Effect of alcohol consumption on biological markers

associated with risk of coronary heart disease: systematic

review and meta-analysis of interventional studies
GROUP !
"delita yuli hapsari #$#-#-##$
"dinda ratna putri #$#-#-##%
"disti &akyatunisa #$#-#-##'
"grietia &wandita ##-#-#(
)"*"R+"
+R,-"*+, U.,/ER-,+0
+he cardiovascular system is a
comple1 system with one central
organ: the heart2 +he heart is the
body3s pacemaker2 ,t pumps
o1ygen-rich blood to the different
parts of the body2 +he blood3s
4ourney through the body is an
e1tensive trip through highways of
veins5 arteries5 and other branches2
+he heart is somewhat centrally
located2 +wo thirds of the heart is on
the left side of the sternum2 ,t is the
si&e of your fist5 weighing in at a
whopping pound and a half2
"lthough it appears small5 its
importance cannot be understated2
+he heart is divided into four chambers: the left and right atria5 and the left and right ventricle2
+he atria are on the upper half of the heart5 and the ventricles make up the lower portion2 +he
ob4ect of the blood is to circulate o1ygen for the growth and development of cells2 +he blood is
composed of red and white blood cells5 platelets5 lymph5 plasma5 and water2 +he red blood cells
carry the o1ygen2 +he white blood cells are part of the immune system2 Platelets are used when
blood clots5 to stop the bleeding2 6ymph is the interstitial fluid in the blood5 also part of the
immune system2 Plasma is the remaining portion of the blood5 the water in which the blood cells
are suspended2
7lood enters the heart in the left atrium5 from
the superior and inferior vena cava2 +he
superior vena cava is the vein that collects the
blood returning from the upper body5 and the
inferior vena cava returns blood from the lower
body2 +he deo1ygenated blood of these two
veins enters the heart in the right atrium and is
pumped to the right ventricle2 +hen the blood
travels out of the heart and enters the pulmonary
artery2 +his artery carries the blood to the lungs
to get o1ygen2
Once the blood reaches the lungs5 carbon dio1ide already in the blood is diffused into the lungs2
8arbon dio1ide is a cell3s waste product after using o1ygen2 +his is where the circulatory system and
the respiratory system intertwine2
+he o1ygen in the lungs is diffused through the alveoli sacs and then through the wall of the lungs
into the bloodstream2 +he blood carries the o1ygen to the various cells in the body2 +o get the
o1ygen to the actual cells5 the arteries branch off into smaller arterioles2 +hese even branch off to
capillaries5 the smallest of blood vessels2 +heir walls are e1tremely thin and elastic2 ,n these vessels5
the red blood cells must travel single file to pass through2 +he o1ygen diffuses across the capillary
wall2 ,t then travels to a nearby cell and enters through the cell membrane2
+he carbon dio1ide that leaves the cell to allow room for the o1ygen makes its way to the
bloodstream2 Once it reaches the capillaries5 it has entered the bloodstream2 +he capillaries then fork
into venules5 which then fork into veins2 +he veins carry the carbon dio1ide in the blood back to the
heart2 +his completes the cycle of the circulatory system2
What is Cardiovascular Disease?
Cardiovascular disease or cardiovascular diseases is the class of diseases that involve the
heart or blood vessels 9arteries and veins:2
;hile the term technically refers to any disease that affects the cardiovascular system 9as used in
<e-=:5 it is usually used to refer to those related to atherosclerosis 9arterial disease:2 +hese
conditions have similar causes5 mechanisms5 and treatments2 ,n practice5 cardiovascular disease
is treated by cardiologists5 thoracic surgeons5 vascular surgeons5 neurologists5 and interventional
radiologists5 depending on the organ system that is being treated2 +here is considerable overlap
in the specialties5 and it is common for certain procedures to be performed by different types of
specialists in different hospitals2
7y the time that heart problems are detected5 the underlying cause 9atherosclerosis: is usually
>uite advanced5 having progressed for decades2 +here is therefore increased emphasis on
preventing atherosclerosis by modifying risk factors5 such as healthy eating5 e1ercise and
avoidance of smoking2
8ardiovascular diseases include the following?
"neurysm
"ngina
"therosclerosis
8erebrovascular "ccident 9-troke:
8erebrovascular disease
8ongestive =eart @ailure
8oronary "rtery Aisease
<yocardial infarction 9=eart "ttack:
Peripheral vascular disease
Unlike many other chronic medical conditions5 8ardiovascular disease is treatable and
reversible5 even after a long history of disease2 +reatment is primarily focused on diet and stress
reduction2
Population based studies in the youth show that the precursors of heart disease start in
adolescence2 +he process of atherosclerosis evolves over decades5 and begins as early as
childhood2 +he Pathobiological Aeterminants of "therosclerosis in 0outh -tudy demonstrated
that intimal lesions appear in all the aortas and more than half of the right coronary arteries of
youths aged BCD years2 =owever5 most adolescents are more concerned about other risks such as
=,/5 accidents5 and cancer than cardiovascular disease2 +his is e1tremely important considering
that in $ people will die from complications attributable to atherosclerosis2 ,n order to stem the
tide of cardiovascular disease5 primary prevention is needed2 Primary prevention starts with
education and awareness that cardiovascular disease poses the greatest threat and measures to
prevent or reverse this disease must be taken2
Basic Cardiovascular Physiology
+his section is a review of some basic tenets of cardiovascular physiology which are relevant to
invasive cardiac monitoring2 =ow these principles apply to the specific catheters will be
discussed on other pages in greater detail2
Some Basic Review:
Circulatory System: +he circulatory system consists of the heart5 the blood vessels5 9arteries5
arterioles5 and blood: and its purpose is to carry o1ygen and nutrients to tissues in the body5 and
to carry away the byproducts of metabolism2
Contractility: 8ontractility is the intrinsic ability of cardiac muscle to develop force for a given
muscle length2 ,t is also referred to as inotropism2
Preload: Preload is the muscle length prior to contractility5 and it is dependent of ventricular
filling 9or end diastolic volume2: +his value is related to right atrial pressure2 +he most
important determining factor for preload is venous return2
Afterload: "fterload is the tension 9or the arterial pressure: against which the ventricle must
contract2 ,f arterial pressure increases5 afterload also increases2 "fterload for the left ventricle is
determined by aortic pressure5 afterload for the right ventricle is determined by pulmonary artery
pressure2

