Heavy Alcohol Consumption Research Articles

The burden of alcoholic cardiomyopathy in China and different regions around the world.

BackgroundAlcoholic cardiomyopathy (ACM) remains a significant public health issue with a growing global burden. The burden of ACM in China and different regions remains poorly understood.MethodsData on ACM deaths, disability-adjusted life years (DALYs), the corresponding global age-standardized death rate (ASDR), age-standardized DALY rate and estimated annual percentage change (EAPC) were analysed based on age, sex, socio-demographic index (SDI) quintiles, different regions and in China from the Global Burden of Disease (GBD) study 2019.ResultsGlobally, the death rate and DALYs due to ACM were 71 723 and 2 441 108 in 2019, 33.06% and 38.79% increase from 1990, respectively. The corresponding ASDR and age-standardized DALY rate decreased with EAPC of -1.52 (95% uncertainty interval (UI) = -2.39, -0.65) and -1.12 (95% UI = -2.14, -0.10). The high-middle SDI regions, especially Eastern Europe, showed the highest number of ACM-related deaths and DALYs. The ACM-related deaths and DALYs were 2545 and 87823 in China in 2019, 171.03% and 147.17% increase from 1990, respectively. Unlike the world level, ASDR and age-standardized DALY rate also increased in China. The ACM burden is higher in men, and people with 50 to 69 years old accounted for the most.ConclusionsACM burden in China and across the world increased substantially from 1990 to 2019. The greatest burden was borne by the high-middle SDI regions, especially by men aged 50-69 years old. Geographically and gender-age tailored strategies were needed to prevent ACM.

Digital methylation assessments of alcohol and cigarette consumption account for common variance in accelerated epigenetic ageing

ABSTRACT Smoking and Heavy Alcohol Consumption (HAC) are established risk factors for myriad complex disorders of ageing. Yet many prior studies of Epigenetic Ageing (EA) have shown only modest effects of smoking and drinking on accelerated ageing. One potential reason for this conundrum might be the reliance of some prior EA studies on self-reported substance use, which may be unreliable in many samples. To test whether novel, non-self-reported indices would show a stronger association of smoking and HAC to EA, we used methylation sensitive digital PCR (MSdPCR) and data from 437 African American subjects from Wave 7 of the Family and Community Health Study Offspring Cohort to examine the effects of subjective and objective measures of smoking and HAC on 7 indices of EA. Because of limited overall correlations between the various EA indices, we examined patterns of association separately for each index. Consistent with expectations, MSdPCR assessments of smoking and HAC, but not self-reported alcohol consumption, were strongly correlated with accelerated EA. MSdPCR assessments of smoking and HAC accounted for 57% of GrimAge acceleration and the shared variance in GrimAge and DunedinPOAM accelerated EA. We conclude that MSdPCR assessments of smoking and HAC are valuable tools for understanding EA, represent directly targetable conditions for the prevention of premature ageing, and substantially improve upon self-reported assessment of smoking and HAC.

Marijuana use modifies the association between heavy alcohol consumption and tobacco use patterns among US adults: Findings from Behavioral Risk Factor Surveillance System, 2020

ObjectiveThis study explored the associations of heavy alcohol consumption with current e-cigarette, cigarette and dual use of e-cigarettes and cigarettes among a nationally representative sample of adults in the United States (US), and if these associations are modified by marijuana use. MethodsData from 157,138 adults who participated in the 2020 Behavioral Risk Factor Surveillance System (BRFSS) were included in this cross-sectional analysis. Multinomial logistic regression was used to estimate the strength of the associations between heavy alcohol consumption (independent variable) and the tobacco use patterns (dependent variable, i.e., non-use, current e-cigarette use, current cigarette use and current dual use of e-cigarettes and cigarettes). We also assessed the interaction between past-month marijuana use and heavy alcohol consumption on the primary outcome. ResultsAfter the adjustment for potential confounders, heavy alcohol consumption (relative to no heavy alcohol consumption) was associated with higher odds of current e-cigarette (3.91 [2.25–6.78]), cigarette (3.02 [2.28–3.99]) and dual (4.78 [3.25–7.01]) use. The test for interaction showed that the associations of heavy alcohol consumption with the tobacco use patterns were modified by past-month marijuana use (p < 0.05 for all groups), with associations being much stronger among past-month marijuana non-users. ConclusionsHeavy alcohol consumption is positively associated with current e-cigarette, cigarette, and dual use among US adults. Further, the findings indicate that these relationships are modified by past-month marijuana use. Longitudinal research is needed to explore the role of marijuana in the association of heavy alcohol consumption with current e-cigarette, cigarette and dual use among adults.

