption 7,15 , The relationship between alcohol and the risk of intracerebral hemorrhage is poorly known but may be U-shaped with lowest risk among light to moderate drinkers 7-9 , and that of ischemic...

Alcohol Abuse And Cardiovascular Disease

Although there is considerable evidence that moderate drinking protects against mortality and morbidity from coronary heart disease 21,22 , heavy consumption is shown to have deleterious cardiovascular effects. It exerts its adverse effects by increasing the risks of cardiomyopathy, hypertension, and stroke 23 , Chronic ethanol consumption has been linked to the prevalence of hypertension, which contributes to an increased incidence of stroke. Heavy drinkers have alO mmHg higher systolic blood pressure than non-drinkers even though the relationship may differ between men and women 24 , Stroke is a leading cause of death and morbidity. Alcohol may increase the risk of stroke through various mechanisms that include hypertension, hypercoagulable states, cardiac arrhythmias, and cerebral blood flow reductions 25 , Hypertension, including borderline hypertension, is probably the most important stroke risk factor based on degree of risk and prevalence. Furthermore, cardiac morbidity,...

Do You Have a Drinking Problem

If you have any doubt about your level of alcohol consumption or your ability to control it, consider these questions If you answered yes to any of these questions, you may be addicted to alcohol. If you think that you or someone you love has a drinking problem, seek help immediately. Stopping now will significantly improve your life and your health, no matter how long you have been drinking. Here is how you can get help Ask your doctor for the name of a healthcare professional who specializes in treatment for alcohol dependency. Call the employee assistance program where you work. Call nearby hospitals or a local mental health center to ask if they provide a program for alcohol addiction. Call the local chapter of AA, a support group of alcoholics who meet regularly to help each other stop drinking and stay sober. If you are concerned about the drinking of a family member or a friend, call the local chapter of Al-Anon, a support group for relatives and friends of alcoholics.

Alcoholism In Women And Incidence Of Ahmd

Compared to men, women drink less and experience less alcohol-related medical problems 6 , However, one third of all alcoholics in the United States are women 6 , Over the last two decades, there is no evidence of any major increase in total alcohol consumption by women, however there has been an important change in the drinking patterns and prevalence of alcohol usage among women 7 , With regard to drinking patterns, younger women report frequent heavy drinking and frequent bouts of intoxication 8 , In addition, alcohol usage has increased among women who are employed full-time in nontraditional settings and among those who are unemployed and divorced 9 , This is of concern, because of the increase in the number of women in the work force as well as the number of women who are unemployed and divorced. Therefore, in the future, more women may experience alcohol-related medical problems. In the United States, long-term excessive alcohol consumption (of any beverage type) in both sexes...

Alcohol and CHD mortality

The observed relationship between alcohol intake and CHD death has been reported to be linear (direct or inverse), L-shaped, U-shaped, or showing no relation. In the 5-year follow-up study of 4,532 middle-aged Finnish men 30 , non-drinkers had the lowest CHD mortality. Increased alcohol intake was associated with increased age-adjusted CHD mortality, especially in men with prior CHD. The opposite was reported in the post-trial follow-up of the Multiple Risk Factor Intervention Trial 25 , The original 5-year trial was to determine the effects of multifactor intervention on death from CHD in a population of high-risk men randomly assigned either to a special intervention program or to their usual sources of medical care in the community. The post-trial follow-up was conducted in 11,488 men who did not develop CHD and survived to the end of the trial. A reverse dose-response relationship between alcohol intake and CHD death rate was found 25 , Many studies have found an L-shaped pattern...

Alcohol and sudden cardiac death

Evidence for a strong association between alcohol and sudden death has been reported among problem drinkers 37,38 , Findings among population studies published in the 1980s were, however, inconsistent. A positive association between alcohol consumption and the incidence of sudden coronary death was detected in the cohort of 4,532 Finnish men with or without prior CHD 30 , No association was found in the Puerto Rico Heart Health Program 10 , the Yugoslavia Cardiovascular Disease Study 11 , and the Framingham Heart Study 39 , The numbers of sudden deaths were small in these reports, however. In the Physicians Health Study, men who consumed light-to-moderate amounts of alcohol (2-6 drinks per week) had a significantly reduced risk of sudden cardiac death compared with those who rarely or never consumed alcohol 16 . Only 3 of the physicians drank 2 or more drinks per day. Men in this open-end category had neither an increase nor a reduction in risk. About 11 of men in the British Regional...

Inherent weakness in observational studies

Consistency is often cited as one of the criteria making an observed association more likely to be causal. However, results from studies with the same design can be wrong or artefactual and remain consistent. Most population studies rely on volunteers. This may bias the study samples toward cooperative persons, who are, perhaps, more health conscious than nonparticipants. The heaviest drinkers are not likely to be included in the large cohort studies and this may diminish the role ofheavier drinking in the overall results. Studies on the highly educated and health conscious groups 12-19,29,35 are more likely to miss the up-turn of a J-shaped relationship between alcohol and outcome. The most fundamental weakness in the observational studies is that the preference and quantity of alcohol intake are entirely self-determined by the participants. Hence, all reports on the benefit of small-to-moderate alcohol consumption to cardiovascular disease reduction are referenced to those who are...

Unhealthy abstainers question

A large proportion of abstainers (non-drinkers) are ex-drinkers 46 , Men who were heavier drinkers are more likely to reduce their alcohol consumption as they grow older 46-48 , This is at least in part associated with the accumulating burden of ill-health and medication as people grow older 49 , The British Regional Health Study suggested a strong downward drift from heavy or moderate drinking to occasional drinking or abstinence under the influence of accumulating ill-health not necessarily related to alcohol intake 47 , Ex- and never-drinkers were more frequently unmarried and had the highest prevalence rates of angina, ECG abnormalities, elevated blood pressure, and several other chronic conditions 50,51 , Thus, abstainers may constitute a misleading reference category for the analysis of the relation between alcohol and disease, and for the interpretation of alcohol-related dose-risk relations, leading to underestimates of alcohol-related effects or overestimates of...

Drinking patterns and beverage types

Drinking patterns have been studied surprisingly little. Yet, drinking patterns vary and are of obvious health relevance. The frequency of drunkenness, the frequency ofhangover and morning drinking have been found to be related to mortality from several causes 54 , Changes in drinking between years may influence mortality 9,55 . Most reports classify participants using a total consumption variable (e.g., drinks per day) based on estimates of customary drinking frequency and amount of alcohol consumed on a typical occasion. This does not quantify variability in drinking frequency or amount consumed binge drinkers may be classified with controlled, regular drinkers on the basis of their common average daily alcohol intake. Because the health effects of moderate drinking may depend on drinking pattern, failure to differentiate between binge drinkers and regular drinkers may obscure real associations. Type ofbeverage may have a role even if the amount of ethyl alcohol imbibed is the same....

What is moderate drinking

While it is generally agreed that we should do all things in moderation 58 , there is less agreement about the precise definition of 'moderate' drinking. Use of different sets of drinking categories in different reports has resulted in different interpretations, and the number and boundaries of categories appears to be determined by the sample size available in the study. Classification of moderate alcohol consumption ranges from a half a drink per day (or less) in some studies, up to six drinks a day in others 59 , Data from the National Health Interview Survey 52 demonstrated that people with different drinking habits perceived 'moderate' drinking differently. Only 25 of men who drink 3 or more drinks per day, in comparison to 56 of other men, considered 2 or fewer drinks per occasion as moderate. Likewise, only 6 of the women who drink at least 2 drinks per day (vs. 27 of other women) perceived moderate drinking as 1 drink or less per occasion. The National Health and Medical...

Some statistical issues

The non-continuous feature of the measures of drinking habit has limited studies on the alcohol-health relationship to categorical analyses. The categories selected, the number of categories, and the distance between the categories were determined by the available data, the sample sizes and number of outcome events. The clear demonstration of a U- or J-shaped relationship requires a much larger amount of data than is generally appreciated. Some studies have combined all cardiovascular diseases or all types of stroke as the endpoint. This is often necessary because of the small numbers of cases for some of the diagnostic endpoints, but might result in partial cancellation of positive and negative associations. Furthermore, as the result of a loss of power in the categorical analysis, many reports drew conclusions based on visual observation on the trends in relative risks by drinking categories and ignored the results of formal statistical tests. Another drawback of the categorical...

Genuine Alcoholic Cardiomyopathy Asymptomatic Type

There is ample evidence that acute or chronic alcohol ingestion may be a myocardial depressant. There is also evidence that acute or chronic alcohol ingestion may be a skeletal muscle depressant. In one study in asymptomatic alcoholics, almost one third of the men and half of the women showed histologic evidence of deltoid muscle myopathy with accompanying muscle weakness and depression of ejection fraction . Low doses of ethanol, even as little as two cocktails, have been shown to be able to decrease myocardial contractility in normal subjects 2-5 , If the subject is alcoholic or already has some cardiac muscle disease on which alcohol is superimposed, the depressant effect of acute alcohol ingestion is exaggerated 6,7 , Partly responsible for the deleterious effects of alcohol in patients who have cardiac disease is the finding that in such patients alcohol acts as a vasoconstrictor 8 , However, when a decreased afterload is necessary for improving the function of a heart in Class...

