Excessive Alcohol Use Research Articles

A study of effect of alcohol consumption on cardiovascular biomarkers in a tertiary care centre in the Kumaon Region

An important mechanism responsible for increased cardiovascular risks in chronic excessive alcohol use is the pro-oxidant effects of alcohol. There are some emerging risk factors like :- (i) lipoprotein(a) {Lp[a]}, (ii) High‑sensitivity C‑reactive protein (hs‑CRP), (iii) Lipid profile, (iv) Prothrombotic and proinflammatory factors that play an important role in the pathogenesis of atherosclerosis. So we investigated the relation between the levels of cardiovascular biomarkers & the degree of alcohol intake in alcoholic subjects. The present study was carried out in the Department of Biochemistry, in association with the Department of Medicine, Government Medical College, Haldwani. Estimation of Serum Level of hs-CRP & Lp (a) byturbidimetric immunoassay. Serum Cholesterol by CHOD-POD & Triglycerides by enzymatic colorimetric method. LDL cholesterol was calculated by Friedwald equation.The mean total cholesterol, TG, LDLc, hs-CRP, Lp(a) & including HDLc levels were significantly raised (p < 0.05) in cases as compared to controls. The mean serum total cholesterol & Lp (a) levels showed no significant association across different alcohol drinking groups (p>0.05). The mean TG & LDLc levels were significantly (p<0.05) higher in occasional drinkers and heavy drinkers than that of low-moderate & moderate drinkers. The mean serum HDL cholesterol levels in the occasional drinkers were significantly elevated in comparison to the low-moderate drinkers, moderate drinkers and heavy drinkers. The mean serum hs-CRP level in the mediocre and heavy drinkers was significantly low (p<0.05) as compared occasional drinkers and low-moderate drinkers. Our study suggests heavy drinking (>30drinks/week) must be strongly discouraged as it may lead to changes in cardiovascular markers and dyslipidemia. Our study also showed a beneficial effect of occasional drinking on HDLc and moderate drinking on hs-CRP.

Unhealthy lifestyle impacts on biological systems involved in stress response: hypothalamic-pituitary-adrenal axis, inflammation and autonomous nervous system.

An unhealthy lifestyle has a critical role in the pathogenesis and course of several chronic disorders. It has been hypothesized that lifestyle may also impact biological systems involved in stress response. A global index of unhealthy lifestyle was calculated based on the cumulative presence of five self-reported lifestyle habits (smoking, excessive alcohol use, drug use, low physical activity and short sleep) in 2783 participants (18-65 years) from the Netherlands Study of Depression and Anxiety. The functioning of biological stress systems was based on multiple physiological measures of cortisol, inflammatory cytokines and autonomic cardiac activity. The unhealthy lifestyle index was associated with hyperactivity of hypothalamus-pituitary-adrenal axis and increased inflammation, indicating that with increasing unhealthy habits, the level of biological stress increases. No association with the autonomic nervous system activity was observed; however, the use of drugs increased parasympathetic cardiac activity and significantly impacted on ANS. Results were not impacted by a recent episode of depression or anxiety disorder. An unhealthy lifestyle may unfavorably impact on biological systems involved in stress response, which may underlie progression of several psychiatric as well as somatic chronic disorders.

A study to assess the knowledge regarding Angina Pectoris among the adults in selected areas of Pune City

INTRODUCTION: According to projections, 17.9 million deaths globally in 2019—or 32% of all fatalities—were caused by Cardia vascular disease. 85 percent of these deaths were caused by heart attacks and strokes. Nearly 75% of cardia vascular disease deaths take place in low- and lower-middle-income countries. Of the 17 million non- communicable disease-related fatalities that occurred in the globe in 2019 (under the age of 70), 38 percent were caused by Cardia vascular disease. The 95% of cardiovascularmay be prevented by addressing recidivism including smoking, poor eating habits, obesity, inactivity, and excessive alcohol use.(1) METHODOLOGY: In the present study non-experimental descriptive apporch. Data collected on 200 samples. A Non-probability purposive sampling technique was used to collect data from the samples. Tool was constructed to identify the demographic variables, and a set of self-structured questionnaires on knowledge regarding Angina Pectoris.(2) RESULT: Data presented in shows that level of knowledge regarding angina pectoris among adults the major findings are 79.5% of adults have average knowledge, the remaining 20% had good knowledge and 0(0%) had poor knowledge. The mean of the level of knowledge regarding angina pectoris among adults is 13.22 with SD is ± 1.75.(3) CONCLUSION :Age, gender, relationship status, education, and employment were demographic factors that did not substantially affect knowledge score since the p value was more than 0.05. No statistically significant correlation between each of the chosen demographic data and adult Angina Pectoris was seen. Although the general public had a fair amount of awareness regarding Angina Pectoris adults lacked accurate understanding of the condition. Health care practitioners should place more focus on health education to raise knowledge of sinus tachycardia in the public (4).

