Effect of alcohol consumption on biological markersassociated with risk of coronary heart disease: systematic

review and meta-analysis of interventional studies

GROUP 18

Adelita yuli hapsari 030-10-003

Adinda ratna putri 030-10-005

Adisti zakyatunisa 030-10-006

Agrietia zwandita 010-10-012

JAKARTA

TRISAKTI UNIVERSITY

     The cardiovascular system is a complex system with one central organ: the heart.  The heart is the body’s pacemaker.  It pumps oxygen-rich blood to the different parts of the body.  The blood’s journey through the body is an extensive trip through  highways of veins, arteries, and other branches.

     The heart is somewhat centrally located. Two thirds of the heart is on the left side of the sternum. It is the size of your fist, weighing in at a whopping pound and a half.  Although it appears small, its importance cannot be understated.

     The heart is divided into four chambers: the left and right atria, and the left and right ventricle.  The atria are on the upper half of the heart, and the ventricles make up the lower portion.   The object of the blood is to circulate oxygen for the growth and development of cells.  The blood is composed of red and white blood cells, platelets, lymph, plasma, and water.  The red blood cells carry the oxygen.  The white blood cells are part of the immune system.  Platelets are used when blood clots, to stop the bleeding.  Lymph is the interstitial fluid in the blood, also part of the immune system.   Plasma is the remaining portion of the blood, the water in which the blood cells are suspended.

     Blood enters the heart in the left atrium, from the superior and inferior vena cava.  The superior vena cava is the vein that collects the blood returning from the upper body, and the inferior vena cava returns blood from the lower body.  The deoxygenated blood of these two veins enters the heart in the right atrium and is pumped to the right ventricle.  Then the blood travels out of the heart and enters the pulmonary artery.  This artery carries the blood to the lungs to get oxygen.

     Once the blood reaches the lungs, carbon dioxide already in the blood is diffused into the lungs. Carbon dioxide is a cell’s waste product after using oxygen.  This is where the circulatory system and the respiratory system intertwine.

     The oxygen in the lungs is diffused through the alveoli sacs and then through the  wall of the lungs into the bloodstream.  The blood carries the oxygen to the various cells in the body.  To get the oxygen to the actual cells, the arteries branch off into smaller arterioles.  These even branch off to capillaries, the smallest of blood vessels.  Their walls are extremely thin and elastic.  In these vessels, the red blood cells must travel single file to pass through.  The oxygen diffuses across the capillary wall.  It then travels to a nearby cell and enters through the cell membrane.

     The carbon dioxide that leaves the cell to allow room for the oxygen makes its way to the bloodstream. Once it reaches the capillaries, it has entered the bloodstream.  The capillaries then fork into venules, which then fork into veins.  The veins carry the carbon dioxide in the blood back to the heart.  This completes the cycle of the circulatory system.

What is Cardiovascular Disease?

Cardiovascular disease or cardiovascular diseases is the class of diseases that involve the

heart or blood vessels (arteries and veins).

While the term technically refers to any disease that affects the cardiovascular system (as used in

MeSH), it is usually used to refer to those related to atherosclerosis (arterial disease). These

conditions have similar causes, mechanisms, and treatments. In practice, cardiovascular disease

is treated by cardiologists, thoracic surgeons, vascular surgeons, neurologists, and interventional

radiologists, depending on the organ system that is being treated. There is considerable overlap

in the specialties, and it is common for certain procedures to be performed by different types of

specialists in different hospitals.

By the time that heart problems are detected, the underlying cause (atherosclerosis) is usually

quite advanced, having progressed for decades. There is therefore increased emphasis on

preventing atherosclerosis by modifying risk factors, such as healthy eating, exercise and

avoidance of smoking.

Cardiovascular diseases include the following;

Aneurysm

Angina

Atherosclerosis

Cerebrovascular Accident (Stroke)

Cerebrovascular disease

Congestive Heart Failure

Coronary Artery Disease

Myocardial infarction (Heart Attack)

Peripheral vascular disease

Unlike many other chronic medical conditions, Cardiovascular disease is treatable and

reversible, even after a long history of disease. Treatment is primarily focused on diet and stress

reduction.

Population based studies in the youth show that the precursors of heart disease start in

adolescence. The process of atherosclerosis evolves over decades, and begins as early as

childhood. The Pathobiological Determinants of Atherosclerosis in Youth Study demonstrated

that intimal lesions appear in all the aortas and more than half of the right coronary arteries of

youths aged 7–9 years. However, most adolescents are more concerned about other risks such as

HIV, accidents, and cancer than cardiovascular disease. This is extremely important considering

that 1 in 3 people will die from complications attributable to atherosclerosis. In order to stem the

tide of cardiovascular disease, primary prevention is needed. Primary prevention starts with

education and awareness that cardiovascular disease poses the greatest threat and measures to

prevent or reverse this disease must be taken.

