PubMed Health⌕ Search

Biomedical subjects

Kenneth J Mukamal

Publications and source records attributed to Kenneth J Mukamal.

At least 37 records · Page 2Linked to original sources
PubMed2005

Alcohol and risk for ischemic stroke in men: the role of drinking patterns and usual beverage.

BACKGROUND: The association of light to moderate alcohol consumption with risk for ischemic stroke remains controversial, as do the roles of beverage type and drinking pattern. OBJECTIVE: To assess the association of drinking patterns and beverage type with risk for ischemic stroke among men. DESIGN: Prospective cohort study. SETTING: United States. PARTICIPANTS: 38 156 male health professionals who were free of known cardiovascular disease or cancer at baseline in 1986. MEASUREMENTS: With a semi-quantitative food-frequency questionnaire, the authors individually ascertained consumption of regular and light beer, red and white wine, and liquor every 4 years. Alcohol consumption was categorized as light (0.1 to 9.9 g/d, or <1 drink daily), moderate (10.0 to 29.9 g/d, or 1 to 2 drinks daily), and heavier (> or =30.0 g/d, or > or =3 drinks daily). RESULTS: During a follow-up period of 14 years, 412 cases of incident ischemic stroke were documented. Compared with abstainers, light drinkers had a multivariate-adjusted relative risk of 0.99 (95% CI, 0.72 to 1.37), moderate drinkers had a multivariate-adjusted relative risk of 1.26 (CI, 0.90 to 1.76), and heavier drinkers had a multivariate-adjusted relative risk of 1.42 (CI, 0.97 to 2.09; P = 0.01 for trend). Consumption of 10.0 to 29.9 g of alcohol per day on 3 to 4 days per week appeared to be associated with the lowest risk (relative risk, 0.68 [CI, 0.44 to 1.05]). Red wine consumption was inversely associated with risk in a graded manner (P = 0.02 for trend), but other beverages were not. The apparently higher risk for ischemic stroke with heavier alcohol use appeared to be most pronounced for the embolic subtype. LIMITATIONS: This study had limited power to examine specific drinking patterns and heavy drinking and could not assess risk for hemorrhagic stroke. CONCLUSIONS: In this sample of male health professionals, light and moderate average alcohol use was generally not associated with an increased risk for ischemic stroke, although drinking pattern and beverage type modified this relation. Intake of more than 2 drinks per day may be associated with a higher risk for ischemic stroke.

Adult↗
PubMed2005

Alcohol consumption and platelet activation and aggregation among women and men: the Framingham Offspring Study.

BACKGROUND: Alcohol intake has been associated with lower platelet activity; however, few large-scale studies have included women, and to our knowledge, the relationship of alcohol intake with measures of platelet activation has not been studied. METHODS: We performed a cross-sectional analysis of adults free of cardiovascular disease enrolled in the Framingham Offspring Study. Study physicians assessed alcohol consumption with a standardized questionnaire. We measured platelet activation in response to 1 and 5 microm of adenosine diphosphate (ADP) with a P-selectin assay among 1037 participants and platelet aggregability in response to ADP, epinephrine, and collagen among 2013 participants. RESULTS: Alcohol consumption was inversely associated with P-selectin expression in response to 1 microm ADP (p = 0.007) and 5 microm ADP (p = 0.02) among men but not women. Alcohol consumption was also inversely associated with platelet aggregation induced by ADP among both women (p = 0.04) and men (p trend = 0.008) and by epinephrine among men (p = 0.03) CONCLUSIONS: Alcohol consumption is inversely associated with both platelet activation and aggregation, particularly in men. Additional research is needed to determine whether these findings contribute to the contrasting associations of alcohol consumption with risk of thrombotic and hemorrhagic cardiovascular events.

Adenosine Diphosphate↗
PubMed2004

Educational attainment and myocardial infarct-related congestive heart failure (the Determinants of Myocardial Infarction Onset Study).

We assessed educational attainment and complications during hospitalization in 3,882 patients with acute myocardial infarction for the Determinants of Myocardial Infarction Onset Study. Educational attainment had a graded, inverse association with prevalence of congestive heart failure (CHF) during hospitalization, with the lowest prevalence among patients who attended college (odds ratio 0.75; 95% confidence interval, 0.57 to 0.99; p for trend 0.02), with similar findings among men, women, whites, and blacks.