CDC: 1 in 8 deaths among 20‐64 year olds from alcohol use

One in eight deaths of Americans ages 20 to 64 is due to excessive alcohol consumption, according to a new study by the federal Centers for Disease Control and Prevention (CDC). The study, “Estimated Deaths Attributable to Excessive Alcohol Use Among U.S. Adults Aged 20 to 64 Years, 2015 to 2019,” published in JAMA Network Open on Nov. 1, found that 12.9% of total deaths among adults ages 20 to 64, and 20.3% of deaths among those ages 20 to 49, are due to alcohol consumption.

Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019

Alcohol consumption is a leading preventable cause of death in the US, and death rates from fully alcohol-attributable causes (eg, alcoholic liver disease) have increased in the past decade, including among adults aged 20 to 64 years. However, a comprehensive assessment of alcohol-attributable deaths among this population, including from partially alcohol-attributable causes, is lacking. To estimate the mean annual number of deaths from excessive alcohol use relative to total deaths among adults aged 20 to 64 years overall; by sex, age group, and state; and as a proportion of total deaths. This population-based cross-sectional study of mean annual alcohol-attributable deaths among US residents between January 1, 2015, and December 31, 2019, used population-attributable fractions. Data were analyzed from January 6, 2021, to May 2, 2022. Mean daily alcohol consumption among the 2 089 287 respondents to the 2015-2019 Behavioral Risk Factor Surveillance System was adjusted using national per capita alcohol sales to correct for underreporting. Adjusted mean daily alcohol consumption prevalence estimates were applied to relative risks to generate alcohol-attributable fractions for chronic partially alcohol-attributable conditions. Alcohol-attributable fractions based on blood alcohol concentrations were used to assess acute partially alcohol-attributable deaths. Alcohol-attributable deaths for 58 causes of death, as defined in the Centers for Disease Control and Prevention's Alcohol-Related Disease Impact application. Mortality data were from the National Vital Statistics System. During the 2015-2019 study period, of 694 660 mean deaths per year among adults aged 20 to 64 years (men: 432 575 [66.3%]; women: 262 085 [37.7%]), an estimated 12.9% (89 697 per year) were attributable to excessive alcohol consumption. This percentage was higher among men (15.0%) than women (9.4%). By state, alcohol-attributable deaths ranged from 9.3% of total deaths in Mississippi to 21.7% in New Mexico. Among adults aged 20 to 49 years, alcohol-attributable deaths (44 981 mean annual deaths) accounted for an estimated 20.3% of total deaths. The findings of this cross-sectional study suggest that an estimated 1 in 8 total deaths among US adults aged 20 to 64 years were attributable to excessive alcohol use, including 1 in 5 deaths among adults aged 20 to 49 years. The number of premature deaths could be reduced with increased implementation of evidenced-based, population-level alcohol policies, such as increasing alcohol taxes or regulating alcohol outlet density.

