The Inside Edge

The impact of an individual's pattern of alcohol consumption on their risk of CHD has been investigated in a meta-analysis of six studies (four cohort and two case-control). Compared with those who abstained from alcohol, regular heavy drinkers and heavy irregular/binge drinkers had significantly different pooled RRs, of 0.75 and 1.10 respectively.For those drinking alcohol on up to two days a week, a J-shaped curve was seen, with a low around 28g alcohol per week and highest protective dose of 131g per week. In contrast, there was a significant protective effect for those drinking alcohol on more than two days a week, even for high amounts of alcohol.
Bagnardi V, Zatonski W, Scotti L et al. J Epidemiol Community Health 2008; 62: 615-19

The clinical use of criteria for metabolic syndrome to predict cardiovascular disease (CVD) and diabetes risk remains uncertain. Researchers investigated this using data from two trials, PROSPER and the British Regional Heart Study (BRHS). In PROSPER (n = 4,812 non-diabetics aged 70-82), metabolic syndrome was not associated with increased CVD risk, but was associated with increased risk of diabetes (HR 4.41), as was each of its components. In BRHS (n = 2,737 non-diabetic men aged 60-79 years), metabolic syndrome was modestly associated with incident CVD (RR 1.27), despite strong association with diabetes (RR 7.47). In both studies, BMI or waist circumference, triglyceride and glucose cut-off points were not associated with CVD risk, but all five components were associated with risk of new-onset diabetes.
Sattar N, McConnachie A, Shaper AG et al. Lancet 2008; 371: 1927-35

Clinical trials of interventions for diabetes have tended to neglect patient-orientated outcomes, such as death, morbidity, pain and function. Researchers recently assessed to what extent continuing and future diabetes trials will ascertain such outcomes. They identified 1,054 phase II through phase IV randomised controlled trials enrolling patients with diabetes, sampled half of these randomly, then selected 436 for further study. Only 18 per cent of these studies included patient-important outcomes as primary outcomes, while 46 per cent reported patient-important outcomes as primary or secondary outcomes. Parallel design and type-2 diabetes trials were less likely to assess patient-important outcomes as a primary outcome.
Gandhi GY, Murad MH, Fujiyoshi A et al. JAMA 2008; 299: 2543-9

It is not known whether chronic kidney disease (CKD) is associated with non-alcoholic fatty liver disease among patients with type-2 diabetes. Researchers in this study followed 1,760 patients with type-2 diabetes and normal or near-normal kidney function and without overt proteinuria for 6.5 years to determine the occurrence of CKD. Non-alcoholic fatty liver disease, diagnosed by liver ultrasound and with exclusion of other common causes of chronic liver disease, was associated with a moderately increased risk for CKD, which persisted after adjustment for factors including age, waist circumference, diabetes duration and baseline eGFR (HR 1.49).
Targher G, Chonchol M, Bertolini L et al. J Am Soc Nephrol 2008; doi: 10.1681/ASN.2007101155

Severe fright may not just be physically paralysing, it could also increase the risk of blood clots and thrombosis, according to researchers at the University of Bonn, Germany. They took blood samples from 31 patients with anxiety disorders and a group of matched controls. Activation of coagulation and inhibition of fibrinolysis were seen in blood samples from anxiety disorder patients, although coagulation values were always within physiological norms. The researchers said a real health threat would only arise when other risk factors, such as smoking and obesity, also occur. They add that this could explain why anxiety patients have a three- to fourfold higher risk of death from heart disease.
Geiser F, Harbrecht U.

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