Using meconium to establish prenatal alcohol exposure in the UK: ethical, legal and social considerations

An expanding policy framework aimed at monitoring alcohol consumption during pregnancy has emerged. The primary justification is prevention of harm from what is termed ‘prenatal alcohol exposure’ (PAE), by enabling...

Chronic alcohol consumption alters home-cage behaviors and responses to ethologically relevant predator tasks in mice.

Alcohol withdrawal is a key component of severe alcohol use disorder. Animal models of alcohol withdrawal tend to focus on traditional anxiety/stress tests. While these have been essential to advancing our understanding of the biology of alcohol withdrawal, abrupt cessation of drinking following heavy alcohol consumption can also trigger withdrawal-related affective states that impact responses to a variety of life events and stressors. To this end, we show that behaviors in a variety of tasks that differ in task demand and intensity are altered during withdrawal in male and female mice after voluntary alcohol access. Male and female miceunderwent six weeks of intermittent two-bottle choice alcohol exposure followed by behavioral tests. The tests included-Home cage: low-stress baseline environment to measure spontaneous natural behaviors; Open field: anxiety-inducing bright novel environment; Looming disc: arena with a protective hut where mice are exposed to a series of discs that mimic an overhead advancing predator, and Robogator-simulated predator task: forced foraging behavioral choice in the presence of an advancing robot predator that "attacks" when mice are near a food pellet in a large open arena. A history ofalcohol exposure impacted behaviors in these tasks in a sex-dependent manner. In the home cage, alcohol induced reductions in digging and heightened stress coping through an increase in grooming time. In males, increased rearing yielded greater vigilance/exploration in a familiar environment. The open-field test revealed an anxiety phenotype in both male and female mice exposed to alcohol. Male mice showed no behavioral alterations to the looming disc task, while females exposed to alcohol showed greater escape responses than water controls, indicative of active stress-response behaviors. In males, the Robogator task revealed a hesitant/avoidant phenotype in alcohol-exposed mice under greater task demands. Few drugs show robust evidence of efficacy in clinical trials for alcohol withdrawal. Understanding how withdrawal alters a variety of behaviors in both males and females that are linked to stress coping can increase our understanding of alcohol misuse and aid in developing better medications for treating individuals with AUD.

Factors Associated with Emergency Department Visits and Consequent Hospitalization and Death in Korea Using a Population-Based National Health Database.

We aim to investigate common diagnoses and risk factors for emergency department (ED) visits as well as those for hospitalization and death after ED visits. This study describes the clinical course of ED visits by using the 2014–2015 population data retrieved from the National Health Insurance Service. Sociodemographic, medical, and behavioral factors were analyzed through multiple logistic regression. Older people were more likely to be hospitalized or to die after an ED visit, but younger people showed a higher risk for ED visits. Females were at a higher risk for ED visits, but males were at a higher risk for ED-associated hospitalization and death. Individuals in the highest quartile of income had a lower risk of ED death relative to lowest income level individuals. Disabilities, comorbidities, and medical issues, including previous ED visits or prior hospitalizations, were risk factors for all ED-related outcomes. Unhealthy behaviors, including current smoking, heavy alcohol consumption, and not engaging in regular exercise, were also significantly associated with ED visits, hospitalization, and death. Common diagnoses and risk factors for ED visits and post-visit hospitalization and death found in this study provide a perspective from which to establish health polices for the emergency medical care system.