PSUN121 Nonalcoholic Steatohepatitis (NASH), Race/Ethnicity, and Gender in Adult US Population of NHANES 17-18

Abstract Nonalcoholic steatohepatitis (NASH) is a more severe form of non-alcoholic liver disease (NAFLD) that is characterized by inflammation and liver damage. Previous studies have identified a strong association between NAFLD and race/ethnicity, but there has been less investigation of a racial disparity specifically in NASH. We tested the association between NASH and race/ethnicity in the adult US population of NHANES 17-18 (n=5492). Hepatic steatosis (HS) was diagnosed by FibroScan® using controlled attenuation parameter (CAP) values (stages): S0 <238, S1 (mild)=238-259, S2 (moderate)=260-290, S3 (severe) >290. Participants with moderate/severe steatosis without the exclusion criteria (elevated transferrin level >50%, chronic hepatitis B, chronic hepatitis C, excessive alcohol use, or prescription medications that might cause HS) were considered to have NAFLD (n=3,292). Subjects with NAFLD and a HAIR score (defined by HOMA-IR, hypertension, and ALT) of ≥ 2 were considered to have NASH, as opposed to simple NAFLD. Data were analyzed using Chi square and multinomial regression adjusting for the other independent variables [demographics: (age, gender, education, poverty), physical activity, smoking, waist-hip ratio, body mass index, triglyceride, cholesterol, glucose, HbA1c, C-reactive protein (hsCRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and healthy eating index (HEI)] using SAS (Release V.9.1.3, 2002; SAS) and including sample weights and design. The overall prevalence of NASH was 7.6% and it varied by race/ethnicity. Mexican Americans had the highest prevalence (10.6%), followed by other Hispanics (9.1%); Non-Hispanic Whites had the lowest prevalence (6.8%) (p<0.05). Females had lower prevalence (4.8%) than males (10.4%) (p<0.05). Among males, Mexican Americans had the highest prevalence (14.3%), followed by Blacks (11.3%), and other race had the lowest prevalence (7.7%). In the overall adjusted model, Blacks had lower odds of NASH relative to Non-Hispanic Whites [Adjusted Odds Ratio (AOR)=0.4, 95% confidence interval (CI)=0.3-0.6, p<0.05)]. Although Mexican Americans had higher odds of NASH relative to Non-Hispanic Whites, it was not statistically significant (AOR=1.9, 95%CI=0.9-3.9, p=0.09). Among males and females, there was no statistical association between NASH and race/ethnicity (p>0.05). We concluded that the prevalence of NASH was highest among Mexican American males relative to the other groups. Targeted interventions for Mexican American males are needed to increase awareness, management and prevention related to NASH. Grants: R01MD012579, R24DA017298, U54MD007598, S21MD000103, UL1TR001881 Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

The Role and Importance of the Clubs of Alcoholics in Treatment of the Continuous Maintenance of Abstinence and the Achieved Results of Recovery from Alcohol

In our work, we will use the term alcohol addiction due to less stigmatization of people who consume alcohol. Alcohol addiction as a medical-social phenomenon is present in a large number of the population. The goal of the work is to gain insight into the importance of Clubs of alcoholics in treatment (CATs) and the continuous maintenance of change in a person undergoing alcoholism treatment. The subject of the research was to determine the contribution of CATs, in the context of readiness for change in the recovery process of persons treated for alcoholism. The work is based on secondary analysis, which includes the collection and analysis of relevant professional and scientific selected literature from this field. For this work, when collecting secondary data, various books, scientific and professional works, and various databases were used. Willingness to continuously maintain change in the treatment of alcohol addiction is applied in different conditions, both inpatient and outpatient, applying different treatment methods, among which Clubs of alcoholics in treatment stand out, which have as their ultimate goal the treatment of a person who is under the influence of alcohol. The personal change of the CATs user takes place procedurally through an increase in the CATs user's awareness of the existence of the disease of alcohol addiction, a dramatic relief concerning the problem and solution to the problem of alcoholism, through evaluating the self-image and a greater degree of self-acceptance, changing the evaluation of the environment with which the user is in daily contact. Self-liberation occurs through direct interventions carried out in CATs, counter-conditioning learning of alternative forms of behavior to the problematic behavior of excessive alcohol use, and stimulus control interventions that provoke and encourage the user of CATs to reconstruct their environment. Using five-year abstinence and recovery from the disease of alcohol dependence as the primary outcome measure of treatment can lead to an improvement in the overall quality of life of the abstainer.

Exploring the Role of Social Networking Sites in Alcohol Consumption among College Students: Which Platforms Have the Greatest Influence?

