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Max
04-04-2003, 01:38 PM
Godfathers of the Cocktail Hour
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By Kathleen Doheny
HealthScoutNews Reporter

FRIDAY, April 4 (HealthScoutNews) -- In the 1970s, Dr. Arthur L. Klatsky was a cardiologist, tending to his patients who had suffered heart attacks or were in danger of having one.


Then, Dr. Gary D. Friedman, an epidemiologist and colleague who was computer-savvy years before it was commonplace, told him about a study he wanted to do. Using the large patient database afforded them by Kaiser Permanente in Northern California, a health maintenance organization where they both worked, they'd plug reams of information into the computer and possibly find new associations between habits and heart health.


Klatsky agreed to the idea. Together, they inputted the information. Many of the risk factors of heart disease were already known at the time; the idea, Klatsky recalled recently, was "to see what we could find that wasn't known."


The idea paid off.


"One of the things that came out was that abstainers [of alcohol] seemed to be at high risk for heart disease," Klatsky says. "That hadn't been reported from an epidemiological standpoint." The theory was around, tossed about by experts.


But now Klatsky and Friedman had convincing proof that moderate drinking -- when cigarette smoking was controlled -- decreased the risk of heart attacks. Their study was published in the Annals of Internal Medicine in late 1974.


In the nearly 30 years since, Klatsky, who says Friedman was his mentor, has been unearthing more details about why and how alcohol might protect the heart. He's also found how it might protect your health in myriad other ways, staving off stroke, gallstones, possibly diabetes and vascular disease in the extremities.


In late 2001, Friedman, Klatsky and others presented an updated analysis of more than 128,000 patients and found that those who drank one or two alcoholic drinks a day had a 32 percent lower risk of dying from heart disease than did abstainers.


The road hasn't been easy at times. "There have been people who got very upset and said it is going to promote alcoholism," says Klatsky, a senior consultant in cardiology and adjunct investigator at the division of research at the Kaiser Permanente Medical Center in Oakland, Calif.


On that point, Klatsky is clear. He's not suggesting anyone take up drinking based on his research to improve health. In fact, that's the trickiest part -- a doctor trying to tell his or her patient whether they should or should not drink for health benefits.


The answer, Klatsky says, is complicated and very individual.


Suppose a woman, 40, has had children, is at low risk of breast cancer (news - web sites) (which has been linked with drinking in some studies), eats a healthy diet, does not smoke, has low cholesterol and no family history of heart disease and no moral reasons not to drink. Should she drink for health benefits?


"I would say she can choose to drink for pleasure," Klatsky says. "The data don't show a net benefit [for health] until a woman reaches menopause [when heart disease risk rises]."


But a man of the same age, with basically the same habits and background, would probably net health benefits from a drink or two a day, he says, because he is more at risk for having a heart attack than the woman, Klatsky says.


As convincing as the data are about alcohol and heart health, drinking must be put into perspective, Klatsky says. "The important thing is, there are lots of lifestyle measures useful to prevent heart attack -- not smoking, exercising, proper diet, getting blood pressure under control if it is high, getting cholesterol under control. All of those things are more important than light drinking."


Klatsky, now 73, practices what he preaches. "I have a little wine with dinner," he says. He's a six-time marathoner, but knee problems have forced a switch to walking, logging four miles a day.


Friedman, now 69, says he is happy the first cardiologist he asked to join his research project three decades ago was too busy and he turned to Klatsky. "He's primarily a clinician who is very bright and got interested in the alcohol field and became a very well-respected researcher," Friedman says.





It took the computerized data to sort it all out, but Friedman says both he and Klatsky had lots of hints about the health effects of alcohol, even way back in their residency days. They both served at Boston City Hospital as house officers, though Klatsky preceded Friedman by about four years.

Later, they talked about some of their patients, Friedman recalls. "We used to see a lot of alcoholics who had cirrhosis -- but very clean arteries."

More information

For advice about alcohol intake, see American Heart Association. For more on heart disease, see National Heart, Lung, and Blood Institute.



