Academic journal article Alcohol Research

Focus on the Heart: Alcohol Consumption, HIV Infection, and Cardiovascular Disease

Academic journal article Alcohol Research

Focus on the Heart: Alcohol Consumption, HIV Infection, and Cardiovascular Disease

Article excerpt

Currently, more than 60 different medical conditions and 4 percent of the global health burden of disease are caused at least in part by, or are attributable to, alcohol consumption (Room et al. 2005). In the United States, 62.5 percent of adults consume alcohol and 17.6 million have an alcohol use disorder (AUD) (Centers for Disease Control and Prevention 2003; Grant et al. 2004). Because of this widespread and, in many cases, excessive alcohol use, alcohol consumption is associated with the two leading causes of death in the United States--cardiovascular disease (CVD) (1) and cancer (Mokdad et al. 2005).

Alcohol consumption and AUDs also are common among adults infected with the human immunodeficiency virus (HIV) (Conigliaro et al. 2003; Cook et al. 2001). With the advent of antiretroviral therapy and, as a result, an increasing life expectancy in this population (Palella et al. 1998), chronic diseases such as coronary heart disease (CHD) have become a prevalent and important health issue facing adults with HIV(Friis-Moller et al. 2003 b; Holmberg et al. 2002, 2004; Klein et al. 2002). For example, among HIV-infected participants in the Veterans Aging Cohort Study (VACS), hazardous drinking and AUDs were independently associated with an increased prevalence of CVD, even after adjusting for traditional CVD risk factors, such as cholesterol levels or coexisting diabetes (Freiberg et al. 2010). Furthermore, among HIV-infected people with an AUD, those who were coinfected with the hepatitis C virus (HCV) had an even higher prevalence of CVD (Freiberg et al. 2007). However, the mechanism(s) by which alcohol use and HCV infection may influence cardiovascular risk and other chronic diseases among HIV-infected people remain unknown.

This article explores the relationships between alcohol use, HIV infection, and CVD. After reviewing the association between alcohol use and CVD among HIV-uninfected adults and the relationship between HIV infection and CVD, the article examines the role of alcohol consumption in CVD among HIV-infected adults. It concludes with a discussion of possible mechanisms underlying alcohol's association with CVD among HIV-infected adults.

ALCOHOL USE AND CVD AMONG HIV-UNINFECTED ADULTS

CVD refers to any type of disease involving the heart or blood vessels. It comprises a variety of conditions, including CHD (which involves the blood vessels supplying the heart muscle), stroke (which involves blood vessels in the brain), congestive heart failure (which refers to any problem with the structure or function of the heart that interferes with adequate blood supply to the body), and others. Alcohol consumption can either positively or negatively influence the risk of any of these conditions.

Alcohol Consumption and CHD

In patients with CHD, the blood vessels of the heart muscle cannot supply the heart and surrounding tissues with enough blood--for example, because they are blocked by build-up of fatty materials (e.g., cholesterol) on the walls of the blood vessels. As a result, the heart muscle cannot function properly and thus cannot pump sufficient blood to the rest of the body. For people without HIV who consume alcohol, CHD risk is strongly associated with the quantity and pattern of alcohol consumption. This association typically is described as a J-shaped curve (Corrao et al. 2000):

* For abstainers, the relative risk (RR) of CHD is set at 1.0, which is an intermediate level.

* Moderate drinkers, who consume 0 to 20 g alcohol, or less than two standard drinks (2) per day, have the lowest risk, with an RR = 0.8 (95% confidence interval [CI] = 0.78-0.83).

* Heavy drinkers who consume more than 89 g alcohol, or more than six standard drinks per day have the highest risk of CHD, with an RR = 1.05 (95% CI = 1.00-1.11).

The same general relationship has been found with respect to heart attacks (i.e., myocardial infarctions [MIs]). …

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