ABSTRACT Excessive alcohol use among college students is associated with a host of deleterious physical, mental, and academic outcomes. Social Networking Sites (SNS) are thought to influence norms around alcohol consumption, leading to increased college student drinking. We utilized a sample of 330 college students to investigate the effects of Facebook, Instagram, Twitter, and Snapchat on college student drinking behavior. Only Snapchat use was associated with college student drinking even while controlling for confounders such as the amount of time spent on SNS. Interventions attempting to lower college student drinking should focus on Snapchat to have the most effective platform.

Plenary 4 Reorienting health services: the transformational potential of health promotion

Abstract Over the past decades, in Europe, the nature of our disease burden has shifted from more communicable and acute to chronic diseases such as cardiovascular diseases, diabetes, cancer and mental ill health. These diseases usually manifest themselves later in life, but they are not necessarily related to biological ageing. They mostly result from an accumulation of unhealthy living patterns since childhood and across the life course. Consumption of processed foods high in fat, salt, and sugar, smoking, excessive alcohol use, too little physical activity and too much stress all contribute to the growing and worsening burden of chronic diseases. These behaviours in turn are shaped by the social, environmental, cultural and economic conditions in which we live, grow, work and age. Once they have developed, chronic diseases can be difficult, or even impossible to cure. Our health services, with a traditional curative approach, are not equipped for this chronic epidemic. There is an urgent need to shift our health services away from the predominant focus on cure and towards prevention, and for policy makers to invest in ensuring healthy living environments and societies. Health promotion and enabling people and population groups to increase control over their health, particularly those facing disadvantage, has the potential to transform our health services, and is critical to ensuring their resilience and sustainability. Despite a growing awareness of the need for change, reorienting structures and systems in practice is challenging, as people can be resistant to change. Siloed approaches within the health sector, but also between social, health, and education sectors continue to prevail, and it is not always easy to find the right levers for change and to build bridges across administrations. This is compounded by a lack of infrastructure, organizational and workforce capacity for health promotion, and sustainable financing mechanisms. Much innovative work is however taking place, which we can learn from and scale up. This plenary session will provide examples of different ways in which health-promoting approaches can reorient health services, strengthen health-promoting and community oriented primary care and prevent chronic diseases. It will highlight what we can learn from behavioural and cultural insights and social prescribing, as well as integrated community initiatives to further support people, across the social gradient, to lead and to maintain healthy lives. It will discuss target setting for further advocacy among policy makers. Speakers: Rüdiger Krech WHO, Geneva, Switzerland Susan Michie University College London, UCL Centre for Behaviour Change, London, UK Jan De Maeseneer European Commission Expert Panel on Effective Ways of Investing in Health and Ghent University, Belgium Jet Bussemaker Council of Public Health & Society, Netherlands, Leiden University Medical Center, Leiden, Netherlands Cristiano Figueiredo USF da Baixa, Central Lisbon Health Centre Cluster, National School of Public Health, NOVA University Lisbon, Portugal

Alcohol Withdrawal Is an Oxidative Stress Challenge for the Brain: Does It Pave the Way toward Severe Alcohol-Related Cognitive Impairment?

Alcohol use is a leading cause of mortality, brain morbidity, neurological complications and minor to major neurocognitive disorders. Alcohol-related neurocognitive disorders are consecutive to the direct effect of chronic and excessive alcohol use, but not only. Indeed, patients with severe alcohol use disorders (AUD) associated with pharmacological dependence suffer from repetitive events of alcohol withdrawal (AW). If those AW are not managed by adequate medical and pharmacological treatment, they may evolve into severe AW, or be complicated by epileptic seizure or delirium tremens (DT). In addition, we suggest that AW favors the occurrence of Wernicke’s encephalopathy (WE) in patients with known or unknown thiamine depletion. We reviewed the literature on oxidative stress as a core mechanism in brain suffering linked with those conditions: AW, epileptic seizure, DT and WE. Thus, we propose perspectives to further develop research projects aiming at better identifying oxidative stress brain damage related to AW, assessing the effect of repetitive episodes of AW, and their long-term cognitive consequences. This research field should develop neuroprotective strategies during AW itself or during the periwithdrawal period. This could contribute to the prevention of severe alcohol-related brain damage and cognitive impairments.

