ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH

Vol. **, No. * ** 2014

Frequency of Heavy Alcohol Drinking and Risk of Metabolic Syndrome in Middle-Aged Men Ichiro Wakabayashi

Background: Frequency of alcohol drinking is known to influence cardiovascular risk. However, little is known regarding the relationship between frequency of drinking and metabolic syndrome (MetS). The aim of this study was to determine how frequency of heavy drinking modifies the prevalence of MetS. Methods: The subjects were middle-aged male nondrinkers and occasional or regular heavy drinkers (ethanol intake: ≥66 g per drinking day). Odds ratios (ORs) for MetS and each component comprising MetS were calculated with adjustment for age and histories of smoking and regular exercise. Results: ORs versus nondrinkers for MetS defined by the criteria of the National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATP III) or the International Diabetes Federation (IDF) were significantly higher than the reference level of 1.00 in occasional heavy drinkers (NCEPATP III, 1.94 [confidence interval (CI): 1.54 to 2.45]; IDF, 1.97 [CI: 1.56 to 2.49]) and regular heavy drinkers (NCEP-ATP III, 1.48 [CI: 1.19 to 1.84]; IDF, 1.50 [CI: 1.20 to 1.86]). When compared with the reference level, OR versus nondrinkers for large waist circumference was significantly higher in occasional heavy drinkers (1.96 [CI: 1.63 to 2.35]), but not in regular heavy drinkers (1.12 [CI: 0.96 to 1.32]), while OR versus nondrinkers for hyperglycemia was significantly lower in regular heavy drinkers (0.66 [CI: 0.46 to 0.95]), but not in occasional heavy drinkers (0.86 [CI: 0.60 to 1.24]). Conclusions: There is a positive association between heavy drinking and MetS, which is stronger in occasional drinkers than in regular drinkers. This difference may be explained by a positive association between occasional heavy drinking and central obesity and an inverse association between regular heavy drinking and hyperglycemia. The results suggest that heavy drinking, even if occasionally, is a cardiovascular risk factor. Key Words: Alcohol, Cardiovascular Disease, Central Obesity, Diabetes Mellitus, Metabolic Syndrome.

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ABITUAL ALCOHOL DRINKING is known to affect cardiovascular health diversely, depending on the amount of alcohol. Risks of coronary artery disease, ischemic type of stroke, and peripheral arterial disease are reduced by light-to-moderate drinking (Corrao et al., 2000), while heavy drinking causes an increase in the risk of hemorrhagic type of stroke such as cerebral hemorrhage and subarachnoid hemorrhage (Mazzaglia et al., 2001; Reynolds et al., 2003). The former beneficial effects of alcohol are mainly explained by its actions on lipid metabolism and blood coagulability. Serum high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol are higher and lower, respectively, in drinkers than in non-

From the Department of Environmental and Preventive Medicine (IW), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. Received for publication December 23, 2013; accepted February 26, 2014. Reprint requests: Ichiro Wakabayashi, MD, PhD, Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan; Tel.: +81-798-45-6561; Fax: +81-798-45-6563; E-mail: wakabaya@ hyo-med.ac.jp Copyright © 2014 by the Research Society on Alcoholism. DOI: 10.1111/acer.12425 Alcohol Clin Exp Res, Vol **, No *, 2014: pp 1–8

drinkers (Castelli et al., 1977). Platelet aggregation is inhibited by alcohol (Rubin, 1999), and levels of blood coagulation factors including fibrinogen are lower in drinkers than in nondrinkers (Meade et al., 1987). Moreover, insulin sensitivity has been shown to be higher in drinkers than in nondrinkers (Hulthe and Fagerberg, 2005). On the other hand, the latter detrimental effects of alcohol on cardiovascular health are explained by alcohol-induced hypertension (Klatsky, 1996), hypertriglyceridemia (Castelli et al., 1977; Van de Wiel, 2012), and hyperuricemia (Yamamoto et al., 2005). In addition to the amount of alcohol consumption, the pattern of alcohol drinking has been shown to be an important factor influencing cardiovascular risk. Binge drinking has been demonstrated to increase the risk of stroke (Sundell et al., 2008) and coronary artery disease (Roerecke and Rehm, 2010), while more frequent drinking (consumption several days per week or even daily) is associated with more favorable outcomes than occasional or weekly drinking (Britton and Marmot, 2004; Mukamal et al., 2005). However, the pattern of daily light drinking associated with protection against cardiovascular disease is in fact not common: Most light drinkers do not drink daily, and most daily drinkers are not light drinkers (Knupfer, 1987). Only 2% of the U.S. population reportedly had such a light daily drinking pattern (Russell et al., 1991). 1

WAKABAYASHI

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Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors such as central adiposity, dyslipidemia, high blood pressure, and glucose intolerance. Although the relationship between alcohol drinking and MetS remains controversial, a meta-analysis has shown an inverse association between light-to-moderate alcohol consumption (2.00); the downward arrows indicate significant decrease (↓: OR,

Frequency of heavy alcohol drinking and risk of metabolic syndrome in middle-aged men.

Frequency of alcohol drinking is known to influence cardiovascular risk. However, little is known regarding the relationship between frequency of drin...
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