British Regional Heart Study

In 1978-80, research nurses administered to each man a standard questionnaire which included questions on frequency, quantity and type of alcohol consumption, smoking habits and medical history. Several physical measurements were made, and blood samples (non-fasting) were taken for measurement of biochemical and haematological variables. All men were followed up for all-cause mortality and cardiovascular morbidity 21 Analysis was restricted to men with no recall of a doctor diagnosis of CHD or stroke (N 7272 men) in whom there were 901 major CHD events and 1308 deaths from all causes (595 cardiovascular and 713 non-cardiovascular) during a mean follow-up period ofl6.8 years. The men were classified into five groups according to their estimated reported weekly intake none, occasional (< 1 unit week), light (1-15 units week) moderate (16-42 units week) and heavy (> 42 units day). One UK unit of alcohol (one drink) is defined as half a pint ofbeer, a single measure of spirits, or a...

What Have Animal Models Taught Us

Animal models of alcoholism have revealed that long-term alcohol consumption is associated with numerous histological and cellular changes in the myocyte. Specific histological changes include myocyte loss and disarray, interstitial and perivascular fibrosis, deposition of lipids with the myocardial tissue, accumulation of fatty acid ethyl esters within intracellular organelles, and mitochondrial and sarcoplasmic reticulum disorganization 22-27 , In terms of cell function, there are reports of altered mitochondrial and sarcoplasmic reticulum function, decreased myofibrillar ATPase activity and decreased calcium sensitivity of the myofilaments 28-32 , In animal models, these changes often precede changes in cardiac structure and function. These studies have been exclusively performed in male animal models. The only exceptions are the studies reported by Lochner and colleagues and Brown and colleagues 33,34 , Therefore, the effects of both acute and chronic alcohol consumption on the...

Ongoing Research In Female Rats

Our laboratory has been studying the effects oflong-term alcohol consumption in both female and male rats. Presented below is preliminary data from our laboratory. The primary aim has been to describe in an animal model (male and female rats) the evolution of alcohol-induced changes in cardiac structure (hypertrophy and dilation) that lead to the development of a cardiomyopathy. The second aim has been to determine if these changes are associated with activation of specific peptide and neurohormonal systems. Preliminary experiments were conducted in male (n 5) and female (n 5) Sprague-Dawley rats which received the Lieber DeCarli liquid diet for 5 months 35 , In brief and as previously described by this laboratory, control (CON) and ethanol (ETOH) groups received The female rats in this study drank a 6.7 vol vol concentration of alcohol as compared to the males, which drank 9 vol vol concentration. Therefore, even though the female group consumed less alcohol (gm day), there were...

Largeartery Atherosclerosis

It is generally thought that thromboembolic strokes are mainly caused by atherosclerotic disease. Atherosclerotic disease is less prevalent among populations regularly consuming alcohol than among binge-drinking populations. The high risk of stroke in a population with a high alcohol intake does not seem to be due to large-artery atherosclerosis 24 , but may be caused by other diseases promoting the onset of stroke, i. e., alcoholic cardiomyopathy. On the other hand, the age-adjusted relation between alcohol intake and carotid artery atherosclerosis has been reported to be U-shaped, with light drinkers facing a lower atherosclerosis risk than either abstainers or heavy drinkers 25 , A strong positive relation between alcohol consumption and the risk of mortality from stroke is apparent 26 , In the Scandinavian countries, binge drinking has been observed to associate with both an increased risk for ischemic stroke mortality 27 and the progression of atherosclerosis 28 , It is therefore...

Cervical Arterial Dissection

Cervical arterial dissection is probably one of the most common causes of ischemic stroke in young subjects. It is diagnosed by imaging with conventional or MR angiography and typically occurs after major trauma, but may also occur spontaneously or after trivial injury. Needless to say, alcoholic intoxication is a major risk factor for all types of trauma. Therefore, it is not surprising that cervical arterial dissections have also been described to have occurred in connection with alcohol abuse 22,37 , Some reports have emphasized that extracranial vessel compression due to unusual posturing during alcoholic stupor or coma could also result in a brain infarct 38-40 , but it has remained unclear whether cervical arterial dissection is the underlying mechanism or not. In at least one of the reported cases dissection was excluded 40 , Surprisingly, case-control studies have not yet been able to prove alcohol as a risk factor for ischemic stroke caused by cervical arterial dissection 13...

Effects Of Light Drinking

Several studies have shown regular light (10-20 g of ethanol daily) or moderate (less than 300 g of ethanol per week) drinking to associate with a decreased risk for ischemic stroke of atherothrombotic origin 43-45 , but the observations on the effects of light and moderate alcohol consumption on stroke mortality have been conflicting 27,46,47 , For example, one study showed light-to-moderate drinking to be associated with a 36 reduction in deaths from ischemic heart disease, but had no effect on death from stroke 47 , A recent study 48 reported that light-to-moderate alcohol consumption reduces the overall risk of stroke and the risk of ischemic stroke in men. The benefit was apparent with as little as one drink per week. More abundant consumption, up to one drink per day, did not increase the observed benefit. Several possible mechanisms have been proposed to explain the beneficial effect oflight-to-moderate alcohol consumption 49 , However, almost all of the proposed mechanisms are...

The Effect Modification Of Alcohol By Smoking

There are only two epidemiologic studies on the effect modification of alcohol by smoking and neither of them examines it in relation to the risk of stroke. In a Japanese cohort of 19,231 men, alcohol consumption and all-cause mortality had a J-shaped association in nonsmokers but not in smokers 78 , In a cross-sectional study of 5,312 German men and women, the rise in blood pressure associated with drinking was higher in smokers than in nonsmokers 79 , Some studies have instead examined the effect modification of smoking by alcohol. In a cohort of 22,071 US male physicians, alcohol attenuated the linear effect of smoking on the risk of total stroke 38 , In a Japanese cohort of 1,775 men, a dose-dependent decrease in diastolic blood pressure and serum HDL cholesterol by increasing cigarette smoking was evident in nondrinkers but not in drinkers The effects of both alcohol and tobacco are manifold, which makes them complicated to examine and understand. The effects may be additive or...

Effect Of Ethanol On Prostacyclin

The effects of ethanol on PGI2, another endothelium-derived vasodilator and potent inhibitor of platelet aggregation, have also been investigated. Ethanol increased PGI2 production in cultured human umbilical vein endothelial cells and elevated plasma levels ofPGI2 in volunteers administered ethanol 29 , Guivernau et al. found that while ethanol did not affect vascular PGI2 release in control rats, in aortas from alcohol-fed animals ethanol stimulated PGI2 production 30 , These data imply that this response to ethanol may be altered by chronic alcohol consumption. In any case, ethanol's modulatory effect on endothelial PGI2 production could

Epidemiological Studies

Recently, the South Bay Heart Watch (Torrance, CA) reported a study ofl,196 asymptomatic subjects with coronary risk factors who were assessed for alcohol consumption history and for the presence of calcium deposits in coronary atherosclerotic lesions as measured by electron beam computed tomography (EBCT). Participants were followed prospectively for 41 months for coronary events, defined as the occurrence of myocardial infarction or CHD death 6 , Subjects who drank alcohol had a relative risk of 0.3 ofhaving a coronary event compared with abstainers. The diminished risk of myocardial infarction or CHD death associated with moderate alcohol consumption was independent of serum HDL cholesterol levels, EBCT coronary calcium scores, and all other coronary risk factors. Abstention from alcohol in this study was as strong a predictor of coronary events as diabetes, smoking, hypertension, and coronary calcification 6 , Also reported recently was an analysis of the relationship between...

Cardioprotective Effect Of Moderate Wine Drinking

What is the mechanism of alcohol cardioprotection The beneficial effects of moderate drinking have been addressed on factors involved in atherogenesis 17 , First of all, alcohol increases plasma HDL level and activity oflipoprotein lipase, which showed an inverse relationship with the risk of CAD. Secondly, in animal models, ethanol reduced atherogenic plaques by influencing the inflammatory process of endothelial lesions. Alcohol interferes with the expression of vascular adhesion molecules such as VCAM-1 and ICAM-1 by inhibiting the transcription factor NF-kB 18 , Additionally, inhibition of the enzyme HMG-CoA reductase, a key enzyme in the synthesis of cholesterol, results in the reduction of plasma cholesterol. Furthermore alcohol has antithrombotic effects which could contribute to its cardioprotective effects. Possible factors responsible for the effects of moderate alcohol consumption on clotting include an increase in the prostacyclin thromboxane ratio, decreased platelet...