Basic Cardiovascular Physiology

This section is a review of some basic tenets of cardiovascular physiology which are relevant to

invasive cardiac monitoring.  How these principles apply to the specific catheters will be

discussed on other pages in greater detail.

Some Basic Review:

Circulatory System:  The circulatory system consists of the heart, the blood vessels, (arteries,

arterioles, and blood) and its purpose is to carry oxygen and nutrients to tissues in the body, and

to carry away the byproducts of metabolism.

Contractility:  Contractility is the intrinsic ability of cardiac muscle to develop force for a given

muscle length.  It is also referred to as inotropism.

Preload:  Preload is the muscle length prior to contractility, and it is dependent of ventricular

filling (or end diastolic volume.)  This value is related to right atrial pressure.  The most

important determining factor for preload is venous return.

Afterload:  Afterload is the tension (or the arterial pressure) against which the ventricle must

contract.  If arterial pressure increases, afterload also increases. Afterload for the left ventricle is

determined by aortic pressure, afterload for the right ventricle is determined by pulmonary artery

pressure.      

 

Atherosclerosis

Atherosclerosis is the buildup of plaque in the arteries. The danger is that plaque can lead to

aneurysms and blood clots, and clots in turn can result in thrombosis, heart attack, and stroke.

High cholesterol levels bring increased risk. As LDL cholesterol (the “bad” cholesterol) levels

increase, CVD risk increases. When other risk factors are present, risk increases even more. A

person’s lipid levels are also affected by age, sex, heredity, and diet.

High blood pressure increases the heart’s workload and can lead to increased arterial damage,

opening the door further for atherosclerosis. High blood pressure is also the biggest risk factor

for stroke. When high blood pressure exists with obesity, smoking, high blood cholesterol

levels, or diabetes, the risk of heart attack or stroke increases several times.

Obesity, a sedentary lifestyle, and diabetes are closely linked risk factors. Those who are

overweight are more likely to develop heart disease and stroke even if they have no other risk

factors. The weight itself is not the culprit; rather, the excess pounds concentrate other risk

factors. Obesity has a negative influence on blood pressure and cholesterol, and may lead to

diabetes. And, of course, one of the reasons for obesity is a sedentary lifestyle.

Stress is also a contributing factor. Research indicates that there is a relationship between the

risk of developing coronary heart disease and stress. This is because stress releases certain

chemicals, which can increase heart rate and raise blood pressure. Stress also contributes

indirectly to CVD, as people under stress may smoke and drink more than those who lead stress-

free lives.

Alcohol and Drugs also Cause Cardiovascular Disease

It has been found that very mild consumption of alcohol helps to decrease the risk of heart

attacks as it increases HDL or good cholesterol level in the body. However, alcoholism can be

devastating. Alcohol addiction can lead to high blood pressure, heart failure, alcoholic

cardiomyopathy and strokes. If a person finds it hard to quit alcohol, then he/she should join an

alcohol rehab center.

Drug addiction is another cause of cardiovascular diseases. Narcotics such as heroin, cocaine and

other similar hard drugs cause contraction in the heart valve and weakens the circulatory system.

Sedentary Lifestyle

Physical activity is absolutely necessary for the human body. Exercises must be a part of our

daily life, but sadly enough we claim to have no time for things that matter most. Sedentary

lifestyle and long work hours has made us highly susceptible to cardiac diseases. Workouts, be it

at the gym or at your home, triggers faster blood flow and strengthens the ligaments and

muscles. Swimming, cycling, jogging etc., should be incorporated in our daily routine.

Cardiovascular exercises are especially advised for people who have heart problems.

Genetics and aging are also known to be risk factors of cardiovascular diseases, but the fact is

that both are only risk factors and not exact causes. Healthy living can go a long way in curing

cardiovascular diseases. It is extremely important that we put a check on our lifestyle so that we

can enjoy all the gifts that life has to offer.

Alcohol and Heart Disease

Any advice about the consumption of alcohol must take into account not only the complex

relation between alcohol and cardiovascular disease but also the well-known association of

heavy consumption of alcohol with a large number of health risks.1 One approach would be to

recommend no consumption of alcohol. However, a large number of recent observational studies

have consistently demonstrated a reduction in coronary heart disease (CHD) with moderate

consumption of alcohol.2 3 Any prohibition of alcohol would then deny such persons a

potentially sizable health benefit. This advisory examines the complex relation between alcohol

and coronary heart disease and offers recommendations for the responsible use of alcohol.

.

