Kyung Eun Yun1, Yoosoo Chang1,2, Sung-Cheol Yun3, George Davey Smith4,5, Seungho Ryu1,2, Sung-Il Cho6, Eun Chul Chung7, Hocheol Shin8, Young-Ho Khang9. 1. Center for Cohort Studies, Total Healthcare Center. 2. Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. 3. Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. 4. MRC Integrative Epidemiology Unit. 5. School of Social and Community Medicine, University of Bristol, Bristol, UK. 6. Department of Epidemiology, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, South Korea. 7. Department of Radiology. 8. Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. 9. Department of Health Policy and Management, Seoul National University College of Medicine, and Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.
Abstract
Background: We examined whether alcohol flushing could be used as an instrumental variable (IV) and investigated the effect of alcohol consumption on coronary calcification using alcohol flushing status as an IV. Methods: We analysed cross-sectional data from 24 681 Korean adults (20 696 men and 3985 women) who had been administered a questionnaire assessing alcohol consumption and alcohol flushing, as well as a coronary artery calcium (CAC) measurement. The associations of alcohol flushing status with potential confounders and alcohol consumption were examined. We employed two-stage predictor substitution methodology for the IV analysis. Results: The prevalence of alcohol flushing did not differ depending on gender, education, household income, cigarette smoking or physical activity. Balanced levels of confounders were observed between alcohol flushers and non-flushers. Alcohol flushing was closely related to alcohol consumption and levels of liver enzymes. In men, a doubling in alcohol consumption was associated with increased odds of coronary calcification in both the IV analysis [odds ratio (OR) of CAC scores of 1 or over = 1.11; 95% confidence interval (CI) = 1.03-1.20) and the multivariable regression analysis (OR = 1.04; 95% CI = 1.01-1.07). For cardiovascular risk factors, the IV analysis showed a positive association between alcohol consumption and blood pressure and high-density lipoprotein-cholesterol. Conclusions: Alcohol flushing can be used as an IV in studies evaluating the health impact of alcohol consumption, especially in East Asian countries. Through such an analysis, we found that increased alcohol consumption was associated with an increased risk of subclinical coronary atherosclerosis.
Background: We examined whether alcohol flushing could be used as an instrumental variable (IV) and investigated the effect of alcohol consumption on coronary calcification using alcohol flushing status as an IV. Methods: We analysed cross-sectional data from 24 681 Korean adults (20 696 men and 3985 women) who had been administered a questionnaire assessing alcohol consumption and alcohol flushing, as well as a coronary artery calcium (CAC) measurement. The associations of alcohol flushing status with potential confounders and alcohol consumption were examined. We employed two-stage predictor substitution methodology for the IV analysis. Results: The prevalence of alcohol flushing did not differ depending on gender, education, household income, cigarette smoking or physical activity. Balanced levels of confounders were observed between alcohol flushers and non-flushers. Alcohol flushing was closely related to alcohol consumption and levels of liver enzymes. In men, a doubling in alcohol consumption was associated with increased odds of coronary calcification in both the IV analysis [odds ratio (OR) of CAC scores of 1 or over = 1.11; 95% confidence interval (CI) = 1.03-1.20) and the multivariable regression analysis (OR = 1.04; 95% CI = 1.01-1.07). For cardiovascular risk factors, the IV analysis showed a positive association between alcohol consumption and blood pressure and high-density lipoprotein-cholesterol. Conclusions: Alcohol flushing can be used as an IV in studies evaluating the health impact of alcohol consumption, especially in East Asian countries. Through such an analysis, we found that increased alcohol consumption was associated with an increased risk of subclinical coronary atherosclerosis.
Authors: Parag A Chevli; Amer I Aladin; Alka M Kanaya; Namratha R Kandula; Diego Malaver; David M Herrington Journal: Nutr Metab Cardiovasc Dis Date: 2019-07-31 Impact factor: 4.222
Authors: Angela M Wood; Stephen Kaptoge; Adam S Butterworth; Peter Willeit; Samantha Warnakula; Thomas Bolton; Ellie Paige; Dirk S Paul; Michael Sweeting; Stephen Burgess; Steven Bell; William Astle; David Stevens; Albert Koulman; Randi M Selmer; W M Monique Verschuren; Shinichi Sato; Inger Njølstad; Mark Woodward; Veikko Salomaa; Børge G Nordestgaard; Bu B Yeap; Astrid Fletcher; Olle Melander; Lewis H Kuller; Beverley Balkau; Michael Marmot; Wolfgang Koenig; Edoardo Casiglia; Cyrus Cooper; Volker Arndt; Oscar H Franco; Patrik Wennberg; John Gallacher; Agustín Gómez de la Cámara; Henry Völzke; Christina C Dahm; Caroline E Dale; Manuela M Bergmann; Carlos J Crespo; Yvonne T van der Schouw; Rudolf Kaaks; Leon A Simons; Pagona Lagiou; Josje D Schoufour; Jolanda M A Boer; Timothy J Key; Beatriz Rodriguez; Conchi Moreno-Iribas; Karina W Davidson; James O Taylor; Carlotta Sacerdote; Robert B Wallace; J Ramon Quiros; Rosario Tumino; Dan G Blazer; Allan Linneberg; Makoto Daimon; Salvatore Panico; Barbara Howard; Guri Skeie; Timo Strandberg; Elisabete Weiderpass; Paul J Nietert; Bruce M Psaty; Daan Kromhout; Elena Salamanca-Fernandez; Stefan Kiechl; Harlan M Krumholz; Sara Grioni; Domenico Palli; José M Huerta; Jackie Price; Johan Sundström; Larraitz Arriola; Hisatomi Arima; Ruth C Travis; Demosthenes B Panagiotakos; Anna Karakatsani; Antonia Trichopoulou; Tilman Kühn; Diederick E Grobbee; Elizabeth Barrett-Connor; Natasja van Schoor; Heiner Boeing; Kim Overvad; Jussi Kauhanen; Nick Wareham; Claudia Langenberg; Nita Forouhi; Maria Wennberg; Jean-Pierre Després; Mary Cushman; Jackie A Cooper; Carlos J Rodriguez; Masaru Sakurai; Jonathan E Shaw; Matthew Knuiman; Trudy Voortman; Christa Meisinger; Anne Tjønneland; Hermann Brenner; Luigi Palmieri; Jean Dallongeville; Eric J Brunner; Gerd Assmann; Maurizio Trevisan; Richard F Gillum; Ian Ford; Naveed Sattar; Mariana Lazo; Simon G Thompson; Pietro Ferrari; David A Leon; George Davey Smith; Richard Peto; Rod Jackson; Emily Banks; Emanuele Di Angelantonio; John Danesh Journal: Lancet Date: 2018-04-14 Impact factor: 202.731