The Coeffect Of Alcohol And Tobacco Smoking

Alcoholics are commonly heavy smokers. There is a synergistic effect of alcohol consumption and smoking on cancer development, with long term ethanol consumption enhancing the mutagenicity of tobacco-derived product 24 , The combined ingestion of ethanol resulted in a significant formation of smoke-related DNA adducts in the esophagus and in their further, dramatic increase in the heart. Thus ethanol consumption increases the bioavailability of DNA binding of smoke components in the upper digestive tract and favors their systemic distribution. Formation ofDNA adducts in the organs examined may be relevant in the pathogenesis oflung and esophageal cancers as well as in the pathogenesis of other types of chronic degenerative diseases, such as chronic obstructive pulmonary diseases and cardiomyopathies 29 , Numerous studies have indicated a correlation between ethanol intake and cigarette smoking in heavy drinkers 30 , On a pharmacological basis, an ethanol-induced potentiation of...

Alphatocopherol And Ethanol Consumption

Chronic alcohol consumption produces an increased breakdown oflipid-soluble vitamins such as hepatic alpha-tocopherol, possibly secondary to a marked increase in the formation ofhepatic alpha-tocopherol quinone, a metabolite of alpha-tocopherol formed by free radical reaction 82 , Since chronic ethanol consumption has been associated with compromised antioxidant status and an increase in lipid peroxidation, the significant decrease of vitamin E compared to other lipid-soluble antioxidants may contribute, at least in part, to enhanced hepatic lipid peroxidation seen in alcoholics. Besides vitamin E, other antioxidants such as vitamin C, glutathione and selenium are also strikingly decreased following chronic ethanol ingestion 83 . It is also interesting that chronic alcohol consumption significantly alters the distribution of alpha-tocopherol and gamma-tocopherol not only in hepatic tissue but in extrahepatic tissues as well 84 ,

Gastrointestinal Tract Including Carcinogenesis

Chronic alcohol consumption is associated with an increased risk of cancer in the upper alimentary tract and the colorectum 109 , It might be possible that the production ofROS is involved in alcohol-associated carcinogenesis since chronic alcohol consumption leads to an induction of cytochrome P450 in the oral mucosa in the esophagus and in the colon of rodents 110,111 , Such an induction can also be demonstrated in the human oral mucosa 112 . In addition, the presence of xanthine oxidase has been located in the epithelial cells of the mouse and of the esophagus 113 . In an experiment by Eskelsson and co-workers, it has been shown that the number of esophageal tumors induced by nitrosamines and stimulated by chronic alcohol administration can be significantly reduced by the concomitant application of vitamin E 114 . Furthermore, this reduction is associated with a reduction in lipid peroxidation products in the esophagus. This is indirect evidence for the involvement ofROS in alcohol...

Lipids And Cardiovascular Disease

Higher levels of cholesterol, LDL-cholesterol and lipoprotein(a) and lower HDL-cholesterol 136 , However, total plasma ATC was comparable in all three groups (control, stable angina and unstable angina), except when expressed per LDL particle, whereupon it was lower in patents with unstable angina pectoris. Values in patents with stable angina pectoris were higher than the latter, but lower than controls 136 , Thus, it seems that the type of cardiovascular disorder needs to be defined and careful attention needs to be paid as to how ATC levels are expressed. Internal factors relevant to the determination of ATC status include triglycerides and apoproteins 10 , However, geographical and cultural dietary habits further compound the relationship between ATC and the etiology ofheart disease. Whole grain intake and nuts correlate negatively with coronary heart disease, which is not explained by the contribution of ATC (nor fiber, folate, vitamin B6) 137,138 , Another example pertains to...

Alcohol And The Heart

Ethanol has important effects on the cardiovascular system and particularly on anti-oxidant systems (reviewed in 75,158 ), Although the relative incidence of alcohol consumption reduces the overall risk of cardiovascular disease by a number of mechanisms (for example, increasing HDL LDL ratio, reducing platelet function and aggregation 140,159 ) excessive alcohol is damaging and can lead to the development of alcoholic cardiomyopathy 160-163 , Paradoxically, moderate alcohol consumption has been advocated to reduce the incidence of coronary artery disease, albeit within the confines of a multifactorial approach 147 , For example, an interaction between alcohol consumption and vitamin C has been proposed to account for the reduced incidence of angina in alcohol consumers 164 , The situation regarding ATC status in alcohol studies is confusing with some reports showing higher plasma ATC in average drinkers 165 whilst others have shown reduced levels in heavy drinkers 166,167 , Apart...

Specific Effects Of Ethanol Consumption On Platelets

While these observations suggest that an anti-platelet effect of ethanol could contribute to the reduced risk of CHD-related mortality in drinkers, it must be emphasized that any contribution of a platelet action of ethanol must be viewed in the context of other actions of ethanol and alcoholic beverage components. Furthermore, the duration of the antiplatelet effect is not known, nor are the effects of chronic vs. acute alcohol consumption or pattern of consumption (regular consumption vs. binge drinking). Nonetheless, this is the first clear demonstration of dose-dependent, inhibitory effects of acute, moderate alcohol consumption on platelet function.

Fatty Acid Ethyl Esters

The majority of ingested alcohol is rapidly absorbed from the small intestine into the bloodstream, and is distributed to tissues that possess high water content and blood flow, e.g., myocardium 5J. Once ethanol has reached myocardium, it has been shown to affect both the sarcolemma (muscle cell membrane) and the sarcoplasmic reticulum (SR). In rat myocytes, chronic alcohol intake creates sarcolemma leaking along with an intracellular calcium increase 23,24 , Several studies also exhibited decreased Ca2+ binding and uptake by the SR 25-29 , Normal function of these components is essential for proper contraction of the heart. Indeed, several investigators have reported depressed cardiac function with acute and chronic exposure to ethanol 26,30-34 , To determine the accumulation of FAEEs in the body, Lange et al. have measured the amount of the ethyl esters in autopsy samples 18 , They have reported FAEE concentrations ranging from 9-115 M in human left ventricles. The autopsy samples...

Dual activity of synthasecarboxylesterase

The important roles that have been established for the carboxylesterase enzyme family have prompted a look into its gene structure. Identification of the respective genes of the carboxylesterase enzyme family will offer insight into the structural and functional tenets of its many enzymes as well as making it feasible to establish a genetic link between alcohol abuse and alcohol-induced heart muscle disease.

Human and nonhuman primate studies

Acute administration of alcohol has no or little effect on apolipoprotein A-I levels. Valimaki et al. examined the time course of 60 g day of alcohol (16 of total calories were derived from alcohol) for 3 weeks in men on total apolipoprotein A-I levels 7 , Apolipoprotein A-I levels did not increase until after 1 week of alcohol consumption. In contrast, in a study using young, healthy men consuming 160 g day of alcohol in three divided doses over three days did not change total apolipoprotein A-I levels or total HDL cholesterol. However, there were pronounced changes in the HDL subfractions. The apolipoprotein A-I content ofHDL2 increased which was mitigated by the decrease in apolipoprotein A-I content of HDL3 8 , The lipid composition of both subfractions was characterized by a relative increase in phospholipids but decrease in cholesterol. These changes in HDL composition likely have important effects on HDL function, since the conformation of apolipoprotein A-I on the surface of...

Apolipoproteins CII and CIII

Apolipoproteins C-II and C-III both play a major role in VLDL metabolism. Apolipoprotein C-II and C-III stimulate and inhibit, respectively, lipoprotein lipase, the enzyme responsible for hydrolyzing the triglycerides in VLDL. In one study comparing apolipoprotein E levels among low (< 20 g alcohol day), moderate (20-50 g day), heavy (> 50 g day) and alcoholic (> 100 g day) drinkers showed a significant increase in serum apolipoprotein C-III levels with increasing alcohol consumption 43 , Incubating human hepatoma cells with alcohol with concentrations up to 50 mM had no effect on apolipoprotein C-II or apolipoprotein C-III secretion 43 ,

Cardiovascular Function

Prostaglandins such as prostacyclin (PGI2) and thromboxane (TXA2) are involved in cardiovascular homeostasis (Figure 16.3) and may play a role in the pathophysiology associated with alcohol consumption 104,105 , Alcohol abuse may lead to an increased incidence of hypertension, angina, myocardial infarct and stroke 106-108 , Conversely, moderate consumption of alcohol may produce qualitatively different effects in the cardiovascular system than does high consumption. Postmortem and epidemiologic data suggest that moderate consumption of alcohol protects against atherosclerosis-related cardiovascular disease 109-111 , Animal data that is consistent with these observations have demonstrated that moderate alcohol inhibited cholesterol- and saturated fatty acid-induced atherosclerosis in rabbits 112,113 , Data obtained from both humans and animals have demonstrated systemic administration of alcohol may induce vasoconstriction or biphasic effects on peripheral blood flow 126-129 ,...

Histological Features Of Alcohol Induced Cardiomyopathy In Clinical Studies

Been described, though most pertinent to this chapter are the perturbations in myofibrillary architecture (also reviewed in 10 ). At the light microscopic level, in alcoholic cardiomyopathy there are considerable size variations between the myofibrils, with concomitant loss of cross striations, destruction, vacuolization and oedema 15,16 , At the electron microscopic level, degenerative changes are apparent with disruption, fragmentation or loss of the myofibrils, loss of structural arrangement, dissolution and rearrangement of the filamentous structures 11-14 , Although many of the histological features of dilated cardiomyopathy and alcoholic cardiomyopathy are traditionally thought to be indistinguishable 14 , subtle differences have been described 9 , Thus, in dilated cardiomyopathy the degree of myocyte hypertrophy, fibrosis and nuclear alterations is greater than for corresponding measurements in myocytes from alcoholics 9 , The differences between these two disorders may result...

