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Journal Club

Journal Club. Alcohol, Other Drugs, and Health: Current Evidence May–June 2019. Featured Article. Conventional and genetic evidence on alcohol and vascular disease aetiology : a prospective study of 500 000 men and women in China Millwood IY , et al. Lancet . 2019;393(10183):1831–1842.

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Journal Club

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  1. Journal Club Alcohol, Other Drugs, and Health: Current Evidence May–June 2019 www.aodhealth.org

  2. Featured Article Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China Millwood IY, et al. Lancet. 2019;393(10183):1831–1842. www.aodhealth.org

  3. Study Objective • “To assess the relationships between cardiovascular risk and genotype-predicted mean alcohol intake in men.” www.aodhealth.org

  4. Study Design • Prospective study of 512,715 adults in China, followed for 10 years. Participants were monitored for cardiovascular disease (CVD). Alcohol use was measured by self-report. • Of these, 161,498 participants were genotyped for variants involved in alcohol metabolism and participated in a Mendelian randomization study. www.aodhealth.org

  5. Assessing Validity of an Article about Prognosis • Are the results valid? • What are the results? • How can I apply the results to patient care? www.aodhealth.org

  6. Are the Results Valid? • Was the sample representative? • Were the subjects sufficiently homogeneous with respect to prognostic risk? • Was follow-up sufficiently complete? • Were objective and unbiased outcome criteria used? www.aodhealth.org

  7. Was the sample representative? • The sample was representative of the population in China. • Participants came from 10 diverse areas of China. • However, very few women consume alcohol in China, so findings are limited to men. www.aodhealth.org

  8. Were the subjects sufficiently homogeneous with respect to prognostic risk? • Mostly, although the authors state that alcohol use varies greatly by study area. • Results were stratified by area and adjusted for age. www.aodhealth.org

  9. Was follow-up sufficiently complete? • Yes. At 10-years, only 4781 (0.9%) of participants were lost to follow-up. • 44,037 (8.6%) died in that time. www.aodhealth.org

  10. Were objective and unbiased outcome criteria used? • Yes. www.aodhealth.org

  11. What Are the Results? • How likely are the outcomes over time? • How precise are the estimates of likelihood? www.aodhealth.org

  12. How likely are the outcomes over time? • Conventional epidemiological analyses adjusted for demographics and smoking found “U-shaped” curves for stroke and coronary heart disease, with nadirs for people who reported drinking occasionally and those drinking 100 g ethanol in a week on average (about 7 US standard drinks). • In the genotypic analyses, there was a linear association between genotype-predicted mean alcohol consumption and stroke risk (with alcohol accounting for 8% of all ischemic strokes and 16% of all intracerebral hemorrhages in men), and no association (protective or harmful) with coronary heart disease. • Of note, both self-reported alcohol and genotype-predicted means were associated linearly with known alcohol effects (systolic blood pressure, HDL cholesterol, and gamma-glutamyl transferase). www.aodhealth.org

  13. How precise are the estimates of likelihood? • For stroke, genotype-predicted mean alcohol intake had a continuously positive log-linear association with risk, which was stronger for intracerebral haemorrhage (relative risk [RR] per 280 g per week 1.58, 95% CI 1.36–1.84) than for ischaemic stroke (1.27, 1.13–1.43). • For myocardial infarction, genotype-predicted mean alcohol intake was not significantly associated with risk (RR per 280 g per week 0.96, 95% CI 0.78–1.18, p=0.69). • Usual alcohol intake in current drinkers and genotype-predicted alcohol intake in all men had similarly strong positive associations with systolic blood pressure (each p<0.0001). www.aodhealth.org

  14. How Can I Apply the Resultsto Patient Care? • Were the study patients and their management similar to those in my practice? • Was follow-up sufficiently long? • Can I use the results in the management of patients in my practice? www.aodhealth.org

  15. Were the study patients similar to those in my practice? • The study population was large and drawn from 10 diverse areas of China. • Only 2% of the women in the study consumed alcohol, compared with 33% of men. www.aodhealth.org

  16. Was follow-up sufficiently long? • Yes. www.aodhealth.org

  17. Can I use the results in the management of patients in my practice? • Yes. • No study is perfect, nor can a single study answer a question definitively. But we now have several Mendelian randomization studies and several high-quality meta-analyses that have minimized confounding and biases and suggest that the previously observed associations between consumption of low amounts of alcohol and cardiovascular outcomes are not cause and effect. www.aodhealth.org

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