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.