Additive Effects of Stress and Alcohol Exposure on Accelerated Epigenetic Aging in Alcohol Use Disorder

BackgroundStress contributes to premature aging and susceptibility to alcohol use disorder (AUD), and AUD itself is a factor in premature aging; however, the interrelationships of stress, AUD, and premature aging are poorly understood. MethodsWe constructed a composite score of stress from 13 stress-related outcomes in a discovery cohort of 317 individuals with AUD and control subjects. We then developed a novel methylation score of stress (MS stress) as a proxy of composite score of stress comprising 211 CpGs selected using a penalized regression model. The effects of MS stress on health outcomes and epigenetic aging were assessed in a sample of 615 patients with AUD and control subjects using epigenetic clocks and DNA methylation–based telomere length. Statistical analysis with an additive model using MS stress and a MS for alcohol consumption (MS alcohol) was conducted. Results were replicated in 2 independent cohorts (Generation Scotland, N = 7028 and the Grady Trauma Project, N = 795). ResultsComposite score of stress and MS stress were strongly associated with heavy alcohol consumption, trauma experience, epigenetic age acceleration (EAA), and shortened DNA methylation–based telomere length in AUD. Together, MS stress and MS alcohol additively showed strong stepwise increases in EAA. Replication analyses showed robust association between MS stress and EAA in the Generation Scotland and Grady Trauma Project cohorts. ConclusionsA methylation-derived score tracking stress exposure is associated with various stress-related phenotypes and EAA. Stress and alcohol have additive effects on aging, offering new insights into the pathophysiology of premature aging in AUD and, potentially, other aspects of gene dysregulation in this disorder.

Gender and Context Matter: Behavioral and Structural Interventions for People Who Use Alcohol and Other Drugs in Africa.

Heavy alcohol consumption and other drug use are prominent across Africa and increase the risk of exposure to violence, HIV acquisition, and other life-threatening injuries. This review synthesizes evidence on alcohol and other drug (AOD) interventions in Africa; evaluates the differences between interventions that do and do not specifically target populations that use AODs; and highlights the impact of comprehensive vs. brief interventions and those that address syndemic issues from a gender and contextualized lens. Literature searches were conducted to identify research outcomes of randomized interventions published between January 2010 and May 2022 that address AOD use in Africa. Thirty-five full-text articles were included in this review. Most of the identified research studies were concentrated in a few countries. Most studies were conducted in South Africa. Many of the studies comprised brief interventions. However, the most comprehensive interventions were the most effective for AOD outcomes. Several studies indicated the importance of addressing AOD use alongside gender-based violence, mental health needs, gender roles, and other social determinants that affect health outcomes. Intervening on AOD use and addressing social determinants from a gender and contextually relevant perspective is essential to ensuring the long-term health and well-being of people in Africa.

Characteristics and predictors of off-label use of antipsychotics in general population sample.

ObjectiveIncreasing number of people have been prescribed antipsychotics (APs) off‐label in recent decades. This study aimed to identify the characteristics and predictors of receiving prescription of antipsychotics off‐label.MethodsThe study sample was part of the Northern Finland Birth Cohort 1966 (n = 7071). Data included questionnaires and national register data. Information on prescribed medications was extracted from the national register. The sample was divided into three groups: Persons who had been prescribed APs off‐label (n = 137), individuals with non‐psychotic mental disorders without APs off label (n = 1478) and individuals who had been diagnosed with psychosis or bipolar disorder and who had been prescribed APs (n = 151). We compared sociodemographic, lifestyle and clinical characteristics between the off‐label and the comparison groups using logistic regression.ResultsThe most common diagnoses in the off‐label group were depression (n = 96, 70.1%) and anxiety (n = 55, 40.1%). Compared with individuals with non‐psychotic mental disorders who were not prescribed APs off‐label, individuals with prescribed off‐label APs had a lower level of education, lower socioeconomic status, were less often married, had a higher level of somatic and psychiatric morbidity, were more often smokers and more often had a substance abuse disorder and heavy alcohol consumption. When comparing the off‐label group to individuals with psychosis or bipolar disorder who used APs, there were less differences, though individuals with psychosis or bipolar disorder had more markers of morbidity and a lower level of education.ConclusionIndividuals who had been prescribed APs off label had a higher level of mental and somatic morbidity and poorer socioeconomic status than individuals with non‐psychotic mental disorders who did not use APs.

Correlates of high phosphatidylethanol (PEth) levels and their concordance with self-reported heavy alcohol consumption among men who have sex with men who binge drink alcohol.