Aged↗
PubMed2004

Obesity and the risk of death after acute myocardial infarction.

BACKGROUND: In the general population, obesity is associated with an increased risk of all-cause death. However, the importance of obesity in patients with established coronary heart disease is less well defined. METHODS: As part of the Determinants of Myocardial Infarction Onset Study, we performed a prospective cohort study of 1898 patients hospitalized with confirmed acute myocardial infarction between 1989 and 1994, with a median follow-up of 3.8 years. We assessed all-cause death through December 1995, using the National Death Index. We categorized patients according to WHO criteria for body mass index (BMI). We compared long-term death according to BMI (kg/m2) by using Cox proportional hazards regression. RESULTS: Of the 1898 eligible patients, 607 (32%) were normal weight (18.5 to 24.9 kg/m2), 832 (44%) were overweight (25.0 to 29.9 kg/m2), 331 (17%) were class I obese (30.0 to 34.9 kg/m2), and 128 (7%) were class II or more obese (> or =35.0 kg/m2). A total of 311 patients died during follow-up. After adjustment for potentially confounding risk factors and excluding patients with noncardiac comorbidity, the risk for death appeared to increase linearly, with increasing BMI across all categories (P for trend =.08). The relative risk of death in all obese patients (> or =30 kg/m2) was 1.46, compared with those with normal weight (95% CI, 0.98 to 2.17). CONCLUSIONS: We found that BMI appeared to have a positive, graded relation with post-myocardial infarction death. Whether weight reduction and secondary prevention strategies would reverse this effect in obese population remains to be seen.

Aged↗
PubMed2004

Caffeinated coffee consumption and mortality after acute myocardial infarction.

BACKGROUND: Previous studies have generally suggested no effect of coffee consumption on the risk of acute myocardial infarction. The effect of coffee consumption on prognosis after acute myocardial infarction is uncertain. METHODS: In an inception cohort study, we observed 1935 patients who were hospitalized with a confirmed acute myocardial infarction between 1989 and 1994 at 45 community hospitals and tertiary care centers in the United States, as part of the Determinants of Myocardial Infarction Onset Study. Trained interviewers assessed self-reported caffeinated coffee consumption before infarction with a standardized questionnaire. We analyzed survival censored at December 31, 1995, using Cox proportional hazards regression. RESULTS: Of the 1902 patients for whom we had information on coffee intake, 315 (17%) died during a median follow-up period of 3.8 years. Coffee drinkers tended to be men, younger, and free of comorbidity, and they were more likely to be current smokers. Coffee consumption was not associated with an overall change in long-term post-infarction mortality rate. However, we did observe an unexpected and unexplained variation in the association between coffee consumption and mortality with time, with an apparent inverse association in the first 90 days after infarction. CONCLUSIONS: Self-reported coffee consumption has no overall association with post-infarction mortality. The unexpected time variation in the effect of coffee intake requires evaluation in other studies.

Aged↗
PubMed2004

Alcohol consumption and inflammatory markers in older adults: the Cardiovascular Health Study.

OBJECTIVE: We sought to determine the relation of alcohol intake and systemic inflammation in a population-based sample of older adults. METHODS AND RESULTS: As part of the Cardiovascular Health Study (CHS), 5865 adults aged 65 years and older reported their intake of beer, wine, and liquor. We determined white blood cell count (WBC), factor VIII coagulant activity (factor VIIIc), and levels of C-reactive protein (CRP), fibrinogen, and albumin as markers of systemic inflammation. Among participants without confirmed cardiovascular disease, alcohol consumption was inversely associated with WBC, factor VIIIc, and fibrinogen level, and positively associated with albumin concentration in multivariate analyses. We found no consistent modification of these results by sex, obesity, or beverage type. The relation of alcohol use and CRP levels was significantly modified by apoE genotype (P interaction 0.03), with a positive association among participants with an apoE4 allele (P = 0.05), but a trend toward an inverse association among those without an apoE4 allele (P = 0.15). CONCLUSIONS: Alcohol intake is associated with lower levels of inflammatory markers in older adults free of cardiovascular disease.

