Chris L. Bryson, MD, MS; David H. Au, MD, MS; Haili Sun, PhD; Emily C. Williams, MPH; Daniel R. Kivlahan, PhD; Katharine A. Bradley, MD, MPH
Grant Support: By the Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service (AUDIT-C as a Scaled Marker for Health Risks in VA Medical Outpatients; IAC 05-206). The ACQUIP was funded by Department of Veterans Affairs grants SDR 96-002 and IIR 99-376. Drs. Bryson and Au were supported by Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service Career Development Awards (RCD 03-177 and RCD 00-018).
Potential Financial Conflicts of Interest: None disclosed.
Reproducible Research Statement:Study protocol: Available from Dr. Bryson (e-mail, firstname.lastname@example.org). Statistical code: Available from Dr. Sun (e-mail, email@example.com). Data set: Not available.
Requests for Single Reprints: Chris L. Bryson, MD, MS, Veterans Affairs Puget Sound Healthcare System, Health Services Research & Development Service, 1100 Olive Way, Suite 1400, Seattle, WA 98101; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Bryson, Sun, Au, and Bradley and Ms. Williams: Veterans Affairs Puget Sound Healthcare System, Health Services Research & Development Service, 1100 Olive Way, Suite 1400, Seattle, WA 98101.
Dr. Kivlahan: Veterans Affairs Puget Sound Healthcare System, 1660 South Columbian Way, Seattle, WA 98108.
Author Contributions: Conception and design: C.L. Bryson, D.R. Kivlahan, K.A. Bradley.
Analysis and interpretation of the data: C.L. Bryson, D.H. Au, H. Sun, E.C. Williams, D.R. Kivlahan, K.A. Bradley.
Drafting of the article: C.L. Bryson, D.H. Au, H. Sun, E.C. Williams, K.A. Bradley.
Critical revision of the article for important intellectual content: C.L. Bryson, D.H. Au, H. Sun, E.C. Williams, D.R. Kivlahan, K.A. Bradley.
Final approval of the article: C.L. Bryson, D.H. Au, H. Sun, E.C. Williams, D.R. Kivlahan, K.A. Bradley.
Statistical expertise: C.L. Bryson, H. Sun, E.C. Williams, K.A. Bradley.
Obtaining of funding: C.L. Bryson, D.R. Kivlahan, K.A. Bradley.
Administrative, technical, or logistic support: E.C. Williams.
Bryson CL, Au DH, Sun H, Williams EC, Kivlahan DR, Bradley KA. Alcohol Screening Scores and Medication Nonadherence. Ann Intern Med. 2008;149:795-803. doi: 10.7326/0003-4819-149-11-200812020-00004
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Published: Ann Intern Med. 2008;149(11):795-803.
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UTCOM Internal Medicine Resident
December 8, 2008
Alcohol drinking recommendations for abstainers and rare drinkers
I read with interest this observational study about Alcohol Screening Scores and Medication Non-adherence. Probably randomized, controlled trials will add more reliable information about that association.
In the mild alcohol misuse groups; 1-year adherence to antihypertensive and statin medication use was lower. (Adjusted percentage of adherent patients, 61% and 63 % respectively compare to non-drinker group (64% and 66 %) with P value of < 0.001 and 0.001 respectively.
Although moderate alcohol use is associated with a mortality benefit relative to abstention or rare drinking in patients with coronary heart disease (1-4), ischemic stroke (5) and Diabetes (6); these above findings emphasize the fact that alcohol drinking should not be recommended for abstainers and rare drinkers as coronary heart disease risk factor modification because that association between even mild drinking and non adherence.
According to a 2001 AHA Science Advisory (7) "Moderate intake of alcoholic beverages (one to two drinks per day) is associated with a reduced risk of CHD in populations. There is no clear evidence that wine is more beneficial than other forms of alcohol, although further research is needed. If wine does have additional effects, it appears that many of the same additional biological effects may be achieved with grape juice. Despite the biologic plausibility and observational data in this regard, it should be kept in mind that these are insufficient to prove causality. Although moderate use of wine and other alcohol-containing beverages does not appear to lead to significant morbidity, alcohol ingestion, unlike other dietary modifications, poses a number of health hazards. Without a large-scale, randomized, clinical endpoint trial of wine intake, there is little current justification to recommend alcohol (or wine specifically) as a cardioprotective strategy. "
According to lifestyle recommendations from the AHA in 2006 "If alcoholic beverages are consumed, they should be limited to no more than 2 drinks per day for men and 1 drink per day for women, and ideally should be consumed with meals".
The bottom line: The consumption of alcohol should not be recommended solely for cardiovascular disease risk factors modification.
(1) Moderate alcohol consumption and risk for angina pectoris or myocardial infarction in U.S. male physicians. Camargo et al. Ann Intern Med 1997 Mar 1;126(5):372-5.
(2) How much alcohol and how often? Population based case-control study of alcohol consumption and risk of a major coronary event. McElduff P; Dobson AJ. BMJ 1997 Apr 19;314(7088):1159-64.
(3) Alcohol consumption and coronary heart disease morbidity and mortality. Rehm JT; Bondy SJ; Sempos CT; Vuong CV. Am J Epidemiol 1997 Sep 15;146(6):495-501
(4) Prospective study of alcohol drinking patterns and coronary heart disease in women and men. Tolstrup et al. BMJ. 2006 May 27;332(7552):1244-8. Epub 2006 May 3.
(5) Alcohol consumption and risk of stroke: a meta-analysis. Reynolds et al ; JAMA 2003 Feb 5; 289(5):579-88.
(6) Alcohol consumption and risk of coronary heart disease by diabetes status. Ajani et al. Circulation 2000 Aug 1; 102(5):500-5.
(7) Goldberg, IJ, Mosca, L, Piano, MR, Fisher, EA. Wineand Your Heart: A Science Advisory for Healthcare Professionals From the Nutrition Committee, Council on Epidemiology and Prevention, and Council on Cardiovascular Nursing of the American Heart Association. Circulation 2001; 103:472.
(8) Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Lichtenstein AH Circulation. 2006 Jul 4;114(1):82-96. Epub 2006 Jun 19.
Tobacco, Alcohol, and Other Substance Abuse, Prevention/Screening.
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