Objective To conduct a comprehensive systematic review and meta-analysis of studies assessing the effect of alcohol consumption on multiple cardiovascular outcomes. Design Systematic review and meta-analysis. Data sources A search of Medline (1950 through September 2009) and Embase (1980 through September 2009) supplemented by manual searches of bibliographies and conference proceedings. Inclusion criteria Prospective cohort studies on the association between alcohol consumption and overall mortality from cardiovascular disease, incidence of and mortality from coronary heart disease, and incidence of and mortality from stroke. Studies reviewed Of 4235 studies reviewed for eligibility, quality, and data extraction, 84 were included in the final analysis. Results The pooled adjusted relative risks for alcohol drinkers relative to non-drinkers in random effects models for the outcomes of interest were 0.75 (95% confidence interval 0.70 to 0.80) for cardiovascular disease mortality (21 studies), 0.71 (0.66 to 0.77) for incident coronary heart disease (29 studies), 0.75 (0.68 to 0.81) for coronary heart disease mortality (31 studies), 0.98 (0.91 to 1.06) for incident stroke (17 studies), and 1.06 (0.91 to 1.23) for stroke mortality (10 studies). Dose-response analysis revealed that the lowest risk of coronary heart disease mortality occurred with 1–2 drinks a day, but for stroke mortality it occurred with ≤1 drink per day. Secondary analysis of mortality from all causes showed lower risk for drinkers compared with non-drinkers (relative risk 0.87 (0.83 to 0.92)). Conclusions Light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes.

https://www.bmj.com/content/bmj/342/bmj.d671.full.pdf

Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis

Objective  To compare the risk for all cause and overdose mortality in people with opioid dependence during and after substitution treatment with methadone or buprenorphine and to characterise trends in risk of mortality after initiation and cessation of treatment.

Design  Systematic review and meta-analysis.

Data sources  Medline, Embase, PsycINFO, and LILACS to September 2016.

Study selection  Prospective or retrospective cohort studies in people with opioid dependence that reported deaths from all causes or overdose during follow-up periods in and out of opioid substitution treatment with methadone or buprenorphine.

Data extraction and synthesis  Two independent reviewers performed data extraction and assessed study quality. Mortality rates in and out of treatment were jointly combined across methadone or buprenorphine cohorts by using multivariate random effects meta-analysis.

Results  There were 19 eligible cohorts, following 122 885 people treated with methadone over 1.3-13.9 years and 15 831 people treated with buprenorphine over 1.1-4.5 years. Pooled all cause mortality rates were 11.3 and 36.1 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 3.20, 95% confidence interval 2.65 to 3.86) and reduced to 4.3 and 9.5 in and out of buprenorphine treatment (2.20, 1.34 to 3.61). In pooled trend analysis, all cause mortality dropped sharply over the first four weeks of methadone treatment and decreased gradually two weeks after leaving treatment. All cause mortality remained stable during induction and remaining time on buprenorphine treatment. Overdose mortality evolved similarly, with pooled overdose mortality rates of 2.6 and 12.7 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 4.80, 2.90 to 7.96) and 1.4 and 4.6 in and out of buprenorphine treatment.

Conclusions  Retention in methadone and buprenorphine treatment is associated with substantial reductions in the risk for all cause and overdose mortality in people dependent on opioids. The induction phase onto methadone treatment and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies to mitigate such risk. These findings are potentially important, but further research must be conducted to properly account for potential confounding and selection bias in comparisons of mortality risk between opioid substitution treatments, as well as throughout periods in and out of each treatment.

https://www.bmj.com/content/bmj/357/bmj.j1550.full.pdf

Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies

This book includes detailed information on many of the factors surrounding injuries--the man-made systems and products involved, the groups at greatest risk, and effective ways to protect people from injuries. The circumstances under which injuries occur, the etiologic agents, and the characteristics of the people involved are examined. Chapter 2 summarizes the importance of injuries in relation to other prominent health problems. Subsequent chapters describe injury mortality and, in cases where good population-based studies are available, nonfatal injuries. The analyses in Chapters 3-15 are primarily of injury deaths during 1977-1979, the most recent years for which detailed mortality data were available in mid-1983 for deaths other than those related to motor vehicles. Most of these data were collected by the U.S. Department of Health and Human Services, National Center for Health Statistics (NCHS). Chapters 16-20 summarize data on deaths from motor vehicle-related injuries. Most of these detailed data were obtained from the U.S. Department of Transportation, National Highway Traffic Safety Administration (NHTSA). Data from the 1980 census provided denominators for the rates throughout the book, except for trendline calculations which were based on interpolations between census years. The purpose of this book is to improve understanding of the nature and magnitude of the injury problem in the United States. Although it includes some discussion of ameliorative approaches, there is no comprehensive coverage of injury research, theory, or prevention, since these have been comprehensively discussed elsewhere. This book is a thorough documentation of the injury problem. Most of the information presented is new, the product of analyses not previously published in any form.

