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Population studies have demonstrated a U-shaped distribution of the relationship between alcohol intake and coronary heart disease (CHD), in that persons with the most "moderate" alcohol consumption appear to enjoy lesser CHD than either nondrinkers or heavy drinkers. Whether the alcohol itself exerts a beneficial effect, or moderate alcohol consumption is associated with other lifestyle factors which enhance cardiovascular health remains unknown.
The current study, the first of its kind, examined the relationship of alcohol consumption to mortality in individuals suffering an acute myocardial infarction (AMI). Mukamal and colleagues interviewed men and women (n = 1935) within a few days of having an AMI about their alcohol consumption in the previous year, stratified by grams of ethanol per week into abstainers, light drinkers (< 7 drinks/week), and moderate drinkers (> 7 drinks/week).
Almost half of the patients reported no alcohol intake in the prior year. Higher alcohol intake correlated with higher educational attainment and higher income. AMI mortality was highest among abstainers, and lowest in moderate drinkers. Mukamal et al conclude that in this population, moderate alcohol intake in the year prior to AMI was associated with a more favorable survival outcome than abstention or light alcohol consumption.
Mukamal KJ, et al. JAMA. 2001;285: 1965-1970.
Life expectancy among persons with dementia has been reported to be substantially reduced, ranging from 5-9 years on average. Such observations suffer from length bias—persons with rapidly progressive dementia and demise participate less often in studies—which would tend to underestimate the effect of dementia on mortality.
In order to gain a clearer picture of the effect dementia imparts on survival, Wolfson and colleagues used data from a randomly selected large Canadian population (n = 10,263) of persons older than age 65 who were screened for cognitive impairment. In addition to determining the presence of dementia, date of onset for cognitive impairment was noted. Subjects were followed for 5 years.
In the cognitively impaired subjects (n = 821), most had Alzheimer’s disease, but almost one-fourth had vascular dementia.
Unadjusted median survival for the group, which did not differ significantly between those with probable Alzheimer’s disease, possible Alzheimer’s disease, or vascular dementia, was 6.6 years. When adjusted for length bias, this median survival was reduced to 3.3 years. This survival is substantially less than in previously reported data, and Wolfson et al note that this places dementia in a category with other substantially mortal disorders like congestive heart failure.
Wolfson C, et al. N Engl J Med. 2001; 344:1111-1116.
St. john’s wort (sjw) is a widely popular treatment for depression, both in the United States and Europe. Meta-analysis has concluded that SJW is superior to placebo, with approximately equal efficacy to traditional proprietary pharmacologic agents, and often fewer side effects. There has been some criticism of previous study flaws that may have undermined the certainty with which conclusions about SJW efficacy may be drawn. This prospective, randomized, double-blind, placebo-controlled (n = 200) investigation was designed to evaluate the comparative efficacy of 300 mg of SJW over an 8-week period. Study participants had suffered depression for an average of more than 2 years.
Because of the risk of suicide in depressed persons, and since this study contained a placebo arm, any demonstration of suicide risk was a reason for exclusion. Additionally, deterioration from baseline depression scores also resulted in exclusion from the trial.
Despite the use of multiple measurement tools for depression outcome (eg, Beck Depression Inventory, Clinical Global Impression, Hamilton Anxiety Scale), Shelton and colleagues were not able to demonstrate an antidepressant response significantly greater than placebo.
Shelton RC, et al. JAMA. 2001;285: 1978-1986.