Alcohol Poisoning and Cardiovascular Mortality in Russia 1956-2005

By Razvodovsky, Yuri E. | Alcoholism and Psychiatry Research, January 1, 2009 | Go to article overview

Alcohol Poisoning and Cardiovascular Mortality in Russia 1956-2005


Razvodovsky, Yuri E., Alcoholism and Psychiatry Research


INTRODUCTION

High mortality from cardiovascular disease (CVD) in Russia and its profound fluctuations over the past decades have attracted considerable interest.1-3 After a substantial decline in 1985-1988, coinciding with a major anti-alcohol campaign, CVD mortality rate was rapidly reversed and increased dramatically after the dissolution of the USSR.4 It was repeatedly emphasized that this phenomenon is only partially associated with the traditional CVD risk factors identified in epidemiologic studies.5,6 The results of population studies have shown that such risk factors as total cholesterol and apoprotein profile had little predictive value.7,8 This evidence suggests an influence of other powerful factors that are associated with the increase of the risk of cardiovascular death. Several scholars argue that these mortality fluctuations may be related to alcohol consumption.9,10 This hypothesis is based on a fairly close temporal covariation between trends in overall consumption and CVD mortality during anti-alcohol campaign. This evidence challenged the view on a curvilinear relationship between alcohol and cardiovascular mortality that has been reported repeatedly in the literature.11-14 Several studies point to binge drinking pattern as a potentially important contributor to a higher cardiovascular mortality rate in Russia.15-17 For example, in the Novosibirsk cohort study it was shown that frequent heavy drinking increased the mortality from CVD.16 Similarly, a case-control study of men aged 20-55 in the Republic of Udmurd established that periods of heavy drinking were associated with an increased risk of CVD mortality.17 This study reported that medium or greater level of intoxication occurred in a quarter of Russian men aged 20-55 dying from CVD. The role of excessive drinking pattern as a powerful risk factor for CVD mortality was emphasized in a study based on data from Moscow that reported an increase in deaths from alcohol poisoning and cardiovascular disease on weekends.3 These findings support the argument that binge drinking pattern may strengthen the negative role of alcohol as the major cause of high cardiovascular death rate in Russia.

The change of the paradigm from drinking volume to drinking pattern (heavy episodic drinking or binge drinking versus regular moderate drinking) as the primary determinant of cardiovascular mortality is supported by the mounting body of research evidence from other settings.18-20 Studies that analyzed the pattern of drinking found out that episodic consumption of large quantities of alcohol is associated with adverse cardiovascular effects including an increased risk of thrombosis or arrhythmia and might precipitate myocardial ischemia increasing the risk of myocardial infarction.21 It was shown, for example, that after the adjustment of age, education, smoking and average alcohol intake, consuming six or more drinks at a time was related to the increased CVD mortality among working age male drinkers.22 The British Regional Heat Study showed a 20% increase in the risk of myocardial infarction in the case of men who had 3-6 drink per day on weekends in comparison to those who had 1-2 drinks daily.23 In one case-control study it was shown that men who drank 9 or more drinks per day had a 2.4-fold increase risk of acute myocardial infarction, while women who drank 5 or more drinks per day showed a 2.8-fold increase risk.24 In the Kuopio Ischemic Heart Disease Risk Study, men whose usual dose of beer was six or more bottles per session had a seven-fold increase in the relative risk of fatal myocardial infarction.25 In a population based prospective study, heavy drinking in men with a history of previous myocardial infarction was associated with a marginally significant increase in the risk of cardiovascular death.26 These studies suggest that binge drinking may lead to an increase in incidence of myocardial infarction by either provoking coronary artery spasm or myocardial ischemia in those pre-existing coronary artery diseases. …

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