Underlying mechanisms in the relationship between stress and alcohol consumption in regular and risky drinkers (MESA): methods and design of a randomized laboratory study

BackgroundExcessive alcohol consumption and alcohol use disorders (AUD) are among the leading preventable causes of premature morbidity and mortality and are considered a major public health concern. In order to reduce the individual and societal burden of excessive alcohol use, it is crucial to identify high-risk individuals at earlier stages and to provide effective interventions to prevent further progression. Stressful experiences are important risk factors for excessive alcohol consumption and AUDs. However, the underlying biological and psychological mechanisms are still poorly understood.MethodsThe project “Underlying mechanisms in the relationship between stress and alcohol consumption in regular and risky drinkers (MESA)” is a randomized controlled study that started in December 2018 and is conducted in a laboratory setting, which aims to identify moderators and mediators of the relationship between acute stress and alcohol consumption among regular and risky drinkers. Regular and risky drinkers are randomly assigned to a stress induction or a control condition. Several processes that may mediate (emotional distress, endocrine and autonomic stress reactivity, impulsivity, inhibitory control, motivational sensitization) or moderate (trait impulsivity, childhood maltreatment, basal HPA-axis activity) the relation between stress and alcohol consumption are investigated. As primary dependent variable, the motivation to consume alcohol following psychosocial stress is measured.DiscussionThe results of this study could help to provide valuable targets for future research on tailored interventions to prevent stress-related alcohol consumption.

Post-Covid Era: Predictive Aspect of Psychological Condition Due to Sudden Pandemic

Covid-19 has impacted the lives of people in various aspects positive as well as negative. It has an
 impact on different areas of life, including the economy, industries, global markets, agriculture,
 human health, etc. The virus caused disruptions to daily life and restrictions on activities in many communities during its multiple outbreaks. Hope for a potential end to the pandemic emerged with the stepping up of vaccination campaigns. However, the continual appearance of mutant strains and vaccine hesitancy has been problems both nationally and internationally. People's normal activities, routines, and livelihoods have been disrupted by self-isolation and quarantine, potentially leading to an increase in loneliness, anxiety, depression, insomnia, excessive alcohol and drug use, and self-harm or suicidal activity. The psychological aspects of the post-covid-19 era are the effect of covid-19 on CNS, and physiological and psychological diseases caused due to covid-19. The article explains Post Trauma Stress Disorder as a psychological scar, Social evils arising due to covid-19, and predictive reasons for the increase in mental illness
 Keywords- Covid-19, Pandemic, Mental Health, Post Trauma Stress Disorder, Depression, Anxiety

Alcohol-Related Liver Disease: An Overview on Pathophysiology, Diagnosis and Therapeutic Perspectives

Alcohol-related liver disease (ALD) refers to a spectrum of liver manifestations ranging from fatty liver diseases, steatohepatitis, and fibrosis/cirrhosis with chronic inflammation primarily due to excessive alcohol use. Currently, ALD is considered as one of the most prevalent causes of liver disease-associated mortality worldwide. Although the pathogenesis of ALD has been intensively investigated, the present understanding of its biomarkers in the context of early clinical diagnosis is not complete, and novel therapeutic targets that can significantly alleviate advanced forms of ALD are limited. While alcohol abstinence remains the primary therapeutic intervention for managing ALD, there are currently no approved medications for treating ALD. Furthermore, given the similarities and the differences between ALD and non-alcoholic fatty liver disease in terms of disease progression and underlying molecular mechanisms, numerous studies have demonstrated that many therapeutic interventions targeting several signaling pathways, including oxidative stress, inflammatory response, hormonal regulation, and hepatocyte death play a significant role in ALD treatment. Therefore, in this review, we summarized several key molecular targets and their modes of action in ALD progression. We also described the updated therapeutic options for ALD management with a particular emphasis on potentially novel signaling pathways.

Phosphodiesterase 4 mRNA Level Suppression is Important for Extract of Black Carrot to Protect Against Hepatic Injury Induced by Ethanol.