Aged↗
PubMed2004

Alcohol consumption and coronary atherosclerosis progression--the Stockholm Female Coronary Risk Angiographic Study.

OBJECTIVE: To assess the association of alcohol intake with progression of coronary atherosclerosis. Although moderate drinkers have a lower risk of coronary heart disease than abstainers, the relation of alcohol use and coronary atherosclerosis has not been well studied. METHODS AND RESULTS: In the Stockholm Female Coronary Risk Angiographic Study, we evaluated 103 women, aged 65 years or younger, hospitalized with acute myocardial infarction or unstable angina pectoris who underwent serial quantitative coronary angiography 3-6 months following their index event and repeated an average of 3 years and 3 months (range 2-5 years) later. Individual alcoholic beverage consumption was assessed by a standardized questionnaire. We used mixed model analysis to estimate the effect of alcohol consumption on progression of coronary atherosclerosis, as measured by mean luminal diameter change, controlling for age, smoking, body-mass index, education, physical activity, index cardiac event, menopausal status, diabetes, and history of dyslipidemia. Of the 93 women with complete information on alcohol intake, 14 consumed no alcohol (abstainers), 55 consumed up to 5 g of alcohol per day (light drinkers), and 24 consumed more than 5 g of alcohol per day (moderate drinkers). Coronary atherosclerosis progressed by a multivariate-adjusted average of 0.138 mm (95% confidence interval (CI): 0.027-0.249) among abstainers, 0.137 mm (95% CI: 0.057-0.217) among light drinkers, and -0.054 mm (95% CI: -0.154 to 0.047) among moderate drinkers (P < 0.001). The inverse association persisted in analyses stratified by index event. No beverage type appeared to confer particular benefit. CONCLUSIONS: Among middle-aged women with coronary heart disease, moderate alcohol consumption (over 5 g/day) was protective of coronary atherosclerosis progression.

Adult↗
PubMed2004

An update on alcohol and atherosclerosis.

PURPOSE OF REVIEW: Epidemiological studies consistently link moderate alcohol use with a lower risk of cardiovascular disease, but a number of important issues remain controversial. These include the putative impact of non-alcoholic constituents of some alcoholic beverages, the role of genetic factors, potential mechanisms for this association, and confirmation of the relationship in experimental models. RECENT FINDINGS: Although high-density lipoprotein cholesterol (HDL-C) is considered the primary mediator of the cardiovascular effects of moderate drinking, recent evidence has shown the alcohol-HDL-C relation is not linear beyond the range of moderate drinking. Moderate alcohol use also has important inverse relations with inflammatory factors. Some, but not all, animal models confirm the anti-atherogenic effects of ethanol and highlight inflammatory factors as one possible mechanism. The non-alcoholic constituents of red wine also have anti-atherogenic and perhaps even life-extending properties in vitro, but their relevance to humans remains uncertain. Genetic variants of the apolipoprotein E and interleukin 6 genes in humans may modify how alcohol influences atherosclerosis, further emphasizing the importance of HDL-C and inflammatory factors as mediators. SUMMARY: The robust relationship between moderate drinking and lower risk of cardiovascular disease remains an intriguing area of investigation. Clarifying potential gene-environment interactions and translational research into uses for non-alcoholic components will be important areas for future investigation.

Alcoholic Beverages↗
PubMed2004

Self-reported alcohol consumption and falls in older adults: cross-sectional and longitudinal analyses of the cardiovascular health study.

