Introduction
Prognosis for both spontaneous intracerebral hemorrhage (ICH) 1-4 and aneurysmal subarachnoid hemorrhage (SAH) 4-7 , despite improvements in medical and neurosurgical treatment, has largely remained unaffected. Outcome of both these main hemorrhagic stroke subtypes, which together account for approximately 20 of all strokes, is still determined mainly by the severity ofbleeding, and overall case-fatality still reaches 40-50 2,3,7 , Hence, identification of modifiable risk factors for ICH and...
Mechanisms of cocaine cardiotoxicity
Cocaine abuse induces coronary vasospasm 1-5 , myocardial infarction 6-8 , hypertension 9,10 , stroke 7,H , and fatal cardiac rhythm disorders, including ventricular fibrillation 12-15 , Chronic cocaine abuse has also been shown to cause dilated cardiomyopathy 16,17 , and left ventricular hypertrophy in normotensive cocaine users 18-20 , It is only since modern electrocardiographic techniques have come into widespread use that the effect of cocaine on cardiac rhythm has been effectively...
Are Female Animal Models Of Alcoholism Helpful In Evaluating The Adverse Effects Of Alcohol
Female animal models of alcoholism should be used to study the effects oflong-term alcohol exposure. However, investigators need to consider variables such as the level concentration of ethanol intake, the pattern of weight gain as well as the absolute weight gain, and hormone levels. As noted above, we have found that female rodents drink less alcohol than male rodents (Table 4.6). Our findings differ from those of others, who have reported that female rodents drink more than male rodents...
Cardiogenic Brain Embolism
Stroke admission rates have been observed to be high among heavy drinkers 10 , Some studies also suggest that alcohol abuse may associate with ischemic stroke recurrence 11,12 . A study on recent alcohol intake showed that heavy drinking is an independent risk factor for most subtypes of ischemic stroke and particularly a risk factor for cardiogenic brain embolism 13 . Table 7.1 Previously published and new case histories illustrating several different mechanisms that could link alcohol abuse...
Baroreceptors
In this series of experiments, we addressed the question whether ethanol-evoked attenuation of the baroreflex bradycardic response is dependent on either or both sets of the baroreceptor afferents. In the first study, bilateral transection of the aortic nerves in the cervical region, Figure 21.1 Bar graphs showing that ethanol (0.1, 0.5 and 1.0 g kg) produces graded decreases in regression coefficient (baroreflex slopes beats min mmHg) in SO, but not in aortic barodenervated (ABD) rats. Values...
Development Of Ahmd
There have been many reasons postulated to explain the differences between males and females, in terms of sensitivity to alcohol-related medical consequences. Several of the reasons are briefly reviewed below. A more comprehensive review is published elsewhere 40 , Female alcoholics develop a multitude of symptoms more rapidly than male alcoholics during the first few years of drinking, a phenomenon which is refered to as 'telescoping' 41,42 , Lewis et al. examined the effect of other...
Baroreflexes
We have previously shown that systemically administered ethanol attenuated the bradycardic and depressor responses to stimulation of the aortic nerve in sinaortic denervated rats 36 , These findings provided indirect evidence of a possible ethanol-evoked impairment of the central pathways that mediate the baroreceptor reflex control ofheart rate. In a subsequent study, we examined the effects of microinjection of ethanol in some CNS sites that are possibly involved in the baroreceptor reflex...
Alcohol Abuse And Cardiovascular Disease
Although there is considerable evidence that moderate drinking protects against mortality and morbidity from coronary heart disease 21,22 , heavy consumption is shown to have deleterious cardiovascular effects. It exerts its adverse effects by increasing the risks of cardiomyopathy, hypertension, and stroke 23 , Chronic ethanol consumption has been linked to the prevalence of hypertension, which contributes to an increased incidence of stroke. Heavy drinkers have alO mmHg higher systolic blood...
Tobacco
Studies on interactions between alcohol and tobacco are most challenging, not only because of the complexity of the effects of either factor, but also because of many inherent methodological problems. Epidemiologic studies on alcohol and tobacco are prone to imprecision in measurements and various biases, their interactions thus being even harder to evaluate in a reliable and valid manner. Alcohol consumption and smoking are usually self-reported and the measurement of either habit is...
The Effect Modification Of Alcohol By Smoking
There are only two epidemiologic studies on the effect modification of alcohol by smoking and neither of them examines it in relation to the risk of stroke. In a Japanese cohort of 19,231 men, alcohol consumption and all-cause mortality had a J-shaped association in nonsmokers but not in smokers 78 , In a cross-sectional study of 5,312 German men and women, the rise in blood pressure associated with drinking was higher in smokers than in nonsmokers 79 , Some studies have instead examined the...