Excessive alcohol use often results in alcoholic liver disease (ALD). An early change in the liver due to excessive drinking is hepatic steatosis, which may ultimately progress to hepatitis, liver fibrosis, cirrhosis, and liver cancer. Among these debilitating processes, hepatic steatosis is reversible with the appropriate treatment. Therefore, it is important to find treatments and foods that reverse hepatic steatosis. Black carrot has antioxidant and anti-inflammatory effects. In this study, we examined the effectiveness of black carrot extract (BCE) on hepatic steatosis in in vivo and in vitro ethanol-induced liver injury models. For the in vivo experiments, serum aminotransferase activities enhanced by ethanol- and carbon tetrachloride were significantly suppressed by the BCE diet. Furthermore, morphological changes in the liver hepatic steatosis and fibrosis were observed in the in vivo ethanol-induced liver injury model, however, BCE feeding resulted in the recovery to an almost normal liver morphology. In the in vitro experiments, ethanol treatment induced reactive oxygen species (ROS) levels in hepatocytes at 9 h. Conversely, ROS production was suppressed to control levels and hepatic steatosis was suppressed when hepatocyte culture with ethanol were treated with BCE. Furthermore, we investigated enzyme activities, enzyme protein levels, and messenger RNA levels of alcohol dehydrogenase (ADH), cytochrome p450 2E1 (CYP2E1), and aldehyde dehydrogenase (ALDH) using enzyme assays, western blot, and quantitative reverse transcription-polymerase chain reaction analyses. We found that the activities of ADH, CYP2E1, and ALDH were regulated through the cAMP-PKA pathway at different levels, namely, translational, posttranslational, and transcriptional levels, respectively. The most interesting finding of this study is that BCE increases cAMP levels by suppressing the Pde4b mRNA and PDE4b protein levels in ethanol-treated hepatocytes, suggesting that BCE may prevent ALD.

Acute ethanol-induced liver injury is prevented by betaine administration.

Binge drinking is the most common form of excessive alcohol use. Repeated episodes of binge drinking cause multiple organ injuries, including liver damage. We previously demonstrated that chronic ethanol administration causes a decline in the intrahepatic ratio of S-adenosylmethionine (SAM) to S-adenosylhomocysteine (SAH). This decline causes impairments in essential methylation reactions that result in alcohol-induced fatty liver (steatosis) and other features of alcohol-associated liver disease (ALD). Co-treatment with betaine during chronic ethanol feeding, normalizes hepatocellular SAM:SAH ratio and alleviates many features of liver damage including steatosis. Here, we sought to examine whether betaine treatment similarly protects against liver injury in an alcohol binge-drinking model. We hypothesized that ethanol binge with prior or simultaneous betaine administration would prevent or attenuate acute alcohol-induced liver damage. Male C57Bl/6 mice were gavaged twice, 12 h apart, with either 6 g ethanol/kg BW or with an equal volume/kg BW of 0.9% NaCl. Two separate groups of mice (n = 5/group) were gavaged with 4 g betaine/kg BW, either 2 h before or simultaneously with the ethanol or saline gavages. All mice were sacrificed 8 h after the last gavage and serum and liver parameters were quantified. Ethanol binges caused a 50% decrease in hepatic SAM:SAH ratio and a >3-fold rise in liver triglycerides (p ≤ 0.05). These latter changes were accompanied by elevated serum AST and ALT activities and blood alcohol concentrations (BAC) that were ∼three-times higher than the legal limit of intoxication in humans. Mice that were treated with betaine 2 h before or simultaneously with the ethanol binges exhibited similar BAC as in mice given ethanol-alone. Both betaine treatments significantly elevated hepatic SAM levels thereby normalizing the SAM:SAH ratio and attenuating hepatic steatosis and other injury parameters, compared with mice given ethanol alone. Simultaneous betaine co-administration with ethanol was more effective in preventing or attenuating liver injury than betaine given before ethanol gavage. Our findings confirm the potential therapeutic value of betaine administration in preventing liver injury after binge drinking in an animal model.

The Impact of Social Supports on the Excessive Alcohol Use of the Middle-Aged Adults in South Korea: Do All Types of Social Supports Have Positive Effects on Excessive Alcohol Users?