OBJECTIVES: To assess the cross-sectional and longitudinal associations between alcohol consumption and risk of falls in older adults. DESIGN: Cross-sectional and longitudinal analyses. SETTING: Four U.S. communities. PARTICIPANTS: A total of 5,841 older adults enrolled in the Cardiovascular Health Study, an ongoing, population-based, prospective cohort study, participated. MEASUREMENTS: Self-reported alcohol consumption at baseline, self-reported frequent falls at baseline, and the 4-year risk of falls of participants who denied frequent falls at baseline. RESULTS: Cross-sectional analysis indicated an apparent inverse association between alcohol consumption and risk of frequent falls (adjusted odds ratio in consumers of 14 or more drinks per week=0.41; 95% confidence interval (CI)=0.14-1.17; P for trend=.06), but longitudinal analysis indicated a similar 4-year risk of falls in abstainers and light to moderate drinkers but a 25% higher risk in consumers of 14 or more drinks per week (95% CI=3-52%; P for trend=.07). Similar results were found in analyses stratified by age, sex, race, and physical activity. CONCLUSION: Consumption of 14 or more drinks per week is associated with an increased risk of subsequent falls in older adults. Cross-sectional studies may fail to identify this risk of heavier drinking, perhaps because older adults at risk for falls decrease their alcohol use over time or because heavier drinkers at risk for falls tend not to enroll in cohort studies. However, because this study relied upon annual reporting of falls, further prospective studies should be conducted to confirm these findings.

Accidental Falls↗
PubMed2003

Alcohol consumption and carotid atherosclerosis in older adults: the Cardiovascular Health Study.

OBJECTIVE: The association of alcohol use with atherosclerosis is inconsistent in previous studies. METHODS AND RESULTS: For the Cardiovascular Health Study, 5888 adults aged 65 years and older underwent a standardized interview and examination. They reported beer, wine, and liquor use individually and underwent B-mode ultrasonography to determine internal and common carotid intima-media thickness (IMT). We compared composite carotid IMT values cross-sectionally using linear regression to adjust for demographic and clinical characteristics. Among 4247 participants free of cardiovascular disease, consumers of 1 to 6 drinks per week had 0.07+/-0.04-mm lower composite IMT and consumers of 14 or more drinks per week had 0.07+/-0.05-mm higher IMT than abstainers (P quadratic trend=0.02). We found similar relationships using internal and common carotid thickness measures and among men and women. The higher IMT associated with heavier alcohol use was particularly strong among 1592 participants with confirmed cardiovascular disease (0.24+/-0.09 mm greater than abstainers). Controlling for HDL cholesterol levels reduced the effect on composite IMT among consumers of 1 to 6 drinks per week by 22%. CONCLUSIONS: Relative to older adults who abstain from alcohol, consumption of 1 to 6 drinks per week had an inverse association with carotid atherosclerosis whereas consumption of 14 or more drinks had a positive association.

Aged↗
PubMed2003

Prospective study of alcohol consumption and risk of dementia in older adults.

CONTEXT: Alcohol consumption has been associated with complex changes in cerebral vasculature and structure in older adults. How alcohol consumption affects the incidence of dementia is less clear. OBJECTIVE: To determine the prospective relationship of alcohol consumption and risk of dementia among older adults. DESIGN, SETTING, AND PARTICIPANTS: Nested case-control study of 373 cases with incident dementia and 373 controls who were among 5888 adults aged 65 years and older who participated in the Cardiovascular Health Study, a prospective, population-based cohort study in 4 US communities. The controls were frequency-matched on age, death before 1999, and their attendance of a 1998-1999 clinic. Participants in this study underwent magnetic resonance imaging (MRI) of the brain and cognitive testing between 1992 and 1994 and were followed up until 1999. MAIN OUTCOME MEASURES: Odds of incident dementia, ascertained by detailed neurological and neuropsychological examinations according to average alcohol consumption, assessed by self-reported intake of beer, wine, and liquor at 2 visits prior to the date of the MRI. RESULTS: Compared with abstention, the adjusted odds for dementia among those whose weekly alcohol consumption was less than 1 drink were 0.65 (95% confidence interval [CI], 0.41-1.02); 1 to 6 drinks, 0.46 (95% CI, 0.27-0.77); 7 to 13 drinks, 0.69 (95% CI, 0.37-1.31); and 14 or more drinks, 1.22 (95% CI, 0.60-2.49; P for quadratic term =.001). A trend toward greater odds of dementia associated with heavier alcohol consumption was most apparent among men and participants with an apolipoprotein E epsilon4 allele. We found generally similar relationships of alcohol use with Alzheimer disease and vascular dementia. CONCLUSIONS: Compared with abstention, consumption of 1 to 6 drinks weekly is associated with a lower risk of incident dementia among older adults.