Heavy alcohol use, including binge drinking, is associated with high morbidity and mortality among men who have sex with men (MSM). Self-reported alcohol measures may lead to inaccurate estimates due to recall and social desirability biases. Objective alcohol biomarkers like phosphatidylethanol (PEth) can be used to corroborate self-report and could help to inform treatment approaches and research strategies for alcohol using MSM. From 2015 to 2020, alcohol using MSM ≥18 years were enrolled in a randomized controlled trial evaluating the efficacy of naltrexone in reducing binge drinking. Using this trial's baseline data, we applied multivariable logistic regression to identify the correlates of high PEth levels (i.e., ≥87 ng/ml) and concordance between PEth levels and self-reported heavy drinking. Of 118 MSM, 64% had PEth levels ≥87 ng/ml and 72% had PEth levels that were concordant with self-reported heavy alcohol use. Factors significantlyassociated in separate models with elevated PEth levels were income ≥$60,000 (adjusted odds ratio [aOR]=4.09; 95% CI=1.13 to 14.82), being employed (aOR=4.04; 95% CI=1.45 to 11.32), episodic cannabis use (aOR=4.63; 95% CI=1.27 to 16.92), and any alcohol/substance use prior to or during anal intercourse (aOR=2.52; 95% CI=1.08 to 5.90). Living with HIV was associated with significantly lower odds of elevated PEth levels (aOR=0.23; 95% CI=0.09 to 0.61). Factors associated with significantly higher concordance between PEth levels and self-reported heavy alcohol use included at least weekly use of poppers (aOR=6.41; 95% CI=1.27 to 32.28) and polysubstance use (aOR=2.53; 95% CI=1.02 to 6.27). Living with HIV was associated with lower odds of concordance (aOR=0.36; 95% CI=0.14 to 0.97). PEth may enhance the detection of heavy drinking among MSM, including the identification of subpopulations that may benefit from targeted alcohol reduction interventions. However, PEth values for MSM living with HIV showed modest concordance with self-reported alcohol use and may need to be supplemented with additional biomarkers or evaluated against a different cutoff.

Clinical features of superficial esophagus squamous cell carcinoma according to alcohol-degrading enzyme ADH1B and ALDH2 genotypes.

Inactivated alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) are related to esophageal carcinogenesis. We aimed to clarify the clinical features associated with the alcohol-degrading enzyme genotypes, ADH1B and ALDH2. We also investigated the risk factors for metachronous esophageal squamous cell carcinoma (ESCC) and head and neck SCC (HNSCC). We conducted a single-center, retrospective study including patients with ESCC treated by endoscopic resection. Patients were recruited between October 2020 and September 2021. Buccal mucosal swabs were obtained from them to analyze the genetic polymorphisms affecting ADH (ADH1B) and ALDH (ALDH2) activity. Patients were categorized into three groups: both inactivated = double-inactivated group; inactivated ADH1B or ALDH2 = single-inactivated group; and both activated = activated group. Among the 297 enrolled patients, patients in the double-inactivated group were significantly younger (P < 0.001) and 60% of them were ≤ 50years old. This group also had more ESCCs located in the upper esophagus (P < 0.001) and more simultaneous multiple ESCCs (P = 0.044). More than half of the patients had multiple Lugol-voiding lesions (LVLs) (P < 0.001) and heavy alcohol consumers (P = 0.012). Metachronous ESCC and HNSCC were more common in the double-inactivated group (P < 0.001, P = 0.001). Multivariate analysis identified located in the upper esophagus, multiple LVLs and history of HNSCC as risk factors for metachronous ESCC. Activation patterns of alcohol-metabolizing enzymes were related to age at ESCC onset, lesion location, and metachronous ESCC and HNSCC. Different approaches to the prophylaxis and treatment of esophageal cancer should be considered, depending on the enzyme activity pattern.

Alcohol and the young: how does the press face the problem?

&#x0D; Background: alcohol is an important component of the Mediterranean diet and its moderate use is protective against cardiovascular risk. Binge drinking, i.e. the heavy consumption of alcohol over a short period of time, is the main consumption pattern of young people in Western countries and may lead to severe toxic effects in many organs. Mass media often address the issue by suggesting prevention measures; however, they may also have the unintended effect of encouraging alcohol misuse. This study aims to assess how the Italian press faces excessive alcohol consumption in young people, comparing the messages given by the press with scientific recommendations.&#x0D; Methods: articles published by the 6 best-selling Italian newspapers and the 4 best-selling Italian magazines were collected from October 15th to November 14th 2009. Medline database, governmental and non-governmental sources were searched for scientific recommendations regarding primary prevention of alcohol misuse. Press articles were described and analysed by filling out a predefined form.&#x0D; Results: fourteen newspaper articles regarding alcohol were found, 79% belonging to the news section. Six quotations of scientific recommendations were found: two about drink-driving, two about raising public awareness, one about Monitoring and Evaluation, and one about community and workplace action.&#x0D; Conclusions: scientific recommendations were often inadequately reported by the Italian press. The most covered recommendations, designed driver and public educational intervention, are also the least effective according to international literature. Therefore, a further effort is needed to tackle this issue in a more scientifically sound way.&#x0D;