Histological Features In The Rat Model

Similar histochemical changes to those seen clinically above can be reproduced in animal models, including myofibrillary lysis, separation and disintegration, with scattered foci of lesions (fibrosis) and loss of parallel array 17-19 , The severity of these lesions worsen with increasing alcohol intake 20 , Overall, there are clear indications that the contractile apparatus is perturbed via experimental alcohol feeding. In the chronic alcoholic feeding model (using the Lieber-DeCarli feeding regimen), left ventricle weights are increased at 411 months, though no changes are seen at 2 months 21 , These changes are accompanied by functional defects, such as reduced cardiac output 21 , The model employing 6 weeks alcohol feeding in a pair-feeding regimen represents a transient phase in the development of the cardiomyopathy, and hence provides a suitable means of studying the pathogenesis of the disease process. The concepts of pair-feeding in chronic alcohol dosing studies have been...

Alcohol And The Immune System

Alterations of the immune system due to alcohol consumption have been a focus of multiple studies that have revealed impaired delayed-type hypersensitivity responses and ameliorated host defense against infections. Acute alcohol use has been associated with increased susceptibility to infections, posttrauma immunosuppression, and a decrease in antigen-specific T-cell proliferation response 13,16 , Malnutrition and cirrhosis are two of the conditions that develop with chronic ethanol consumption that affect the efficiency of the immune system to combat infections 11,12 , Ethanol influences the function of lymphocytes, monocytes and polymorphonuclear cells 13-15 ,

Alcoholic versus viral or idiopathic chronic dilated cardiomyopathy DCM

The pathology of the heart in alcoholic patients with chronic DCM is somewhat different from non-alcoholics with chronic DCM. The alcoholics tend to have more myocardial hypertrophy, interstitial fibrosis, and electrical irritability 26,27 , Although gross microscopic examination has not been able to distinguish chronic idiopathic DCM from the chronic DCM found in alcoholics 28 , electron microscopy has shown that patients who have also been chronic alcoholics have swelling of the sarcoplasmic reticulum which is more severe and generalized rather than focal 29,30 , However, these differences from the DCM in non-alcoholics do not mean that the severe cardiomyopathy was caused by the alcohol but may only mean that the alcohol, in addition to the other causes of idiopathic DCM, can cause characteristic pathologic changes. Likewise, even though it is true that patients with chronic DCM due to alcohol have less muscle strength and more histologic findings of skeletal myopathy than patients...

The Role Of Lifestyle

Lower risk of all cause and cardiovascular mortality seen in wine drinkers in this and other studies is a consequence of the multiple healthier lifestyle characteristics and higher socio-economic status in wine drinkers resulting in lower fatality, rather than the result of a specific benefit of wine. HDL-cholesterol cannot explain the lower absolute risk of wine drinking compared to other types of alcohol drinkers as the dose-response relationship between alcohol intake and HDL-cholesterol was similar in male beer, spirit and wine drinkers 27 and wine drinkers showed identical levels of HDL-cholesterol to non-wine drinkers (Table 3.2).

Alcohol and nonfatal myocardial infarction or incidence of CHD

Table 1.1 Large population studies examining alcohol intake and cardiovascular disease Sample Categories of CHD Size Alcohol Intake Sample Categories of Size Alcohol Intake acute myocardial infarction or CHD than do non-drinkers. However, it is unresolved as to whether there is a dose-response relation between increasing alcohol intake and decreasing incidence and whether there is an increase in risk at the high end of alcohol intake. An inverse relationship between alcohol intake and incidence of CHD was found in the Framingham Heart Study 7 , the Yugoslavia Cardiovascular Disease Study H , the Physicians' Health Study 14 , the Health Professional's Follow-up Study 19 , and in the middle-aged group (51-64 years) of the Honolulu Heart Program 9 , A clear dose-response relationship among drinkers was not found in the British Regional Health Study 26,28 , the Nurses' Health Study 12 , and the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study 23 , The...

Ethanol And Other Aspects Of Hemostasis

Because a variety ofhemostatic factors beyond those associated with platelets also contribute to the complications associated with coronary heart disease, it is important to consider the above information on platelets in the context of some of these other observations. One of the strongest risk factors for myocardial infarction is elevated plasma fibrinogen level 41 . The association of fibrinogen and alcohol consumption was evaluated by Mennen and colleagues 42 , Alcohol consumption was associated with plasma fibrinogen levels in a U-shaped fashion for men only, with fibrinogen being the lowest in those subjects who drank 20-59 grams of alcohol per day. Fibrinogen levels were greater for nondrinkers and those who consumed over 60 grams of alcohol per day. The type of alcohol consumed also apparently played a role, with a lower level of fibrinogen in those who drank wine and spirits as opposed to those who drank beer and cider (in which no association was found).

Cardiogenic Brain Embolism

Stroke admission rates have been observed to be high among heavy drinkers 10 , Some studies also suggest that alcohol abuse may associate with ischemic stroke recurrence 11,12 . A study on recent alcohol intake showed that heavy drinking is an independent risk factor for most subtypes of ischemic stroke and particularly a risk factor for cardiogenic brain embolism 13 . Table 7.1 Previously published and new case histories illustrating several different mechanisms that could link alcohol abuse to an increased risk of ischemic brain infarct Table 7.1 Previously published and new case histories illustrating several different mechanisms that could link alcohol abuse to an increased risk of ischemic brain infarct The association between alcohol abuse with cardiogenic brain embolism suggests several mechanisms via which heavy drinking could precipitate brain infarct. First, there is the possibility of alcoholic heart muscle disease. Excessive chronic alcohol consumption leads to dilated...

Smallvessel Occlusion

Small-vessel occlusions, i.e., thrombosis of a single perforating cerebral artery, cause lacunar ischemic strokes. A lacunar infarct usually occurs in the internal capsule or thalamus and presents clinically as a pure motor stroke, pure sensory stroke, sensomotor stroke, dysarthria clumsy hand or ataxic hemiparesis. Patients with typical lacunar infarct syndromes account for approximately 20 of all ischemic strokes, and hypertensive small-vessel disease seems to be the most important etiology 29 , Because heavy drinking of alcohol is a frequent cause of arterial hypertension, it is assumed to associate with small-vessel occlusion as well. However, conflicting observations have also been reported. Some studies have not shown alcohol to be a significant risk factor 29-31 , whereas others have 9,32 , The study ofYou et al. included a rather large series of young adults with lacunar infarcts 33 . This study suggested that long-term heavy alcohol consumption is a risk factor for ischemic...

Concommitant Cocaine And Ethanol Consumption

20-32 years of age) of varied socioeconomic status in 1987, and then to evaluate the relationship between lifetime cocaine use in 1987 and cardiovascular disease risk factors 5 years later. The longitudinal design, the cardiovascular focus of CARDIA, and the inclusion of essentially healthy individuals at baseline, provided a unique opportunity to assess the cardiotoxicity of chronic cocaine use. Results of the CARDIA study indicate that lifetime cocaine use experience in 1987, after adjustment for age, ethnicity, daily alcohol intake, cigarettes smoked per day, body mass index, sum of skinfolds, physical activity, and other illicit drug use, was not related to blood pressure, blood pressure difference, heart rate, or hypertension prevalence in cross-sectional analysis in either men or women. Regarding the long-term, multivariate relationships between lifetime cocaine use experience in 1987 and blood pressure, blood pressure difference, and heart rate in 1992, the data from CARDIA...

The Editors

Watson, Ph.D., initiated the Specialized Alcohol Research Center at the University of Arizona College ofMedicine and had directed the center for 6 years. Dr. Watson has edited 50 books, including lOon alcohol abuse and 4 on other drugs of abuse. He has worked for several years on research for the U.S. Navy Alcohol and Substance Abuse Program. Dr. Watson attended the University of Idaho but graduated from Brigham Young University in Provo, Utah with a degree in chemistry in 1966. He completed his Ph.D. degree inl971 in biochemistry at Michigan State University. His postdoctoral schooling in nutrition and microbiology was completed at the Harvard School of Public Health and included a 2-year postdoctoral research experience in immunology. He was an assistant professor of immunology and did research at the University ofMississippi Medical Center in Jackson from 1973 to 1974. He was an assistant professor of microbiology and immunology at the Indiana University Medical School...