The purpose of the study is to discuss the necessity of interventions on excessive alcohol use among middle-aged adult Koreans and attempt to investigate the effect of social supports including family support and friend support on excessive alcohol use. To achieve these goals, a self-administered online survey was conducted on middle-aged adult Koreans from 40 to 59 years old sampled through the convenience allocation extraction method, with responses of a total of 767 samples analyzed. The results from the analysis was that the support of the family reduced excessive alcohol use, whereas the support of friends provoked excessive alcohol use. Based on these results, the necessity of a distinction in the different types of social supports for interventions in excessive alcohol use was revealed. In addition, several practical and political implications for the alleviation of excessive alcohol use among middle-aged adults are recommended.

Prevalence of modifiable risk factors and related poor cardiovascular outcomes following atrial fibrillation ablation

Abstract Background Atrial fibrillation (AF) has become a global epidemic. Early catheter ablation and therapies modifying risk factors (RF) have been shown to improve outcomes of AF ablation. However, the time invested in pursuing risk factor modification may delay ablation, which could negate the procedural benefit. Purpose This study sought to investigate the prevalence and impact of potentially modifiable RF among AF patients undergoing catheter ablation in clinical practice. Methods This retrospective study included 724 consecutive patients undergoing AF ablation at a tertiary care center from 2012–2019. Pre-specified modifiable risks were examined, including the time from AF diagnosis to ablation, fluctuation/increase in BMI >5% prior to ablation, mean systolic/diastolic blood pressure >125/80 mmHg, obstructive sleep apnea with CPAP noncompliance, hyperlipidemia without statin therapy, tobacco use, excessive alcohol use, and diabetes mellitus with hemoglobin A1c (HbA1c) >6.5%. The primary outcome was a composite of recurrent atrial arrhythmias, cardiovascular (CV) hospitalizations and mortality following AF ablation. A multivariate analysis was performed. Results The mean age was 61±10 years old, 32.5% were female and 72.2% had persistent AF. Many study patients had modifiable RF, ranging from 4.7% with excessive alcohol use to 64.0% experiencing delayed AF ablation. The mean time from AF diagnosis to ablation was 4.7 years. During a mean follow-up of 1.6 years after ablation, 467 (64.5%) patients met the primary outcome. Independent RF for the primary outcome were an increase/fluctuation in BMI >5% (adjusted hazard ratio [AHR] 1.31, 95% confidence interval [CI] 1.07–1.60; P=0.008), diabetes with HbA1c >6.5% (AHR 1.50, 95% CI 1.09–2.03; P=0.014) and hyperlipidemia without statin therapy (AHR 1.30, 95% CI 1.08–1.57; P=0.005). Delayed AF ablation over 1.5 years did not alter the outcome, Figure 1. Conclusion Substantial portions of patients undergoing AF ablation have potentially modifiable RF. Increased or fluctuating BMI, diabetes with HbA1c >6.5%, and hyperlipidemia not treated with statin therapy portend an increased risk of recurrent atrial arrhythmia, CV hospitalizations and mortality. These findings underscore an importance pursuing RF management in patients with AF to reduce adverse outcomes after ablation. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Jensen Family Research Sponsorship at the University of Nebraska Medical Center

DIEULAFOY LESION CAUSING LOWER GI BLEEDING: A CASE OF COVID-19 CRITICAL ILLNESS PROMPTING UNUSUAL PRESENTATION OF A MORE RARE CONDITION

DIEULAFOY LESION CAUSING LOWER GI BLEEDING: A CASE OF COVID-19 CRITICAL ILLNESS PROMPTING UNUSUAL PRESENTATION OF A MORE RARE CONDITION