Aged↗
PubMed2003

Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men.

BACKGROUND: Although moderate drinking confers a decreased risk of myocardial infarction, the roles of the drinking pattern and type of beverage remain unclear. METHODS: We studied the association of alcohol consumption with the risk of myocardial infarction among 38,077 male health professionals who were free of cardiovascular disease and cancer at base line. We assessed the consumption of beer, red wine, white wine, and liquor individually every four years using validated food-frequency questionnaires. We documented cases of nonfatal myocardial infarction and fatal coronary heart disease from 1986 to 1998. RESULTS: During 12 years of follow-up, there were 1418 cases of myocardial infarction. As compared with men who consumed alcohol less than once per week, men who consumed alcohol three to four or five to seven days per week had decreased risks of myocardial infarction (multivariate relative risk, 0.68 [95 percent confidence interval, 0.55 to 0.84] and 0.63 [95 percent confidence interval, 0.54 to 0.74], respectively). The risk was similar among men who consumed less than 10 g of alcohol per drinking day and those who consumed 30 g or more. No single type of beverage conferred additional benefit, nor did consumption with meals. A 12.5-g increase in daily alcohol consumption over a four-year follow-up period was associated with a relative risk of myocardial infarction of 0.78 (95 percent confidence interval, 0.62 to 0.99). CONCLUSIONS: Among men, consumption of alcohol at least three to four days per week was inversely associated with the risk of myocardial infarction. Neither the type of beverage nor the proportion consumed with meals substantially altered this association. Men who increased their alcohol consumption by a moderate amount during follow-up had a decreased risk of myocardial infarction.

Alcohol Drinking↗
PubMed2003

Alcohol use and prognosis in patients with coronary heart disease.

Substantial evidence has shown that moderate drinkers have lower rates of coronary heart disease (CHD) than abstainers, but the effects of alcohol consumption among patients with established CHD are less clear. Alcohol intake has important effects on risk factors for reinfarction, including higher levels of high-density lipoprotein cholesterol and triglycerides, lower levels of fibrinogen and other prothrombotic factors, lower fibrinolytic potential, and antiplatelet activity. Studies of patients at risk for CHD, such as those with diabetes, hypertension, and hyperlipidemia, have shown that the association of moderate drinking and CHD is at least as strong as it is in the general population. Most recently, studies have found that survivors of acute myocardial infarction who drink moderately have a risk of death approximately 20%-30% lower than do abstainers or rare drinkers. Nonetheless, the risks and benefits of alcohol use remain complex, even among patients with CHD, and no simple recommendation regarding alcohol consumption can be made for all patients.

Alcohol Drinking↗
PubMed2003

Circadian variation in the onset of myocardial infarction: effect of duration of diabetes.

There are conflicting reports regarding circadian variation in the onset of acute myocardial infarction (MI) among patients with diabetes. We therefore, studied the circadian pattern of the incidence of acute MI in patients (n = 3,882) who were enrolled in the Onset Study stratified by the presence, type, and duration of diabetes. The Onset Study was conducted at 64 U.S. medical centers between August 1989 and September 1996. We used harmonic regression model to evaluate the circadian variation of MI symptom onset in patients with and without diabetes. Subgroup analysis was performed according to the presence, type, and duration of diabetes by the chi(2) test (dividing the day into four 6-h intervals). Patients without diabetes exhibited a prominent morning peak in the incidence of acute MI symptom onset (P < 0.001). In contrast, patients with type 1 diabetes and type 2 diabetes > or =5 years had a marked attenuation of the morning peak. Patients who had type 2 diabetes diagnosed within the previous 5 years had a pattern of onset of acute MI similar to patients without diabetes. Patients with type 1 diabetes and those with type 2 diabetes > or =5 years have an attenuation of the morning peak in acute MI. Inconsistency in observation of such an effect in patients with diabetes in the past may well have been due to difference in the duration of diabetes and thus the variable extent of underlying autonomic dysfunction.

Age of Onset↗