Alcohol and stroke

Alcohol was recognized as a possible risk factor for stroke as early as the 17th century 41 , Results gathered from large prospective studies were not available until the late 1970s to early 1980s and the epidemiological evidence has been highly inconsistent. Variations in the reported alcohol-stroke relationship are much greater than for the alcohol-CHD relationship. Increasing alcohol consumption was related to an increased incidence of all strokes (fatal and non-fatal) in men from the Honolulu Heart Program 8 , in the Swedish conscripted men 33 , and in the male smokers in the Finnish Cancer Prevention Study 31 . Alcohol intake was also associated with an increased total stroke mortality in men from the Yugoslavia Cardiovascular Disease Study 42 and the Japanese male physicians 35 , On the other hand, some studies 17,21 have reported an L-shaped alcohol-stroke relationship. The Cancer Prevention Study II 21 found that men who consumed alcohol less than daily through 4 or more...

Other confounders

The difficulty of controlling completely for correlates of alcohol use and of cardiovascular disease is obvious. For example, alcohol use is related to age, sex, race ethnic background, geographical location, smoking, coffee use, educational attainment socioeconomic status, marital status, adiposity, salt use and other dietary habits, religious affiliation, social network, stress, psychological well-being, and physical activity. People who drink (excluding heavy drinkers) had a better self-perceived health status than did non-drinkers 52 , The differences in self-perceived health status accounted for one-fourth to one-third of the lower risk of

Conclusions

Two thirds of Americans report using alcohol and since social drinking is a potentially modifiable behavior, the relation between alcohol consumption and cardiovascular disease is a subject of considerable importance. Although the literature is not unanimous, evidence from large epidemiologic studies leads to the conclusion that moderate alcohol intake decreases risk of non-fatal and fatal CHD and ischemic stroke. The observed differences in the shape of the relationship between various studies might be partly explained by varying distributions of other risk factors and partly by the variation of alcohol intake in the study populations. If heavy drinking was infrequent in a study sample, an L-shaped relationship would be observed instead of a J-shape. If only abstainers and light drinkers were studied, an inverse linear association should appear. If the study sample did not include abstainers, a positive linear trend could emerge. A randomized, controlled clinical trial is the gold...

Development Of Ahmd

Female alcoholics develop a multitude of symptoms more rapidly than male alcoholics during the first few years of drinking, a phenomenon which is refered to as 'telescoping' 41,42 , Lewis et al. examined the effect of other co-morbidities on the rapid accrual of symptoms in women and found that this rapid accrual was independent of the number of co-morbidities 41 , Others have found that women are at greater risk for the development of alcoholic liver disease and brain damage 43-45 , These data, along with the data reviewed in this chapter, suggest that women are more vulnerable to the medical consequences of alcohol. Putative gender-related effects may be due to sex-related differences in alcohol pharmacokinetics which allow women to achieve higher blood alcohol levels (BAL) compared to men, after consuming an equivalent amount of alcohol. Some reports suggested that higher BALs in nonalcoholic women were attributable in part to a difference in the first-pass metabolism of alcohol...

Mechanisms

When alcohol is fed to experimental animals, a transient alpha receptor blocking activity has been observed. A single dose of alcohol or chronic use decreased the sensitivity of adrenergic receptors 31 . In chronic alcoholism however, elevated norepinephrine levels and Beta-receptor antagonist drugs have been found to be useful in a wide variety of clinical conditions and are firmly established in the treatment ofhypertension, ischemic heart disease, arrhythmias, endocrinologic and neurologic disorders. Short-term studies in normal subjects indicate that ethanol increases both the elimination rate and bioavailability of propranolol 35 , The plasma clearance rate of propranolol, which is metabolized by the liver, is increased and the blood pressure-reducing effect of the drug is diminished. Ethanol and beta blockade individually affect heart rate and arterial pressure in the opposite direction. The combination of ethanol and propranolol will produce effects that are dose dependent, but...

Case

In April 1994, a 60-year-old nonsmoking man who had diabetes and untreated hypertension, but who did not use any medication, suddenly developed right hemiparesis and a visual field defect several hours after getting out ofbed in the morning. He was an episodic heavy drinker and had ingested a large amount of alcohol on the preceding evening (150 g ethanol). His usual weekly alcohol intake averaged 300 g of ethanol. On admission, he had atrial fibrillation. During the preceding month, he had both an upper respiratory infection and a bacterial dental infection, and two weeks before the index stroke he experienced symptoms suggestive of a transient ischemic attack. A computed tomography head scan showed a new left temporo-occipital brain infarct and an older left deep capsular infarct. Duplex imaging of the carotid and vertebral arteries did not suggest any significant stenoses, but TEE showed an enlarged left atrium with a moving appendicular thrombus.

Tobacco

Studies on interactions between alcohol and tobacco are most challenging, not only because of the complexity of the effects of either factor, but also because of many inherent methodological problems. Epidemiologic studies on alcohol and tobacco are prone to imprecision in measurements and various biases, their interactions thus being even harder to evaluate in a reliable and valid manner. Alcohol consumption and smoking are usually self-reported and the measurement of either habit is susceptible to both recall and response bias. The reporting of alcohol use especially tends to be differential, heavy drinkers more likely reporting themselves as moderate-to-light drinkers than nondrinkers 24 , Differential misclassification is likely to lead to biased estimates of relative risks, and the amount and direction of such bias is hard to evaluate. Furthermore, the classification of alcohol intake and cigarette smoking, and the selection of respective reference categories (e. g., current...

Exposure To Ethanol

Because no clinical trials actually test prospectively the relationship between alcohol consumption and coronary heart disease, efforts to identify the mediators of ethanol-induced cardiac protection in humans focus on statistical modeling of observational data. These analyses have identified increased HDL cholesterol levels 8,9 , decreased platelet aggregation 10 , and increased expression of tissue-type plasminogen activator 11 as potential mechanisms underlying ethanol-induced cardiac protection. Moderate ethanol exposure may also protect against CHD through direct effects on heart muscle. For example, Auffermann et al. reported that ethanol significantly reduces the functional and structural damage caused by one component of ischemia-reperfusion injury, the pathological influx of Ca2+ into myocardial cells termed the calcium paradox injury 12 . Using isolated Langendorff-perfused rat hearts, these investigators found that addition of 2.5 (vol vol) ethanol to the perfusate...

Cardioprotection

Because activation of epsilon protein kinase Cisa critical event in several important forms of cardiac preconditioning, interest in the field is now focused on uncovering the downstream mediators of protection. Exhaustive examination of ischemic preconditioning in a conscious rabbit model by Ping et al. has identified p44 p42 mitogen-activated protein kinases 33 , p46 p54 c-Jun NH2-terminal kinases 34 , and Src and Lck tyrosine kinases 35 as downstream elements of ePKC-mediated signal transduction. Studies to determine the precise mechanisms linking ePKC to these signaling molecules, the requirement for their activation in other forms of preconditioning, and their own downstream cellular targets, are ongoing. Our laboratory has cloned the anchoring protein or RACK (receptor for activated c- inase) for activated ePKC, that was identified as the COPI coatomer protein yft-COP 36 , The ePKC inhibitor peptide, eVl-2 19 , acts by competing for binding of activated ePKC to y0'-COP 36 and...

Summary

Both cigarette smoking and alcohol drinking are involved in lipid metabolism and proinflammatory response. They are also related to unhealthy eating patterns. Alcohol abuse can promote the formation of smoke-related DNA adducts distributed in organs including the heart, which may be responsible for cardiomyopathies. Furthermore, ethanol intake has a correlation with nicotine addictive.

Metabolism

Most of the data available with respect to the production ofROS following ethanol administration have been obtained from studies in hepatic tissue. However, since many of the enzymes responsible for ethanol metabolism are also present in extrahepatic tissues such as the gastrointestinal mucosa, ROS can also be produced in these tissues. In the liver, alcohol consumption increases the amount of reactive oxygen species by several mechanisms

Cytochrome P450 2E1

Alcohol consumption results in an induction of cytochrome P450 2E1 associated with enhanced activity of Acute alcohol exposure increases superoxide production in the respiratory chain of mitochondria, which may be responsible for the damage to this subcellular organelle during alcohol consumption 27 , When hepatic mitochondria from chronically ethanol fed rats are incubated with NADH or NADPH in vitro, an increased production ofROS is observed 27 , It is noteworthy that ethanol stimulates the activity of rotenone-insensitive NADH cytochrome C-reductase, an enzyme of the outer mitochondrial membrane 28 ,

Skeletal Muscle

Alcoholic myopathy is arguably the most prevalent skeletal muscle disease in the Western Hemisphere, occurring in between 30-60 of all chronic alcohol misusers (see reviews in 213-215 ), In a UK study, serum levels of ATC were shown lower in alcoholics with skeletal muscle myopathy compared to those alcoholics or non-alcoholic subjects without myopathy 166 , However, this has not been reproduced in Spanish alcoholics, which may reflect geographical or other differences between the patient population and or nutritional intake 216 ,

Function

As discussed elsewhere in this volume, quite a few epidemiological studies have examined the association between morbidity and mortality from CHD and moderate alcoholic beverage consumption, and an inverse association has been established in studies involving nearly a million subjects 29 , One example of such reports is a study of American Cancer Society volunteers, which showed that the rate of death from all cardiovascular diseases was 30-40 lower among men and women who consumed at least one alcoholic drink daily than among nondrinkers. While it should be emphasized that alcohol consumption is associated with higher death rates from injuries, violence, suicide, cirrhosis, certain cancers and hemorrhagic stroke 30 , the incidence of death from heart disease is much greater compared to these other causes, making any role of platelets potentially important. Cross-cultural studies have shed light onto the French paradox involving the Mediterranean diet. A Mediterranean diet typically...