S3226 Hepatic Sarcoidosis Manifesting as Asymptomatic Elevation in Liver Enzymes

Introduction: Sarcoidosis is a systemic disorder of unknown etiology characterized by the formation of non-caseating granulomas and can affect any organ in the human body. The most frequently involved organs are lungs and hilar lymph nodes; however, involvement of the liver has been described in prior literature. The spectrum of hepatobiliary involvement can range from asymptomatic hepatic granulomas, and minimally deranged LFTs to symptomatic disease complicated with cholestasis, portal HTN, and cirrhosis. We report a case of asymptomatic LFT elevation in a patient with a prior history of sarcoidosis. Case Description/Methods: An 82-year-old African American woman with a past medical history of coronary artery disease, hyperlipidemia, hypertension, Asthma, and Sarcoidosis presented with asymptomatic elevated LFTs discovered by her PCP. The patient denied any complaints from the GI or any other organ system standpoint. Prior blood transfusions, needle sharing, IV drug use, excessive alcohol use, herbal/alternative medicine use, recent changes in medications, or suicidal ideation were ruled out by meticulous history taking. Initial AST, ALT, ALP, GGT, T. bilirubin, and CK measured 783, 532, 1041, 443, 1.6, and 5,699, respectively. (Table 1) Imaging ruled out gallstone and intra-abdominal pathologies, prompting further investigation of possible infiltrative/infectious/autoimmune/neoplastic etiology. Subsequent laboratory findings ruled out thyroid abnormalities, viral or toxic hepatitis, hemochromatosis, Wilson’s Disease, autoimmune hepatitis, and primary biliary cholangitis. The liver biopsy showed granulomatous hepatitis and noncaseating (non-necrotizing) epithelioid granuloma favoring sarcoid deposition (Figure 1). Discussion: This case highlights the importance of considering hepatic sarcoidosis as a potential cause of LFT elevation, especially in a patient with a prior history of sarcoidosis. In such patients, after common causes of LFT elevations have been ruled out based on the patient’s history, imaging, blood tests, and screening for autoimmune diseases, liver biopsy should be considered earlier in the management course to reach a timely diagnosis. This is especially important as not all cases of hepatic sarcoidosis require treatment, so considerations for treatment vs. closer follow-up could be decided as soon as the liver biopsy results are available. This would significantly decrease the burden on healthcare resources by avoiding unnecessary testing and aiding in timely and accurate management.Figure 1.: Liver Biopsy Results. Table 1. - LFT trend Test name Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day of discharge AST 783 673 566 469 429 355 267 237 ALT 532 441 395 335 330 284 238 224 ALP 1041 920 898 822 780 715 631 653 Total Bilirubin 1.6 1.5 1.3 1.0 0.9 0.9 0.9 1.0 CK 5699 4154 3225 2721 2378 1402 725 437

Implementing a Screening and Brief Intervention Protocol for Excessive Alcohol Use in a Trauma Center: A Healthcare Improvement Project.

The aim of this healthcare improvement project was to evaluate healthcare provider use of screening and brief interventions (SBIs) for patients screening positive for alcohol at an upper Midwestern adult trauma center transitioning from Level II to Level I. Trauma registry data for 2,112 adult patients with trauma who screened positive for alcohol were compared between three periods: pre-formal-SBI protocol (January 1, 2010, to November 29, 2011); first post-SBI protocol (February 6, 2012, to April 17, 2016) after protocol implementation, healthcare provider training, and documentation changes; and second post-SBI protocol (June 1, 2016, to June, 30, 2019) after additional training and process improvements. Data analysis included descriptive statistics and logistic regression for comparisons over time and between admitting services. For the trauma admitting service, SBI rates increased from 32% to 90% over time, compared with 18%-51% for other admitting services combined. Trauma-service-admitted patients screening positive for alcohol had higher odds of receiving a brief intervention than other admitting services in each period in adjusted models: pre-SBI (OR = 1.99, 95% CI [1.15, 3.43], p = .014), first post-SBI (OR = 2.89, 95% CI [2.04, 4.11], p < .001), and second post-SBI (OR = 11.40, 95% CI [6.27, 20.75], p < .001) protocol periods. Within trauma service admissions, first post-SBI protocol (OR = 2.15, 95% CI [1.64, 2.82], p < .001) and second post-SBI protocol (OR = 21.56, 95% CI [14.61, 31.81], p < .001) periods had higher rates and odds of receiving an SBI than the pre-SBI protocol period. The number of SBIs completed with alcohol-positive adult patients with trauma significantly increased over time through SBI protocol implementation, healthcare provider training, and process improvements, suggesting other admitting services with lower SBI rates could adopt similar approaches.