How much and how often should we drink?
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Alcohol Drinking↗
Biomedical subjects
Annie Britton
Publications and source records attributed to Annie Britton.
Does autonomic function link social position to coronary risk? The Whitehall II study.
BACKGROUND: Laboratory and clinical studies suggest that the autonomic nervous system responds to chronic behavioral and psychosocial stressors with adverse metabolic consequences and that this may explain the relation between low social position and high coronary risk. We sought to test this hypothesis in a healthy occupational cohort. METHODS AND RESULTS: This study comprised 2197 male civil servants 45 to 68 years of age in the Whitehall II study who were undergoing standardized assessments of social position (employment grade) and the psychosocial, behavioral, and metabolic risk factors for coronary disease previously found to be associated with low social position. Five-minute recordings of heart rate variability (HRV) were used to assess cardiac parasympathetic function (SD of N-N intervals and high-frequency power [0.15 to 0.40 Hz]) and the influence of sympathetic and parasympathetic function (low-frequency power [0.04 to 0.15 Hz]). Low employment grade was associated with low HRV (age-adjusted trend for each modality, P< or =0.02). Adverse behavioral factors (smoking, exercise, alcohol, and diet) and psychosocial factors (job control) showed age-adjusted associations with low HRV (P<0.03). The age-adjusted mean low-frequency power was 319 ms2 among those participants in the bottom tertile of job control compared with 379 ms2 in the other participants (P=0.004). HRV showed strong (P<0.001) linear associations with components of the metabolic syndrome (waist circumference, systolic blood pressure, HDL cholesterol, triglycerides, and fasting and 2-hour postload glucose). The social gradient in prevalence of metabolic syndrome was explained statistically by adjustment for low-frequency power, behavioral factors, and job control. CONCLUSIONS: Chronically impaired autonomic function may link social position to different components of coronary risk in the general population.
Aged↗
Alcohol consumption and cognitive function in the Whitehall II Study.
The authors investigated the relation between alcohol consumption and cognitive function in a United Kingdom cohort study (4,272 men, 1,761 women) with median follow-up of 11 years. Measures of alcohol consumption were obtained at baseline (1985-1988) and four subsequent phases of data collection. Cognitive function (memory test, AH4, Mill-Hill, phonemic and semantic fluency) was assessed at phase 5 (1997-1999), when participants were aged 46-68 years. Of people who reported drinking alcohol in the past year, those who consumed at least one drink in the past week, compared with those who did not, were significantly less likely to have poor cognitive function. The beneficial effect extended to those drinking more than 240 g per week (approximately 30 drinks). The effect was stronger for women than men and was not confined to those with evidence of vascular disease. Similar associations were found in cross-sectional and longitudinal analyses. The relations were not explained by confounding by smoking and by physical and mental health and, to a large extent, were not mediated by cholesterol or blood pressure. However, the relations were weakened when social position was added to the model. The authors concluded that for middle-aged subjects, increasing levels of alcohol consumption were associated with better function regarding some aspects of cognition. Nonetheless, it is not proposed that these findings be used to encourage increased alcohol consumption.
Adult↗
Does access to cardiac investigation and treatment contribute to social and ethnic differences in coronary heart disease? Whitehall II prospective cohort study.
OBJECTIVE: To determine whether access to cardiac procedures and drugs contributes to social and ethnic differences in coronary heart disease in a population setting. DESIGN: Prospective study with follow up over 15 years. Civil service employment grade was used as a measure of individual socioeconomic position. Need for cardiac care was determined by the presence of angina, myocardial infarction, and coronary risk factors. SETTING: 20 civil service departments originally located in London. PARTICIPANTS: 10,308 civil servants (3414 women; 560 South Asian) aged 35-55 years at baseline in 1985-8. MAIN OUTCOME MEASURES: Use of exercise electrocardiography, coronary angiography, and coronary revascularisation procedures and secondary prevention drugs. RESULTS: Inverse social gradients existed in incident coronary morbidity and mortality. South Asian participants also had higher rates than white participants. After adjustment for clinical need, social position showed no association with the use of cardiac procedures or secondary prevention drugs. For example, men in the low versus high employment grade had an age adjusted odds ratio for angiography of 1.87 (95% confidence interval 1.32 to 2.64), which decreased to 1.27 (0.83 to 1.94) on adjustment for clinical need. South Asians tended to be more likely to have cardiac procedures and to be taking more secondary prevention drugs than white participants, even after adjustment for clinical need. CONCLUSION: This population based study, which shows the widely observed social and ethnic patterning of coronary heart disease, found no evidence that low social position or South Asian ethnicity was associated with lower use of cardiac procedures or drugs, independently of clinical need. Differences in medical care are unlikely to contribute to social or ethnic differences in coronary heart disease in this cohort.