Human studies

Little information is available about the effects of alcohol consumption on apolipoprotein E metabolism in humans. In one study, comparing apolipoprotein E levels among low (< 20 g alcohol day), moderate (20-50 g day), heavy (> 50 g day) and alcoholic (> 100 g day) drinkers showed no difference in serum apolipoprotein E levels between groups 43 , Conversely, other studies have shown that alcohol intake is associated with increases or decreases in apolipoprotein E 11,44 , Interestingly, there may be a gender difference in the alcohol effect on apolipoprotein E in that male alcoholics have a higher level of apolipoprotein E levels compared to controls whereas this difference does not exist between female alcoholics and controls 11 . In examining the distribution of apolipoprotein E between VLDL and HDL, Lin et al. found that alcoholics have a lower level of VLDL apolipoprotein E and higher level of HDL apolipoprotein E than controls 11 .

Vitamin E

Excessive alcohol consumption is a major health problem in the United States. Prolonged consumption of alcohol results in alterations of immune responses, ultimately manifested by increasing susceptibility to infectious agents. Vitamin E supplementation has been associated with enhancement of immune response and improvement of host defense, and may provide a useful therapeutic approach for treatment of alcoholics to improve host defense 34-38 ,

Apolipoprotein B

VLDL secretion from liver is regulated by a number of factors including the availability of lipid for packaging and the production of apolipoprotein B. If excess apolipoprotein B is produced, it is degraded. Microsomal triglyceride transfer protein (MTP) assembles VLDL within the endoplasmic reticulum. MTP appears to regulate the number of apolipoprotein B-containing lipoproteins secreted and not the lipid composition. Epidemiological studies in humans have shown that the effect of alcohol consumption on total serum apolipoprotein B is varied. This discordance may reflect the fact that total serum apolipoprotein B does not differentiate between apolipoprotein B-containing lipoproteins, i.e., VLDL-apolipoprotein B may increase while LDL-apolipoprotein B decreases. In addition, dietary and genetic factors may influence the response to alcohol. Like apolipoprotein A-I, the alcohol effect on total serum apolipoprotein B may be dose dependent. In squirrel monkeys, total serum...

Cryptogenic Stroke

Finally, ischemic brain infarcts of unknown origin (cryptogenic stroke) have also been described in connection with heavy drinking of alcohol 41,42 , Alcohol also has complex effects on cerebral blood flow and autoregulation. Whether or not these mechanisms play a significant role is unclear. Thus far, we have not found an alcoholic binge to result in marked hypotension and watershed infarcts. We believe that many of the cryptogenic ischemic brain infarcts are due to emboli of unknown origin.

Potential Therapeutic Applications

Alcohol Dependence - There is a growing body of evidence suggesting that NPY plays a major role in alcohol dependence. Alcohol consumption is elevated in NPY- deficient mice, but decreased in transgenic mice that overexpress NPY (44). Alcohol consumption behavior was enhanced in mutant mice lacking the NPY Yi receptors, (45) but reduced in mutant mice deficient of NPY Y2 receptors (46). In addition, mutant mice without the NPY Y1 receptor were less sensitive to alcohol-induced sedation, whereas mutant mice lacking the NPY Y5 receptor had increased sleeping time without altering voluntary alcohol consumption behavior (45). Recently, it has been confirmed that icv administration of the selective NPY Y2 receptor antagonist, BIIE0246, can suppress alcohol self-administration in rodents, without affecting the consumption of a sweetened solution (47). These data suggest that a Y2 receptor antagonist might be a novel treatment for alcoholism.

Partial Agonist Approach To Medication Development

Antagonist treatment has been used in opioid addiction (e.g., oral naltrexone) but the results have been mixed. There is a possibility that a depot form of naltrexone being developed for the treatment of alcoholism could be useful in the treatment of opioid addiction 15 .

If my clinician does not discuss screeningfor osteoporosis at what age should I make sure that I am screened

You and your clinician should discuss your bone health during every annual exam, regardless of your age. Your calcium and Vitamin D intake, your level of physical activity, and your lifestyle factors such as smoking and drinking alcohol can affect bone health at any age.

Findings From Genetic Studies In Adhd

5-HT1B knockout mice display an increased locomotor response to cocaine acquisition and alcohol intake, along with hyperactivity and aggressive behavior (103). The hyperloco-motion effect of this agonist is absent in the mouse lacking 5-HT1B, indicating that the agonist effect is mediated by this receptor. Hawi et al. (104) and Quist et al. (105) reported association between a 5-HT1B polymorphism (861G-C) and ADHD. The serotonin HTR2A is a G protein-coupled receptor functioning in signal transduction. Antagonism of 5HT2A has been shown to reduce dopamine-induced hyperactivity in mice (106,107). Hyperlocomotion induced by the noncompetitive W-methyl-D-aspartate antagonist (MK-801) in mice is attenuated by the nonselective 5-HT2A antagonist ritanserine and by the 5-HT2A selective antagonist MDL100907 (107). Several recent studies have investigated 5-HT2A markers for possible association with ADHD, with association reported by Quist et al. (106) and Levitan et al. (108) but not by Hawi...

How will my clinician use my test results to determine whether I have osteoporosis

A Z-score is usually not helpful in making the diagnosis of osteoporosis. However, if it is particularly low (lower than -1.5), it is important for your clinician to evaluate you for conditions and illnesses that may be causing your bone loss associated with secondary osteoporosis. Such causes of secondary osteoporosis might include thyroid or parathyroid disease, cigarette smoking, excessive alcohol intake, problems with absorption from your gastrointestinal tract, or the use of medications known to be harmful to bone. Patients with secondary conditions associated with low bone mass (for example, hyperthyroidism, malabsorption, hyperparathyroidism, alcoholism)

Infectious Lung Disorders

Another type of bacterial pneumonia, called legionnaires' disease, is caused by the Legionella pneumophila bacterium. The natural habitats for these bacteria are bodies of water, but they also thrive in the evaporative condensers of air-conditioning systems and may be found in humidifiers and vaporizers as well. Legionnaires' disease is most common among middle-aged men. Risk factors include smoking, alcohol abuse, and a suppressed immune system (especially due to taking corticosteroid medications). The fever associated with legionnaires' disease is usually high, and other flulike symptoms occur, such as a vague sense of being ill, a cough, muscle pain, and a headache. The cough is initially dry but produces more mucus as the disease progresses. Antibiotics will eliminate the bacteria, but recovery may be slow.

Impact of Child Abuse on Emotional Development

Where children experience emotional, physical, or sexual abuse during their early childhood years, they often grow up with issues in the emotional domain, especially since they are not always mentally present using denial, repression, and sometimes dissociation as frequent defenses against feeling the emotional pain from both the abusive behavior and the inconsistent parenting they received. Children who grow up in homes where one or both parents have alcoholism or abuse other substance also experience the emotional effects from inconsistent parenting. Many of these children learn to become their parent's parent, which may be called being overparentified. They often grow up feeling anxious unless they are taking care of other people. However, they quickly become exhausted and may alternate an excessive sense of responsibility together with spacing-out, or dissociating, or simply not being present. These women may be unable to parent a child and yet are unable to make the decision not...

Materials And Methods

The standardized personal interview was used based on a structured questionnaire and was carried out by four public health nurses who were well-trained in the interview technique and questionnaire details. Information obtained from the interview included the duration of well water consumption, residential history, sociodemographic characteristics, cigarette smoking, alcohol consumption, physical activities, history of sunlight exposure, as well as personal and family history of hypertension, diabetes, cerebrovascular disease, heart disease, and cancers. Well water samples were collected during the interviews at home, acidified with hydrochloric acid immediately and then stored at 20 C until sub

Conclusion the role of functional foods

As we have seen, some of the most compelling evidence for a protective effect of diets against cancer to emerge in recent years is that for fruit and vegetables.681 Despite the difficulties of disentangling the effects of diet from other aspects of lifestyle such as smoking, exercise and alcohol consumption, most authorities agree that, compared to those at the other end of the scale, the highest consumers of fruits and vegetables in most populations have about half the risk of developing most types of cancer.

Risk Factors for Infection by Penicillin Resistant S pneumoniae

Knowing risk factors is essential for the clinician to suspect resistance to S. pneu-moniae and to select appropriate empiric antimicrobial treatment. Risk factors for the acquisition of antimicrobial-resistant S. pneumoniae have been studied by means of multivariate analyses (Niederman, 2001) (see Table 1.2), and various authors have found that patients with penicillin-resistant pneumococci have a significantly higher incidence of (1) use of P-lactam antibiotics during the previous 3-6 months, (2) hospitalization during the previous 3 months, (3) nosocomial pneumonia, (4) suspected aspiration, (5) episodes of pneumonia during the previous year, (6) alcoholism, (7) noninvasive disease, and (8) an initially critical condition. Additional risk factors include age less than 5 years or greater than 65 years, Pallares et al., 1987). Nosocomial infection (Bedos et al., 1996 Pallares et al., 1987) Previous hospitalization (Aspa et al., 2004 Pallares et al., 1987) CAP in previous year...