Atherosclerosis
"therosclerosis is the buildup of pla>ue in the arteries2 +he danger is that pla>ue can lead to
aneurysms and blood clots5 and clots in turn can result in thrombosis5 heart attack5 and stroke2
High cholesterol levels bring increased ris! "s 6A6 cholesterol 9the EbadF cholesterol: levels
increase5 8/A risk increases2 ;hen other risk factors are present5 risk increases even more2 "
person3s lipid levels are also affected by age5 se15 heredity5 and diet2
High blood "ressure increases the heart3s workload and can lead to increased arterial damage5
opening the door further for atherosclerosis2 High blood "ressure is also the biggest ris factor
for stroe! ;hen high blood pressure e1ists with obesity5 smoking5 high blood cholesterol
levels5 or diabetes5 the risk of heart attack or stroke increases several times2
#besity$ a sedentary lifestyle$ and diabetes are closely lined ris factors! +hose who are
overweight are more likely to develop heart disease and stroke even if they have no other risk
factors2 +he weight itself is not the culprit? rather5 the e1cess pounds concentrate other risk
factors2 Obesity has a negative influence on blood pressure and cholesterol5 and may lead to
diabetes2 "nd5 of course5 one of the reasons for obesity is a sedentary lifestyle2
Stress is also a contributing factor! Research indicates that there is a relationship between the
risk of developing coronary heart disease and stress2 +his is because stress releases certain
chemicals5 which can increase heart rate and raise blood pressure2 -tress also contributes
indirectly to 8/A5 as people under stress may smoke and drink more than those who lead stress-
free lives2
Alcohol and Drugs also Cause Cardiovascular Disease
,t has been found that very mild consumption of alcohol helps to decrease the risk of heart
attacks as it increases =A6 or good cholesterol level in the body2 =owever5 alcoholism can be
devastating2 "lcohol addiction can lead to high blood pressure5 heart failure5 alcoholic
cardiomyopathy and strokes2 ,f a person finds it hard to >uit alcohol5 then heGshe should 4oin an
alcohol rehab center2
Arug addiction is another cause of cardiovascular diseases2 .arcotics such as heroin5 cocaine and
other similar hard drugs cause contraction in the heart valve and weakens the circulatory system2
Sedentary %ifestyle
Physical activity is absolutely necessary for the human body2 E1ercises must be a part of our
daily life5 but sadly enough we claim to have no time for things that matter most2 -edentary
lifestyle and long work hours has made us highly susceptible to cardiac diseases2 ;orkouts5 be it
at the gym or at your home5 triggers faster blood flow and strengthens the ligaments and
muscles2 -wimming5 cycling5 4ogging etc25 should be incorporated in our daily routine2
8ardiovascular e1ercises are especially advised for people who have heart problems2
Genetics and aging are also known to be risk factors of cardiovascular diseases5 but the fact is
that both are only risk factors and not e1act causes2 =ealthy living can go a long way in curing
cardiovascular diseases2 ,t is e1tremely important that we put a check on our lifestyle so that we
can en4oy all the gifts that life has to offer2
Alcohol and Heart Disease
"ny advice about the consumption of alcohol must take into account

not only the comple1
relation between alcohol and cardiovascular

disease but also the well-known association of
heavy consumption

of alcohol with a large number of health risks2& One approach

would be to
recommend no consumption of alcohol2 =owever5 a

large number of recent observational studies
have consistently

demonstrated a reduction in coronary heart disease 98=A: with

moderate
consumption of alcohol2' ( "ny prohibition of alcohol

would then deny such persons a
potentially si&able health benefit2

+his advisory e1amines the comple1 relation between alcohol
and coronary heart disease and offers recommendations for the