https://link.springer.com/content/pdf/10.2307%2F3342319.pdf

The injury fact book

ContextObservational studies suggest that heavy alcohol consumption may increase
the risk of stroke while moderate consumption may decrease the risk.ObjectiveTo examine the association between alcohol consumption and relative
risk of stroke.Data SourcesStudies published in English-language journals were retrieved by searching
MEDLINE (1966–April 2002) using Medical Subject Headings alcohol drinking, ethanol, cerebrovascular accident, cerebrovascular disorders, and intracranial embolism and thrombosis and the key word stroke; Dissertation Abstracts Online using the keywords stroke and alcohol; and bibliographies of
retrieved articles.Study SelectionFrom 122 relevant retrieved reports, 35 observational studies (cohort
or case control) in which total stroke, ischemic stroke, or hemorrhagic (intracerebral
or total) stroke was an end point; the relative risk or relative odds and
their variance (or data to calculate them) of stroke associated with alcohol
consumption were reported; alcohol consumption was quantified; and abstainers
served as the reference group.Data ExtractionInformation on study design, participant characteristics, level of alcohol
consumption, stroke outcome, control for potential confounding factors, and
risk estimates was abstracted independently by 3 investigators using a standardized
protocol.Data SynthesisA random-effects model and meta-regression analysis were used to pool
data from individual studies. Compared with abstainers, consumption of more
than 60 g of alcohol per day was associated with an increased relative risk
of total stroke, 1.64 (95% confidence interval [CI], 1.39-1.93); ischemic
stroke, 1.69 (95% CI, 1.34-2.15); and hemorrhagic stroke, 2.18 (95% CI, 1.48-3.20),
while consumption of less than 12 g/d was associated with a reduced relative
risk of total stroke, 0.83 (95%, CI, 0.75-0.91) and ischemic stroke, 0.80
(95% CI, 0.67-0.96), and consumption of 12 to 24 g/d was associated with a
reduced relative risk of ischemic stroke, 0.72 (95%, CI, 0.57-0.91). The meta-regression
analysis revealed a significant nonlinear relationship between alcohol consumption
and total and ischemic stroke and a linear relationship between alcohol consumption
and hemorrhagic stroke.ConclusionsThese results indicate that heavy alcohol consumption increases the
relative risk of stroke while light or moderate alcohol consumption may be
protective against total and ischemic stroke.

Alcohol Consumption and Risk of Stroke: A Meta-analysis

http://www.womensheart.org/PDFs/2007-GuidelineUpdate-CVDWomen.pdf

Evidence-based guidelines for cardiovascular disease prevention in women: 2007 Update

Background and Purpose Since stroke is a principal cause of death in elderly people, we analyzed the association between alcohol and stroke mortality in a cohort of 15 077 middle-aged and older men and women. Methods Data on alcohol habits were obtained from a questionnaire in 1967. The subsequent 20 years yielded 769 deaths from stroke, of which 574 were ischemic. Relative mortality risks (RR) were estimated from logistic regression analyses with lifelong alcohol abstainers as a reference group. Adjustments were made for age and smoking. Results No association was found between alcohol intake and hemorrhagic stroke. An elevated risk of ischemic stroke was found for men who drank infrequently, that is, a few times a year or less often (RR, 2.0; 95% confidence interval [CI], 1.3 to 3.2), for those who were intoxicated now and then (RR, 1.8; 95% CI, 1.1 to 2.8), and for those who reported “binge” drinking a few times in the year or less often (RR, 1.6; 95% CI, 1.1 to 2.5). Among women only ex-drinkers had a...

Alcohol Consumption and Stroke Mortality 20-Year Follow-up of 15 077 Men and Women

Aim: To determine the total mortality related to the Stockholm methadone programme during the period 1988-2000, both the mortality related to the treatment and fatal methadone intoxications in th ...

Methadone maintenance treatment: the balance between life-saving treatment and fatal poisonings.