Rationale And Justification For Categorical Model

For the purpose of illustration, we will summarize some of the empirical support for a dimensional classification of personality disorder. We are confining this summary to personality disorders as the magnitude of this research across all areas of psychopathology has now grown so large that it is not feasible to do justice to any one of them. Quite extensive and compelling arguments regarding other areas of psychopathology are available elsewhere (e.g., Cloninger, 1998 Goldberg, 1996 Krueger and Markon, in press Widiger & Samuel, 2005), including more specifically (but not limited to) depression (Flett et al., 1997), anxiety disorders (Watson, in press), mood and anxiety disorders (Clark, in press), alcoholism (Meyer, 2001 Widiger & Smith, 1994), and psychotic disorders (Peralta, Cuesta,

Cardiac Muscle Disorders Dilated Cardiomyopathy

DCM is the end result of a number of different conditions. About 50 of cases can be attributed to obstruction of the coronary arteries, viral infections, nutritional deficiencies, abnormalities of the immune system, or myocardial toxins, such as excessive alcohol consumption. The basis of the underlying pathogenesis in the remaining cases of DCM is unknown (i.e., idiopathic). Of these idiopathic occurrences, approximately 25 to 35 are familial. Both familial and sporadic DCM are clinically diverse. In some patients, DCM is accompanied by a defect in the electrical conduction system of the heart. The conduction system of the heart consists of specialized cardiac cells (sinuatrial node), which generate and distribute electric impulses to the heart muscle and ensure the coordinated contraction of the atria and ventricles. In another group, the phenotype is primarily ventricular dilation. In addition, DCM sometimes occurs with skeletal muscle degeneration. In other cases, DCM is...

What is kyphoplasty Would it help my spinal fractures

Besides adding calcium and Vitamin D, should I be changing anything in my diet I heard that drinking alcohol could increase my risk of osteoporosis. Do I have to stop drinking entirely Alcohol is an interesting paradox when it comes to osteoporosis. Although heavy alcohol consumption can bring about major social, financial, and health problems, mild-to-moderate consumption is associated with decreased rates of osteoporosis as well as decreased rates of heart attack, stroke, and diabetes. The Nurses' Health Study showed that women who drank moderate amounts of alcohol had higher bone mineral densities at the spine than their non-drinking counterparts. Heavy alcohol consumption, though, increases bone breakdown, meaning that you are more likely to have weaker bones. But since moderate consumption contributes in a positive way to bone formation, you can continue to drink moderately with a diagnosis of osteoporosis. But what is moderate consumption The latest dietary guidelines from...

First observation of recovery of consciousness in hepatic coma

A 50-year-old female was admitted with a history of alcohol abuse, onset of jaundice, fatigue, nausea, vomiting, and dark urine. There was no history of contact with hepatitis or of intravenous or intramuscular medication. On admission, she had spider nevi and ascites. The diagnosis was acute alcoholic hepatitis. Her condition deteriorated after admission and she became comatose and unresponsive. After remaining comatose for two days, her condition was considered as terminal and with the insistence of her relatives she was referred by her physician to me for possible hemoperfusion since nothing else could be done. One hour after hemoperfusion, she started to regain consciousness and began to recognize her relative and answer questions in sentences. Hemoperfusion was carried out for a total of 80 min. She remained conscious for about an hour after the end of the hemoperfusion, but lapsed into coma again. Three days later she was still comatose, and a second hemoperfusion was initiated....

Ecological And Crosssectional Studies

Analyzed at the individual level 0.29 (p 0.002) in men and 0.17 (p 0.047) in women. In the multivariate regression analysis, HCC was significantly associated with AF levels, after adjusting for age, sex, and HBsAg. Adjustments for smoking and alcohol consumption in a subset of 190 subjects with available interview data and the inclusion of interaction terms did not materially affect the findings. Thus, the very different types of analyses all pointed to an association between urinary AF and HCC.

How does the cardiovascular physiology of a patient with endstage liver disease differ from that of a normal patient

Patients with end-stage liver disease have a hyperdynamic circulation, characterized by increased cardiac index and decreased systemic vascular resistance. This results in a consistently lower blood pressure and increased heart rate. Patients are significantly less responsive to catecholamines. Cirrhotic patients tend to be overloaded with total body water but arterially dehydrated. Pulmonary blood flow is increased and can result in increased pulmonary artery pressures pulmonary vascular resistance usually remains normal. Coronary artery disease with resulting impaired myocardial function (previously thought to be uncommon in patients with liver disease) may be present, especially when the patient has diabetes. Coronary artery disease in liver transplant patients older than 50 years occurs in a range of 5 to 27 . Abnormalities in both systolic and diastolic function may be present and result in an inadequate cardiac output for the degree of vasodilation. This is especially true in...

Personality and the self

Develop a meditative practice and, in so doing, learn to observe yourself in whatever you are doing. Compare your own behaviour if and when you drink alcohol, smoke and or take any other drugs with your behaviour ordinarily. Work out the reasons why you take such substances (if you do) and whether or not you wish to continue.

Sarcosinebased GlyT1 inhibitors

A Phase II study was recently completed whereby Org-25935 was compared against placebo for the ability to improve negative symptoms in 246 subjects maintained on a stable dose of an atypical antipsychotic (data not disclosed) 46 . A second Phase II study in progress (200 patients) is designed to assess the efficacy of Org-25935 as a stand-alone therapy versus placebo, using olanzapine as the active control 46 . Org-25935 is also being investigated in separate Phase II studies as a treatment for panic disorder and for recidivism in subjects with alcohol dependence 46 .

Polygenic Inheritance and Pleiotropy

Pleiotropy Examples Humans

Phenomenon in which genes at two or more loci, or even on different chromosomes, contribute to a single pheno-typic trait. Human eye and skin colors are normal poly-genic traits, for example. They result from the combined expression of all the genes for each trait. Several diseases are also thought to stem from polygenic inheritance, including some forms of alcoholism, mental illness, cancer, and heart disease.

Hemiparkinsonismhemiatrophy

Transient parkinsonism seen during alcohol withdrawal, developing a few days after consumption of the last drink. Most patients have previous transient episodes. Rapid progression of parkinsonian symptoms tremor, in presence of HIV with or without related CNS infections such as toxoplasmosis Parkinsonism in presence of other abnormalities suggestive of SSPE Parkinsonism with flulike symptoms, and dystonia, with elevated mycoplasma antibody levels Parkinsonism, cognitive impairment, celebellar signs, speech abnormalities, pyramidal signs, psychiatric features and sensory abnormalities

Alcohol and substance abuse

Acutely alcohol depresses the central nervous system by inhibiting polysynaptic function, which is characterized by generalized blunting and loss of higher motor, sensory, and cognitive function. Although the behavioral effects of alcohol consumption may seem excitatory or stimulating to observers and users, this impression is probably caused by a depressive effect on inhibitory pathways (disinhibition). Acute alcohol intake may cause hyperventilation via disinhibition of central respiratory regulation centers and increases in dead-space ventilation. Despite hyperventilation, alcohol depresses the ventilatory response to carbon dioxide. Aspiration of gastric contents is a risk. Chronic alcohol users are susceptible to pulmonary infections, often by staphylococci or gram-negative organisms. There is also a generalized decrease in all lung capacities (vital, functional residual, and inspiratory capacity). 10. How should sober chronic alcohol abusers be anesthetized 11. What are the...

Adiposity vs Bone Formation

Aging of the human skeleton is characterized by decreased bone formation and bone mass. The decrease in bone volume associated with age-related osteopenia is accompanied by an increase in marrow adipose tissue as determined by histomorphometry (38,39). Adipogenesis is also observed in almost all conditions that lead to osteoporosis (40,41), such as ovariectomy (42), limb immobilization (43), alcoholism (44), and excessive treatment with glucocorticoids (45). Conversely, adipogenesis is inhibited in conditions with increased bone formation (46). Habitual consumption of significant quantities of ethanol is recognized as a major factor for osteopenia and increased fracture risk in both men and women. Bone mass is decreased in alcoholics and their osteopenic skeletons show increased bone marrow adiposity (50,51).

Risk Factors For Resistance

Recent hospitalization, alcoholism, institutional residence, immu-nosuppressive illness such as HIV infection, extremes of age, and exposure to children in day care are markers for exposure to carriers and also risk factors for DRSP (35,37-39). The introduction of the pneumococcal conjugate vaccine has led to a decrease in DRSP (40,41), though one recent study shows that it may have increased the antimicrobial resistance among non-vaccine serotypes (41).

