Alcohol use disorders and the heart
Alcohol use disorders and the heart
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DOI：
10.1111/add.14703
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发表时间：
2019-07-15
期刊：
影响因子：
6
通讯作者：
Rudd, James H. F.
中科院分区：
文献类型：
--
作者：
Day, Ed;Rudd, James H. F.
酒精使用是非传染性疾病的一个重要的可预防和可改变的原因，对心血管系统有复杂的影响，随剂量而变化。观察性和前瞻性研究一致表明，与戒酒者相比，低饮酒水平的人心血管和全因死亡率的风险较低（“J”形曲线）。最大的潜在益处发生在女性每天0.5至1标准饮料（7 - 14 g纯乙醇）（全因死亡率降低18%，95%置信区间（CI）= 13 - 22%）和男性每天1至2标准饮料（14 - 28 g乙醇）（全因死亡率降低17%，95% CI = 15 - 19%）。然而，这一证据存在争议，总体而言，酒精的有害影响远远超过有益影响，平均每天摄入10 g乙醇后，过早死亡的风险稳步增加。血压（BP）以剂量依赖性方式通过定期饮酒而升高，对于50 g乙醇/天和100 g/天，高血压（收缩压> 140 mm Hg或舒张压> 90 mm Hg）的相对风险分别为1.7和2.5。在戒酒1个月后，血压读数可能会显著下降。即使在心脏功能正常的人中，酗酒也与急性心律失常的发生有关。房颤是与慢性大量饮酒相关的最常见的心律失常，超过14 g酒精/天，每额外标准饮酒（14 g乙醇）的相对风险增加10%。乙醇及其代谢产物对心肌细胞具有毒性作用，酒精性心肌病（ACM）占所有非缺血性扩张型心肌病病例的三分之一。筛查饮酒量超过低水平的人并进行简短的干预可能会预防心血管并发症的发生。虽然患有心血管疾病的人显示出减少低量饮酒的结果有所改善，但没有安全的饮酒量，ACM患者应该以禁欲为目标，以优化医疗。
Alcohol use is an important preventable and modifiable cause of non-communicable disease, and has complex effects on the cardiovascular system that vary with dose. Observational and prospective studies have consistently shown a lower risk of cardiovascular and all-cause mortality in people with low levels of alcohol consumption when compared to abstainers (the 'J'-shaped curve). Maximum potential benefit occurs at 0.5 to one standard drinks (7-14 g pure ethanol) per day for women (18% lower all-cause mortality, 95% confidence interval (CI) = 13-22%) and one to two standard drinks (14-28 g ethanol) per day for men (17% lower all-cause mortality, 95% CI = 15-19%). However, this evidence is contested, and overall the detrimental effects of alcohol far outweigh the beneficial effects, with the risk of premature mortality increasing steadily after an average consumption of 10 g ethanol/day. Blood pressure (BP) is increased by regular alcohol consumption in a dose-dependent manner, with a relative risk for hypertension (systolic BP > 140 mm Hg or diastolic > 90 mm Hg) of 1.7 for 50 g ethanol/day and 2.5 at 100 g/day. Important reductions in BP readings can be expected after as little as 1 month of abstinence from alcohol. Heavy alcohol consumption in a binge pattern is associated with the development of acute cardiac arrhythmia, even in people with normal heart function. Atrial fibrillation is the most common arrhythmia associated with chronic high-volume alcohol intake, and above 14 g alcohol/day the relative risk increases 10% for every extra standard drink (14 g ethanol). Ethanol and its metabolites have toxic effects on cardiac myocytes, and alcoholic cardiomyopathy (ACM) accounts for a third of all cases of non-ischaemic dilated cardiomyopathy. Screening people drinking alcohol above low-volume levels and delivering a brief intervention may prevent the development of cardiovascular complications. Although people with established cardiovascular disease show improved outcomes with a reduction to low-volume alcohol consumption, there is no safe amount of alcohol to drink and patients with ACM should aim for abstinence in order to optimize medical treatment.