INTRODUCTION AND AIMS: To examine the overall mortality and causes of deaths of a large cohort of users of illicit drugs in Stockholm over 37 years. DESIGN AND METHODS: People with substance abuse were identified through records collected by different institutions in Stockholm in 1967. Subjects were followed in registers recording mortality and cause of death and in-patient care stays until 2003. RESULTS: More than half (n = 860) of the 1705 identified substance abusers died at an average age of 47 years, 25-30 years younger than the general population. The standardized rate ratio (SRR) for mortality was 3.3 among men and 3.5 among women. Incidence of mortality per 1000 person-years was also increased, but somewhat lower for women. The difference between these two measures is mainly explained by a lower mortality among women in general. In-patient care stays with both alcohol and drug-related diagnoses were associated with higher risk of dying among women than men: SRR = 14.5 and SRR = 4.0, respectively. Accidents and suicide were the most common cause of death among the youngest subjects (15-24 years) and cardiovascular diseases and tumors among the oldest (> or =55 years). DISCUSSION AND CONCLUSIONS: Accidents and suicide, especially at a young age, are two common causes of death that might be prevented by increased awareness in medical personnel, along with better treatment and supportive measures. Language: en

Mortality and cause of death among 1705 illicit drug users: A 37 year follow up

Several epidemiological studies have shown that moderate alcohol consumption is associated with reduced mortality from cardiovascular diseases in middle aged and elderly subjects,1 but its effect in younger people is unknown. High alcohol consumption is associated with increased total mortality, but the findings for stroke have varied.1 2 We analysed the association between alcohol consumption and the incidence of myocardial infarction, stroke, and mortality in a 25 year follow up of military conscripts.

This study is based on 49 618 Swedish men conscripted between 1 July 1969 and 30 June 1970 and born between 1949 and 1952.2 At conscription, all men were given two questionnaires with questions covering social background, behaviour, and use of alcohol and tobacco, and all met with a psychologist for assessment. The percentage of non-responders was between 1% and 2%.

From questions about quantity and frequency …

https://www.bmj.com/content/bmj/319/7213/821.full.pdf

Association between alcohol consumption and mortality, myocardial infarction, and stroke in 25 year follow up of 49 618 young Swedish men.

This study analyzed indicators of alcohol-related problems in opiate addicts before, during, and after leaving methadone maintenance treatment (MMT), in relation to illicit drug use and retention in treatment. The study was based on 204 patients, admitted to MMT for the first time between 1 January 1995 and 31 July 2000, and followed until 31 December 2000. Three measures were used to indicate alcohol use and alcohol-related problems; records of hospital care with an alcohol-related diagnosis, any treatment with alcohol-sensitizing drugs (disulfiram or calcium carbimide) during MMT, and results of the 5-hydroxytryptophol to 5-hydroxyindoleacetic acid ratio (5HTOL/5HIAA) in urine, a sensitive biomarker for recent drinking. Use of illicit drugs was determined by routine urine drug testing. About one third of the patients (n = 69) had a lifetime prevalence of hospital treatment for an alcohol-related diagnosis, 45 of whom had been hospitalized (mean 4.2 stays) prior to the start of MMT. There was a significant association (p<0.05) between the number of alcohol-related diagnoses prior to treatment and a positive 5HTOL/5HIAA test during MMT. The alcohol indicators first became positive on average 1.6 years after admission to treatment, compared with after about 4 months for illicit drugs. Use of cannabis or benzodiazepines was significantly associated with alcohol use. Female methadone patients with indications of alcohol-related problems relapsed more often into illicit drug use than did women without such indications (3.9 vs. 2.5 relapse periods/year; p<0.005), whereas no significant association was found for men. The results of the present study indicate that drinking problems among patients undergoing MMT is associated with an increased risk of relapse into illicit drug use and with discharge from treatment. Concurrent treatment of alcohol-related problems, including systematic monitoring of alcohol use, therefore should be recommended to reduce the risk for relapse into illicit drug use and improve overall treatment outcome in MMT.

Anders Leifman

Papers

Alcohol Consumption and Stroke Mortality 20-Year Follow-up of 15 077 Men and Women

Methadone maintenance treatment: the balance between life-saving treatment and fatal poisonings.

Mortality and cause of death among 1705 illicit drug users: A 37 year follow up

Association between alcohol consumption and mortality, myocardial infarction, and stroke in 25 year follow up of 49 618 young Swedish men.

Problem drinking in relation to treatment outcome among opiate addicts in methadone maintenance treatment.