Mice lacking α4 nicotinic acetylcholine receptors are protected against alcohol-associated liver injury.

Chronic heavy alcohol consumption is a major risk factor for the development of liver steatosis, fibrosis, and cirrhosis, but the mechanisms by which alcohol causes liver damage remain incompletely elucidated. This group has reported that α4 nicotinic acetylcholine receptors (α4 nAChRs) act as sensors for alcohol in lung cells. This study tested the hypothesis that α4 nAChRs mediate the effects of alcohol in the liver. Expression of acetylcholine receptor subunits in mouse liver was determined by RNA sequencing (RNA-seq). α4 nAChR knockout (α4 KO) mice were generated in C57BL/6J mice by introducing a mutation encoding an early stop codon in exon 4 of Chrna4, the gene encoding the α4 subunit of the nAChR. The presence of the inactivating mutation was established by polymerase chain reaction and genomic sequencing, and the lack of α4 nAChR function was confirmed in primary fibroblasts isolated from the α4 KO mice. Wild-type (WT) and α4 KO mice were fed the Lieber-DeCarli diet (with 36% of calories from alcohol) or pair fed an isocaloric maltose-dextrin control diet for a 6-week period that included a ramping up phase of increasing dietary alcohol. Chrna4 was the most abundantly expressed nAChR subunit gene in mouse livers. After 6 weeks of alcohol exposure, WT mice had elevated serum transaminases and their livers showed increased fat accumulation, decreased Sirt1 protein levels, and accumulation of markers of oxidative stress and inflammation including Cyp2E1, Nos2, Sod1, Slc7a11, TNFα, and PAI1. All these responses to alcohol were either absent or significantly attenuated in α4 KO animals. Together, these observations support the conclusion that activation of α4 nAChRs by alcohol or one of its metabolites is one of the initial events promoting the accumulation of excess fat and expression of inflammatory mediators. Thus, α4 nAChRs may represent viable targets for intervention in chronic alcohol-related liver disease.

FAMILY SUPPORT OF GERIATRICS IN COVID-19 ERA: A PANACEA FOR CREATING HAPPINESS

As the population of elderly people continues to climb, the number of dependent persons in the majority ofdeveloping countries appears destined to rise. To pinpoint the proper preventative and intervention services,especially in Nigeria during COVID-19, health systems require improved data to identify the health hazardsolder people experience. The percentage of people who have at least three of the six health risk factors(physical inactivity, current tobacco use, heavy alcohol consumption, a high-risk waist-hip ratio,hypertension, or obesity) increases with age, but the patterns and percentages differ by country, accordingto data from the Study on Global Ageing and Adult Health (2010). Households in emerging nations willlikely face additional difficulties in caring for elderly relatives as a result of changing family structures, suchas fewer families and a decreased incidence of multigenerational cohabitation. Therefore, this articleexamines how the country's aging population's health and wellbeing are affected by the changing familystructure.

A rare case of thrombocytosis presentation in patient alcoholic liver disease with portal hypertension gastropathy: a stepwise evaluation

Thrombocytosis is rarely found in patient with chronic liver disease (CLD). The possibility of reactive thrombocytosis could be due to sustained process such as iron deficiency anemia (IDA) because of occult bleeding. Occult bleeding can happen in CLD patient because of portal hypertension gastropathy (PHG) as complication of portal hypertension. A carefully evaluation of anemia can lead to underlying cause of disease, even in limited of supportive evaluation and some other confounding presentation that is thrombocytosis. We report a case of 54 years-old male patient with severe anemia. He had same symptom previously and got transfusion. Peripheral blood smear showed microcytic hypochromic anemia, anisocytosis, and poikilocytosis even pencil cells (pencil cells or cigar cells) with thrombocytosis. No symptom of acute inflammation setting and no clear blood loss was founded. As patient admitted to smoking and heavy alcohol consumption in the past, Ultrasound was performed for screening of underlying disease that cause occult bleeding. Ultrasound of the liver showed generally increased echogenicity suggestive of liver cirrhosis, splenomegaly and minimal ascites. Thus, our patient clinically be suggestive of CLD with portal hypertension that cause PHG.