Adult↗
Different measures of alcohol consumption and risk of coronary heart disease and all-cause mortality: 11-year follow-up of the Whitehall II Cohort Study.
AIMS: To investigate the relationship between three measures of alcohol consumption obtained simultaneously in a large cohort and the validated risk of coronary heart disease and all-cause mortality during follow-up. DESIGN: Prospective cohort study with median follow-up of 11 years. SETTING: The Whitehall II Cohort Study: London-based civil service. PARTICIPANTS: A total of 10,308 (33% female) civil servants aged 35-55 years at baseline (1985-88). MEASUREMENTS: Self-reported volume of alcohol consumed during past week, frequency of drinking over past year, usual amount consumed per drinking session. MAIN OUTCOME MEASURES: Coronary heart disease and all-cause mortality until 1999. FINDINGS: A U-shaped relationship was found between volume of alcohol consumed per week and outcome. Compared to those who drank moderately (10-80 g alcohol per week), non-drinkers and those drinking more than 248 g per week had approximately a twofold increased risk of mortality. The optimal frequency of drinking was between once or twice a week and daily, after adjustment for average volume consumed per week. Those drinking twice a day or more had an increased risk of mortality (male hazard ratio 2.44 95% CI 1.31-4.52) compared to those drinking once or twice a week. Drinking only once a month or only on special occasions had a 50% increased risk of mortality. The usual amount consumed per drinking session was not indicative of increased health risk in this cohort. CONCLUSIONS: Epidemiological studies should collect information on frequency of drinking in addition to average volume consumed in order to inform sensible drinking advice.
Adult↗
Prognosis of angina with and without a diagnosis: 11 year follow up in the Whitehall II prospective cohort study.
OBJECTIVE: To investigate the prognosis of angina among people with and without diagnosis by a doctor and an abnormal cardiovascular test result. DESIGN: Prospective cohort study with a median follow up of 11 years. SETTING: 20 civil service departments originally located in London. PARTICIPANTS: 10 308 civil servants aged 35-55 years at baseline. MAIN OUTCOME MEASURES: Recurrent reports of angina; quality of life (SF-36 physical functioning); non-fatal myocardial infarction; death from any cause (n = 344). RESULTS: 1158 (11.4%) participants developed angina, and 813 (70%) had no evidence of diagnosis by a doctor at the time of the initial report. Participants without a diagnosis had an increased risk of impaired physical functioning (age and sex adjusted odds ratio of 2.36 (95% confidence interval 1.91 to 2.90)) compared with those who had neither angina nor myocardial infarction throughout follow up. Among reported cases of angina without a diagnosis, the 15.5% with an abnormality on a study electrocardiogram had an increased risk of death (hazard ratio 2.37 (1.16 to 4.87)). These effects were similar in magnitude to those in participants with a diagnosis of angina. CONCLUSION: Undiagnosed angina was common and had an adverse impact on prognosis comparable to that of diagnosed angina, particularly among people with electrocardiographic abnormalities. Efforts to improve prognosis among people with angina should take account of this submerged clinical iceberg.
Adult↗
Trends in mortality attributable to current alcohol consumption in east and west Germany.
There is emerging awareness of alcohol as a cause of the persisting health divide between east and west Germany. This study quantifies the burden of alcohol attributable mortality in the two parts of Germany in the 1990s, taking account of both adverse and beneficial effects of alcohol. We used an epidemiological approach that applies cause-specific alcohol attributable fractions derived from published relative risks and data on the distribution of alcohol consumption in east and west Germany in 1990/1992 and 1998 to mortality data for the two regions in 1992 and 1997, thus producing an estimate of the number of alcohol attributable deaths 'caused' or 'prevented'. Including the cardio-protective effect of alcohol, there were about 1.4% more deaths among men aged 20+ in 1992 in Germany than would have been expected in a non-drinking population, while there were 0.1% fewer deaths among women. By 1997, this had increased to 1.8% excess male deaths and 0.1% excess female deaths. In 1997, alcohol 'caused' 9.0% of all deaths in east German men compared with 5.6% in the west (women east: 2.5%; women west: 2.2%). At the same time, alcohol 'prevented' 5.2% deaths in east German men compared with 4.3% in the west, while there were 2.9% and 2.0% fewer deaths in women. This resulted in a net excess of deaths due to alcohol, except east German women, where 0.3% deaths were estimated to have been averted by alcohol. Although by 1997 net deaths 'caused' by alcohol had increased in the west and declined in the east, the burden of mortality due to alcohol among men remained highest in the east whereas in women the order had reversed.Mortality attributable to alcohol contributes considerably to overall mortality and to the east-west gap in Germany. This study points to the need for comprehensive policies on alcohol in Germany to close the persisting east-west health gap.
Accidents, Traffic↗
Alcohol consumption and stroke: difficulties in assessing the relationships.
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Alcohol Drinking↗