What is the significance of autonomic dysfunction How might you tell if a patient has autonomic dysfunction

Patients with autonomic dysfunction tend to have severe hypotension intraoperatively. Evaluation of changes in orthostatic blood pressure and heart rate is a quick and effective way of assessing autonomic dysfunction. If the autonomic nervous system is intact, an increase in heart rate of 15 beats min and an increase of 10 mm Hg in diastolic blood pressure are expected when changing position from supine to sitting. Autonomic dysfunction is suggested whenever there is a loss of heart rate variability, whatever the circumstances. Autonomic dysfunction includes vasomotor, bladder, bowel, and sexual dysfunction. Other signs include blurred vision, reduced or excessive sweating, dry or excessively moist eyes and mouth, cold or discolored extremities, incontinence or incomplete voiding, diarrhea or constipation, and impotence. Although there are many causes, it should be noted that people with diabetes and chronic alcoholics are patient groups well known to demonstrate autonomic dysfunction.

What factors may influence MAC

The highest MACs are found in infants at 6 to 12 months of age and decrease with both increasing age and prematurity. For every Celsius degree drop in body temperature, MAC decreases approximately 2 to 5 . Hyponatremia, opioids, barbiturates, a2-blockers, calcium channel blockers, acute alcohol intoxication, and pregnancy decrease MAC. Hyperthermia, chronic alcoholism, and central nervous system (CNS) stimulants (cocaine) increase MAC. Factors that do not affect MAC include hypocarbia, hypercarbia, gender, thyroid function, and hyperkalemia. MAC is additive. For example, nitrous oxide potentiates the effects of volatile anesthetics.

Aspiration Pneumonia and Lung Abscess

Aspiration of food and vomitus is common in those who are prone to aspirate because of debilitation, dysphagia, alcoholism, nasogastric tube feeding, congenital malformations of the upper airways, central nervous system disorders such as seizures, and altered consciousness. If active or passive clearance of the aspirate is not achieved, there is a short latent period of several hours before the onset of pneumonia. Poor oral hygiene, gingivitis, and periodontitis, as well as therapy with diphenylhydantoin contribute to poor oral hygiene and promote the development of pneumonia in those who aspirate.

Pyrazole CB1 antagonists

Several groups have recently described SR141716 analogues, leading to a good understanding of the structure-activity relationship (SAR) within this chemical series 11-15 . Based on this information, several three-dimensional pharmacophore models as well as models of receptor-ligand interactions were generated 13,16-18 . While most compounds described in these papers are less potent than SR141716, two of them deserve special attention. The first one is AM251 (2), obtained by replacing the 5-phenyl chloro substituent by iodo 19 and often cited in the literature as a close analog of SR141716. The second is SR147778 (3), obtained by replacing the 5-phenyl chloro substituent by bromo and methyl by ethyl at position 4 of the pyrazole ring. This compound was able to reduce food intake in fasted and non-deprived rats 20 and to selectively decrease alcohol intake in selectively bred Sardinian alcohol preferring (sP) rats 21 . It is currently undergoing phase I clinical trials.

Parkinsonism Owing To Toxin Exposure

Alcohol-induced parkinsonism is a rare and poorly characterized disorder. Transient form of par-kinsonism has been reported in alcoholics during withdrawal. This disorder is seen in chronic alco- holies of both sexes, usually older than 50 yr with no evidence of hepatic dysfunction (57). The condition develops a few days after the consumption of the last drink rarely during acute intoxication. The patients often show other features of alcohol withdrawal and alcoholism including postural tremor, ataxia, and confusion. Most of the patients have previous history of transient episodes of parkinsonism. CT and MRI studies do not show any specific changes. Some patients have moderate to severe brain atrophy resulting from alcoholism, and one patient had basal ganglia calcifications

Disorders of the Gallbladder the Pancreas and the Liver

In acute pancreatitis, the pancreas suddenly becomes inflamed and then returns to normal. Most people experience only one attack, but the condition can recur. Acute pancreatitis usually is caused by alcohol abuse or by gallstones. An attack usually lasts about 48 hours and begins with severe pain in the upper abdomen. The pain may appear suddenly and be severe, or it may worsen gradually, especially after eating. The abdomen may be swollen and tender. The pain is often accompanied by nausea, vomiting, fever, and a rapid heart rate. Chronic pancreatitis is more common in men than in women and usually develops after many years of alcohol abuse. Symptoms are usually the same as those of acute pancreatitis, but the attacks become more frequent as the disease progresses. People with chronic pancreatitis experience pain, weight loss (due to malabsorption of nutrients), and diabetes (due to insufficient production of insulin by the pancreas). Blood tests and other procedures such as...

Content Changes

I have updated information on the following, drawing on research and review literature as recent as April 2002, even as the book was in production genetic translation in the nucleus (4), signal peptides (4), stem cell research (5), hair analysis (6), osteoporosis treatments (7), knee surgery (9), muscle-connective tissue relationships (11), mitosis in cardiac muscle (11), astrocyte functions (12), surgical treatment of parkinsonism (12), amyotrophic lateral sclerosis (13), memory consolidation (14), functional MRI (14), the sensory role of filiform papillae (16), a new class of retinal photoreceptors (16), the history of anesthesia (16), the relationship of growth hormone to somatomedins (17), cytotoxic T cell activation (21), asthma (21), neuroimmunology (21), atrial natriuretic peptide (23), hunger and body weight homeostasis (26), heritability of alcoholism (26), the functions of relaxin (28), contraceptive options (28), the fate of sperm mitochondria (29), Werner syndrome (29),...

Hypertension

Data also suggest that hypertension is a risk factor for aneurysmal rupture. In a review of 20,767 Medicare patients with unruptured aneurysms, not only was the prevalence of hypertension significantly higher in the aneurysm group (43.2 vs. 34.4 ), but follow-up data showed that hypertension was a significant risk factor for subsequent SAH (111). In a review of the literature for longitudinal and case-control studies that evaluated risk factors for SAH, in addition to smoking and alcohol consumption, hypertension was found to be a significant risk factor (112 ).

Addictive Gambling

Compulsive gambling is an addiction, like alcohol dependence or other drug addiction. Because no physical substance is ingested, gambling has been called the purest form of addiction. Although it is strictly psychological, the uncontrollable impulse to gamble can become overwhelming and eventually cause major disruption in a person's life including loss of job, financial ruin, a broken home, criminal activity, and loss of self-respect and the respect of others. Many people have the potential to become addicted to gambling.

Emotions and health

Emotion always serves the function of giving information. It can be extreme, unusual, debilitating, painful, and so on, but information is always being provided. Emotional reactions are always simply emotional reactions they can never be abnormal. However, traditionally, emotions have been seen as contributing to the neuroses, the psychoses, to the affective disorders (such as bipolar disorder), to psychopathy and to excessive (or minimal) eating, alcoholism and drug abuse. But even in psychiatric conditions, emotions are perfectly normal with respect to what brings them about. They are just what they are, with no values attached to them. However, it is reasonable to say that emotions can be dysfunctional or dysregulational.

Thirst

Alcoholism We all have urges, some of them not regarded as socially appropriate and so they are often inhibited. Alcohol tends to release us from such inhibitions, allowing us to be more aggressive, more extraverted, to eat more and, of course, to go on drinking even more. As well as releasing our inhibitions, alcohol also acts as a relaxant, slowing us down physically, even though it might not seem so to do. Thus, for example, we tend to drive faster but react more slowly after drinking alcohol. Alcohol also affects memory, making it difficult to remember things that happen or that we learn when under its influence. Memory and retrieval of In small amounts, it is clear that alcohol can be a social lubricant, but in larger amounts it is enormously costly to society in many ways, from deaths on the road to the social and economic costs of alcohol-related diseases and alcohol-related behaviour. In the extreme, when addiction occurs, this is alcoholism, the causes of which range from...

History

A patient with portal hypertensive bleeding from varices or mucosal congestion may present with hematemesis, melena, hematochezia, or any combination of the above. In the evaluation of a patient with GI bleeding, the following historical features should increase the physician's concern that portal hypertension may be present. A history of excessive alcohol intake or chronic viral hepatitis should be noted. Additionally, any history of chronic parenchymal liver disease or cholangiopathy such as autoimmune hepatitis, hemochromatosis, Wilson's disease, a1-antitrypsin deficiency, primary sclerosing cholangitis (PSC), or PBC raises concern that symptoms of bleeding may be caused by portal hypertension. A history of hypercoagulability or intraabdominal malignancy should prompt concern for vascular thrombosis or malignant infiltration with concomitant portal hypertension. Extrahepatic processes such as cardiac failure can lead through congestion to cardiac cirrhosis. Chronic pancreatitis...

Tuberculosis

Although anyone can contract tuberculosis, certain groups of people are at higher risk. This includes homeless people, poor and medically underserved people, prisoners, nursing home residents, intravenous drug users, people with alcoholism, people with HIV infection, people with AIDS, and people with any disease that reduces the effectiveness of their immune system. People who are in regular contact with at-risk populations are also more likely to become infected. People from countries with high rates of tuberculosis may bring the infection with them when they emigrate.

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