Abstract 2236: A novel integrated predictive model for pancreatic cancer

Abstract Background: Pancreatic cancer is the 7th leading cause of cancer-related mortality and the 12 th most common cancer globally. Many studies have identified risk factors for pancreatic cancer, nevertheless, there have been few combined risk factor models developed for the UK specific population. Due to the high incidence with a poor survival rate together with the potential high preventable rate, it is important to establish an accessible predictive risk factor model for identifying potential high-risk populations. Study aim: To establish a pancreatic cancer risk prediction model by integrating the current risk factors together with established genomic biomarkers. Method:Using data from the UK biobank we have investigated the role of established and suggested risk factors for pancreatic cancer. The established risk factors include age, BMI, smoking, alcohol consumption, diabetes and pancreatitis. We also calculate the added prediction from the current polygenic risk score (PRS) to evaluate the risk for genetic predisposition. Last, we utilise the multivariate logistic regression models to establish a novel risk model by integrating the well-known risk factors such as cigarette smoking, heavy alcohol consumption, increased BMI, chronic pancreatitis, diabetics, some germline mutation, and our new evaluated PRS and biological clocks. Results: We will present the performance of the novel integrated model which will be useful for use in primary care to identify the at-risk population. This will assist in the promotion of prevention recommendations and for future health check follow-up. Citation Format: Temin Ke, Artitaya Lophatananon, Kenneth Muir, Xinzhu Yu. A novel integrated predictive model for pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2236.

Alcohol use disorder is associated with DNA methylation-based shortening of telomere length and regulated by TESPA1: implications for aging

Chronic heavy alcohol consumption is associated with increased mortality and morbidity and often leads to premature aging; however, the mechanisms of alcohol-associated cellular aging are not well understood. In this study, we used DNA methylation derived telomere length (DNAmTL) as a novel approach to investigate the role of alcohol use on the aging process. DNAmTL was estimated by 140 cytosine phosphate guanines (CpG) sites in 372 individuals with alcohol use disorder (AUD) and 243 healthy controls (HC) and assessed using various endophenotypes and clinical biomarkers. Validation in an independent sample of DNAmTL on alcohol consumption was performed (N = 4219). Exploratory genome-wide association studies (GWAS) on DNAmTL were also performed to identify genetic variants contributing to DNAmTL shortening. Top GWAS findings were analyzed using in-silico expression quantitative trait loci analyses and related to structural MRI hippocampus volumes of individuals with AUD. DNAmTL was 0.11-kilobases shorter per year in AUD compared to HC after adjustment for age, sex, race, and blood cell composition (p = 4.0 × 10−12). This association was partially attenuated but remained significant after additionally adjusting for BMI, and smoking status (0.06 kilobases shorter per year, p = 0.002). DNAmTL shortening was strongly associated with chronic heavy alcohol use (ps < 0.001), elevated gamma-glutamyl transferase (GGT), and aspartate aminotransferase (AST) (ps < 0.004). Comparison of DNAmTL with PCR-based methods of assessing TL revealed positive correlations (R = 0.3, p = 2.2 × 10−5), highlighting the accuracy of DNAmTL as a biomarker. The GWAS meta-analysis identified a single nucleotide polymorphism (SNP), rs4374022 and 18 imputed ones in Thymocyte Expressed, Positive Selection Associated 1(TESPA1), at the genome-wide level (p = 3.75 × 10−8). The allele C of rs4374022 was associated with DNAmTL shortening, lower hippocampus volume (p < 0.01), and decreased mRNA expression in hippocampus tissue (p = 0.04). Our study demonstrates DNAmTL-related aging acceleration in AUD and suggests a functional role for TESPA1 in regulating DNAmTL length, possibly via the immune system with subsequent biological effects on brain regions negatively affected by alcohol and implicated in aging.

Light-to-Moderate Alcohol Consumption Increases the Risk of Biliary Tract Cancer in Prediabetes and Diabetes, but Not in Normoglycemic Status: A Nationwide Cohort Study.