Mechanisms for Cardioprotective Effects of Moderate Consumption of Alcohol

Recent analyses suggest that approximately 50% of the protective effect of alcohol is mediated

through increased levels of HDL cholesterol.17 HDL removes cholesterol from the arterial wall

and transports it back to the liver and probably has several other protective effects on the arterial

system. A number of epidemiological studies and small clinical trials have demonstrated that

moderate consumption of alcohol raises HDL cholesterol levels. When HDL cholesterol was

added to computer models predictive of CHD, about half the benefit of alcohol in protecting

against CHD could be attributed to its effect on HDL levels.

A number of other mechanisms have been proposed to explain the other half of the protective

effect of alcohol against CHD. One or two alcoholic drinks per day apparently do not affect other

major risk factors, such as LDL cholesterol and blood pressure. Several studies have suggested

that alcohol may affect blood clotting, either by causing the blood to clot less avidly through

effects on coagulation factors and platelets or by enhancing the ability of the blood to break up

clots when they form. These studies are supported by epidemiological data that suggest that

acute alcohol consumption causes a short-term beneficial effect in protection against CHD in

addition to long-term effects. Other studies have focused on the nonalcoholic components of

alcoholic beverages, particularly in red wine and dark beer, which may have antioxidant

properties. However, the epidemiological evidence favoring one type of beverage over another is

inconsistent, possibly because of large differences in diet, smoking, and other risk behaviors

among drinkers. Again, at least half of the inverse association between alcohol and CHD appears

to be directly linked to alcohol through increased HDL cholesterol levels.

Alcohol's Affect on the Heart

Numerous studies suggest that moderate alcohol consumption helps protect against heart disease

by raising HDL (good) cholesterol and reducing plaque accumulations in your arteries. Alcohol

also has a mild anti-coagulating effect, keeping platelets from clumping together to form clots.

Both actions can reduce risk of heart attack but exactly how alcohol influences either one still

remains unclear.

On the other hand, drinking more than three drinks a day has a direct toxic effect on the heart.

Heavy drinking, particularly over time, can damage the heart and lead to high blood pressure,

alcoholic cardiomyopathy, (enlarged and weakened heart), congestive heart failure, and stroke.

Heavy drinking puts more fat into the circulation in your body, raising your triglygeride level.

That's why doctors will tell you “If you don't drink, don't start”. There are other, healthier ways

to reduce your risk of heart disease like eating right, getting regular exercise and maintaining a

healthy weight.

What's “Moderate Drinking” for one may be legally drunk for another. By nature's design, a

woman's body metabolizes alcohol differently so that 1 alcoholic beverage in a woman is equal

to 2 in a man. Alcohol remains in a woman's body longer than in a man's. Also, the older you are,

the less efficient the body can metabolize alcohol. Many states have revised their drunk-driving

laws and 0.08 percent is considered to be intoxicated. Women, especially women of small

stature, must be alert to these laws and metabolic differences when drinking, and limit their

alcohol intake accordingly.

Role play

One day in the bar...

*The Bartender is shaking the wine bottles. *

A : there’s a bar. Do you wanna drink something like wine or champagne to refresh

our mind? That exam was killing me.

B : that’s good idea, i’d love to. Let’s go !

*A and B sitting on the chair in front of the bartender*

C : evening beutiful miss, what do you want to order ? we have rainbow vodka,

cheerful beer, and the best one in this bar is Heaven Champagne

A : oh my god we just had a very bad exam, what’s the appropriate drink for us ?

what do you think ?

C : all right, for pretty woman like you, i’ll get a big bottle of heaven champagne.

A : okay, i’ll get one, what about you ?

B : i just wanna simple one, like a rainbow vodka in the small glass.

C : okay, here you go !

*A and B are drinking*

While A and B were drinking, there is a doctor who just back from her hospital and she

comes to the bartender and....

D : can i get a light vodca ? in a small glass

C : yes, here you go

suddenly A feels pain in her chest and she screams loudly

A : aaarrrrgh...!

B : what happen to you ?

D : *grab A* open her clothes ! *grab her sthetoscope and check A’s chest*

*a doctor give her an aspirin*

D : i’m a general practitioner and i recomended to your friend that she has to go to

harapan Kita heart hospital, because my assumption is maybe she has risk factor of

coronary heart disease and she had drunk to much alcohol, right ?

B : yes, she likes alcohol so much, and thank you for your recommendation. I’ll tell

her. I think, i have to bring her to the hospital now.

D : and... you drunk a little bit alcohol right? By consumpting a little bit alcohol

dose in a moderate, you can avoid coronary heart disease. Because alcohol can increased

levels of HDL cholesterol and it can decreased fibrinogen levels.

B : oooh okay. I’ll remember that.

D : Okay, becareful on the way. See you soon.