Conclusions
Two thirds of Americans report using alcohol and since social drinking is a potentially modifiable behavior, the relation between alcohol consumption and cardiovascular disease is a subject of considerable importance. Although the literature is not unanimous, evidence from large epidemiologic studies leads to the conclusion that moderate alcohol intake decreases risk of non-fatal and fatal CHD and ischemic stroke. The observed differences in the shape of the relationship between various studies...
Pancreas
Injury to the pancreas has important metabolic consequences, due to its central role in endocrinological and nutritional homeostasis. Susceptibility of pancreatic tissue to damage by ROS may be due to the relatively low activities of endogenous antioxidant enzymes such as glutathione peroxidase, and comparatively low cellular levels of ATC 93 , Certainly, pancreatic islet cells are profoundly sensitive to vitamin E deficiency, as reflected by reduced Mn-superoxide dismutase and increased...
Drinking patterns and beverage types
Drinking patterns have been studied surprisingly little. Yet, drinking patterns vary and are of obvious health relevance. The frequency of drunkenness, the frequency ofhangover and morning drinking have been found to be related to mortality from several causes 54 , Changes in drinking between years may influence mortality 9,55 . Most reports classify participants using a total consumption variable (e.g., drinks per day) based on estimates of customary drinking frequency and amount of alcohol...
Cardioprotective Effect Of Moderate Wine Drinking
There is evidence that moderate wine consumption protects against CAD. Two studies linked the beneficial effects of moderate drinking only to wine 13,14 , Red wine contains several flavonoids and phenolic compounds with significant antioxidant properties. The protection effects against atherogenesis suggested that antioxidants in wine might play a role through modification of LDLs 15 , However, it seems unlikely that the cardioprotective effects are due solely to the antioxidant properties of...
Function
As discussed elsewhere in this volume, quite a few epidemiological studies have examined the association between morbidity and mortality from CHD and moderate alcoholic beverage consumption, and an inverse association has been established in studies involving nearly a million subjects 29 , One example of such reports is a study of American Cancer Society volunteers, which showed that the rate of death from all cardiovascular diseases was 30-40 lower among men and women who consumed at least one...
Cocaine Cardiotoxicity
As cocaine abuse has become widespread, the number of cocaine related cardiovascular events, such as angina pectoris, myocardial ischemia and infarction, cardiac myopathy, left ventricular hypertrophy, and sudden death has increased substantially 1-15 , These occur in young subjects, a significant percentage of whom had no evidence of atherosclerotic coronary artery disease on subsequent angiography 10,11,18-21 . Twice as many men as women experience cocaine related cardiac ischemic events, at...
Alcoholic versus viral or idiopathic chronic dilated cardiomyopathy DCM
The most prevalent confusion with the alcoholic heart disease caused by thiamine and nutritional deficiency is with viral or idiopathic chronic DCM. Between 20 and 35 of all cases ofDCM are thought to occur because of excessive ethanol intake 25 , However, in both alcoholic and idiopathic chronic DCM, the clinical picture is similar. In the early stages of both categories of congestive heart failure, the patients often show some response to bedrest, salt restriction, diuretics, and digitalis....
References
1 Rajiyah G, Agarwal R, Avendano G, Lyons M, Soni B, Regan TJ. Influence of nicotine on myocardial stiffness and fibrosis during chronic ethanol use. Alcoholism Clinical amp Experimental Research, September 1996 20 6 985-989. 2 Kannel WB. Blood pressure as a cardiovascular risk factor Prevention and treatment. JAMA 1996 275 1571-1576. 3 Mattila MJ. Alcohol and Drug Interactions. Annals ofMedicine 1990 22 363-369. 4 Medical safety Avoiding Drug Interactions. Harvard Health Letter March 1998 23 5...
Dependence Of Ethanolevoked Attenuation Of Baroreflex Sensitivity On The Ovarian Hormones
Very few studies dealt with the acute effects of ethanol on cardiovascular reflexes in the female population. Even when female subjects were included 27 , the small sample size did not permit conclusions of whether the action of ethanol on baroreflexes is sexually dimorphic. Our recent studies have demonstrated that ethanol causes a dose-related attenuation ofbaroreflex-mediated bradycardia in female rats 54 , even though the baseline baroreflex sensitivity was significantly lower in female...
Figures
4.1 Survival curves of cardiac deaths in male patients with alcoholic dilated cardiomyopathy DCM . Solid line indicates patients with alcoholic DCM and alcohol abstinence, large dashed line indicates patients with alcoholic DCM without abstinence and small dashed line indicates idiopathic DCM. Used with permission from Fauchier etal. European Heart J. 2000 21 306-314 37 4.2 Representative echocardiograms from control and ethanol-fed female rat 40 4.3 Representative echocardiograms from control...