To determine whether the dose-response association between alcohol consumption and the risk of biliary tract cancer (BTC), including cholangiocarcinoma (CCA) and gallbladder cancer (GBC), differs according to glycemic status. This nationwide cohort study included 9,520,629 individuals age ≥ 20 years without a history of cancer who underwent national health screening under the Korean National Health Insurance Service in 2009. The participants were followed up until December 2018 for BTC development. Cox proportional hazard regression analysis was performed to estimate risk. During the 78.3 million person-years of follow-up, 21,079 patients were newly diagnosed with BTC. In individuals with prediabetes and diabetes, light-to-moderate alcohol consumption increased the risk of CCA (adjusted hazard ratio [aHR], 1.20; 95% CI, 1.13 to 1.28 and aHR, 1.58; 95% CI, 1.47 to 1.69) and GBC (aHR, 1.18; 95% CI, 1.07 to 1.31 and aHR, 1.45; 95% CI, 1.28 to 1.64). In normoglycemic individuals, light-to-moderate alcohol consumption was not associated with CCA or GBC risk. When heavy alcohol consumption was combined with diabetes, CCA and GBC risk increased synergistically (aHR, 2.04; 95% CI, 1.83 to 2.26; and aHR, 1.65; 95% CI, 1.33 to 2.04, respectively; all P < .001). Prediabetes and heavy alcohol consumption had a synergistic interactive effect on CCA and GBC risks (all P < .001). Comparable results were obtained for intrahepatic and extrahepatic CCA analyses. Even light-to-moderate alcohol consumption was associated with an increased risk of BTC in individuals with prediabetes and diabetes, but not in normoglycemic individuals. Complete avoidance of alcohol consumption may help reduce the risk of BTC in patients with prediabetes and diabetes, suggesting the need for individualized prevention strategies for BTC.

A systematic review of the effectiveness of protective behavioral strategies in reducing heavy alcohol consumption and associated harms among young adults

A systematic review of the effectiveness of protective behavioral strategies in reducing heavy alcohol consumption and associated harms among young adults

PREDICTING THE RISK OF SYNCOPE IN PATIENTS WITH AN INDICATION FOR ANTIHYPERTENSIVE TREATMENT: DEVELOPMENT OF THE STRATIFY-SYNCOPE PREDICTION MODEL

Objective: Syncope is one of the most common side effects associated with antihypertensive medication. In patients at increased of syncope, the additional risk of harm from antihypertensive medication may outweigh the potential benefits of treatment in terms of cardiovascular risk reduction. However, it is unclear how to identify patients at most risk of syncope events. This study aimed to develop a clinical prediction model for risk of hospitalisation or death from syncope. Design and method: This was a cohort study using data from the Clinical Practice Research Datalink (CPRD) in the UK. The electronic health records of patients aged greater than 40, with at least one blood pressure measurement between 130–179 mmHg were included. Outcomes were defined as a syncope event resulting in hospitalisation or death within 10 years of baseline. Predictors of syncope were based on the literature and expert opinion and included patient characteristics, past medical history and prescribed treatment (including antihypertensive prescription). A Fine-Gray model was used to adjust for competing risk of mortality and results are reported as subdistribution hazard ratios (SHR). Results: A total of 1,772,617 patients were eligible for the study, with mean age of 59 and 48% males. Median follow up was 6.2 years with 39898 syncope events (2.3%). The antihypertensive medications most strongly associated with syncope were alpha blockers (SHR: 1.21, 95%CI 1.15 to 1.28) and ACE inhibitors (SHR: 1.19, 95%CI 1.16 to 1.22). Other important predictors included age (Figure 1), male sex, high social deprivation, heavy alcohol consumption, previous syncope, diabetes, dementia, structural cardiac problems, arrhythmias, spinal cord injuries, parkinsonism, cardiopulmonary disease and prescription of antidepressants, antipsychotics and opioids (table 1). Conclusions: This prediction model identified a number of strong predictors of syncope which are routinely available in an individual's electronic health records. The accuracy of this model will examined in a further ∼3,000,000 patients from a different electronic health record database. If it is found to perform well, such a model could be used to provide personalised estimates of an individual's risk of harm from antihypertensive treatment, thus facilitating more informed treatment choices.