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Max
04-04-2003, 01:40 PM
Moderate Drinking May be a Heart-Smart Choice...
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By Kathleen Doheny
HealthScoutNews Reporter

FRIDAY, April 4 (HealthScoutNews) -- Whenever a new study touts yet another health benefit associated with drinking -- and there have been legions in the last decade -- most of us are poised to raise a toast.


In Yahoo! Health


Whether the latest research confirms yet again that moderate alcohol consumption confers protective effects on our cardiovascular system, helping us to live longer, or whether it points to wine as a better choice than beer or hard liquor, our response is usually the same:


"We'll drink to that."


Fine, say alcohol researchers, most of them ready to join us. But what's often missing, they say, is some perspective. What often gets lost in the shuffle is that wine or other alcohol is but one health practice of many that's potentially valuable in helping us stay healthier and live longer.


That's a message that bears repeating, particularly in April, which has been designated Alcohol Awareness Month.


The word "moderate" is often not heard, either. For women and men over age 65, that's one drink a day; for younger men, two.


Even moderate drinking, as good as it can be for the heart, isn't good for everyone. Those with a family history of alcohol abuse, for instance, might be better off the wagon, experts say.


Nor does the evidence, strong as it is, warrant persuading abstainers with no interest in alcohol to take up the habit.


But the research that alcohol in moderation improves our health, particularly our heart health, is indisputable, experts say.


Alcohol works in a variety of ways to lower heart disease risk, researchers say, including raising levels of high-density lipoprotein (HDL), the so-called good cholesterol, and apparently affecting blood clotting in a way that prevents heart attacks.


And alcohol may help more than the heart.


"In addition to coronary benefits, there are papers out there showing that moderate alcohol intake is also associated with a variety of other benefits," says John Barefoot, a professor of psychiatry and behavioral sciences at Duke University and a researcher on the topic.


Alcohol has been found to reduce the risk of stroke and gallstones and may cut the risk of diabetes and peripheral vascular disease, a review of medical literature shows.


Not a bad return for a daily glass of wine, shot of liquor or mug of beer.


But it might not be as simple as that, researchers suspect. It could be that those who drink alcohol moderately -- especially wine drinkers -- are just healthier overall, the same people who are likely to eat a healthful diet, exercise often and get regular physical examinations.


That's what Barefoot found when he evaluated 4,435 men and women enrolled in the University of North Carolina Alumni Heart Study. The wine drinkers ate more fruits and vegetables and less red meat. They were also less likely to smoke and more likely to be leaner and to work out.


So moderate drinking, perhaps especially wine drinking, "might be something that goes with a whole lifestyle," Barefoot says. "The whole lifestyle is what is really important."





The moderation part of the equation is important, too, adds Dr. Wendy Chen, an oncologist and epidemiologist at Brigham and Women's Hospital and the Dana Farber Cancer Institute, both in Boston.

"All the studies have looked at average daily use [of alcohol, meaning a moderate intake]. With a higher level, there is an increased risk of health problems," she says.

Heavy drinking is associated with a variety of ills, including liver damage and throat cancer, not to mention the increased risk of automobile accidents.

The other emerging consensus is that there's no one-size-fits-all recommendation for who should drink and who should not.

While some studies have linked two drinks a day to a 30 percent greater risk of breast cancer (news - web sites), that doesn't mean a woman, even one with a family history of the disease, should never drink, Chen says. Depending on individual risk factors, having a drink a day might give such a woman a net health benefit because it would probably protect her from heart disease and stroke more than it would raise her risk for breast cancer.

The decision to drink or not must be tailored to a person's health profile and take into account medical history and family history, among other factors.

During pregnancy, alcohol use is generally discouraged, although Chen says there's some disagreement about alcohol in the second trimester, with most experts agreeing it should be strictly avoided in the first and used only sparingly, if at all, in the third.

The moderate message is one that experts are always trying to get across. "Non-drinkers have a higher risk [of heart disease]," says Barefoot, "but once you get into heavy drinking the health risks go up dramatically."

More information


To read a report about moderate alcohol consumption and health benefits, see the American Council on Science and Health. To learn about National Alcohol Screening Day, click here.



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