responsible use of alcohol2

2

)echanisms for Cardio"rotective *ffects of )oderate Consum"tion of Alcohol
Recent analyses suggest that appro1imately %#H of the protective

effect of alcohol is mediated
through increased levels of =A6

cholesterol2B =A6 removes cholesterol from the arterial wall
and transports it back to the liver and probably has several

other protective effects on the arterial
system2 " number of

epidemiological studies and small clinical trials have demonstrated

that
moderate consumption of alcohol raises =A6 cholesterol

levels2 ;hen =A6 cholesterol was
added to computer

models predictive of 8=A5 about half the benefit of alcohol

in protecting
against 8=A could be attributed to its effect

on =A6 levels2

" number of other mechanisms have been proposed to e1plain the

other half of the protective
effect of alcohol against 8=A2

One or two alcoholic drinks per day apparently do not affect

other
ma4or risk factors5 such as 6A6 cholesterol and blood

pressure2 -everal studies have suggested
that alcohol may affect

blood clotting5 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 form2 +hese studies are supported by epidemiological data that

suggest that
acute alcohol consumption causes a short-term beneficial

effect in protection against 8=A in
addition to long-term effects2

Other studies have focused on the nonalcoholic components of
alcoholic beverages5 particularly in red wine and dark beer5

which may have antio1idant
properties2 =owever5 the

epidemiological evidence favoring one type of beverage over

another is
inconsistent5 possibly because of large differences

in diet5 smoking5 and other risk behaviors
among drinkers2

"gain5 at least half of the inverse association between alcohol

and 8=A appears
to be directly linked to alcohol through increased

=A6 cholesterol levels2

Alcohol+s Affect on the Heart
.umerous studies suggest that moderate alcohol consumption helps protect against heart disease
by raising =A6 9good: cholesterol and reducing pla>ue accumulations in your arteries2 "lcohol
also has a mild anti-coagulating effect5 keeping platelets from clumping together to form clots2
7oth actions can reduce risk of heart attack but e1actly how alcohol influences either one still
remains unclear2
On the other hand5 drinking more than three drinks a day has a direct to1ic effect on the heart2
=eavy drinking5 particularly over time5 can damage the heart and lead to high blood pressure5
alcoholic cardiomyopathy5 9enlarged and weakened heart:5 congestive heart failure5 and stroke2
=eavy drinking puts more fat into the circulation in your body5 raising your triglygeride level2
+hatIs why doctors will tell you E,f you donIt drink5 donIt startF2 +here are other5 healthier ways
to reduce your risk of heart disease like eating right5 getting regular e1ercise and maintaining a
healthy weight2
;hatIs E<oderate ArinkingF for one may be legally drunk for another2 7y natureIs design5 a
womanIs body metaboli&es alcohol differently so that alcoholic beverage in a woman is e>ual
to ( in a man2 "lcohol remains in a womanIs body longer than in a manIs2 "lso5 the older you are5
the less efficient the body can metaboli&e alcohol2 <any states have revised their drunk-driving
laws and #2#! percent is considered to be into1icated2 ;omen5 especially women of small
stature5 must be alert to these laws and metabolic differences when drinking5 and limit their
alcohol intake accordingly2
Role "lay
One day in the bar222
J+he 7artender is shaking the wine bottles2 J
" : there3s a bar2 Ao you wanna drink something like wine or champagne to refresh
our mindK +hat e1am was killing me2
7 : that3s good idea5 i3d love to2 6et3s go L
J" and 7 sitting on the chair in front of the bartenderJ
8 : evening beutiful miss5 what do you want to order K we have rainbow vodka5
cheerful beer5 and the best one in this bar is Heaven Cham"agne
" : oh my god we 4ust had a very bad e1am5 what3s the appropriate drink for us K
what do you think K
8 : all right5 for pretty woman like you5 i3ll get a big bottle of heaven champagne2
" : okay5 i3ll get one5 what about you K
7 : i 4ust wanna simple one5 like a rainbow vodka in the small glass2
8 : okay5 here you go L
J" and 7 are drinkingJ
;hile " and 7 were drinking5 there is a doctor who 4ust back from her hospital and she
comes to the bartender and2222
A : can i get a light vodca K in a small glass
8 : yes5 here you go
suddenly " feels pain in her chest and she screams loudly
" : aaarrrrgh222L
7 : what happen to you K
A : Jgrab "J open her clothes L Jgrab her sthetoscope and check "3s chestJ
Ja doctor give her an aspirinJ
A : i3m a general practitioner and i recomended to your friend that she has to go to
harapan *ita heart hospital5 because my assumption is maybe she has risk factor of
coronary heart disease and she had drunk to much alcohol5 right K
7 : yes5 she likes alcohol so much5 and thank you for your recommendation2 ,3ll tell
her2 , think5 i have to bring her to the hospital now2
A : and222 you drunk a little bit alcohol rightK 7y consumpting a little bit alcohol
dose in a moderate5 you can avoid coronary heart disease2 7ecause alcohol can increased
levels of =A6 cholesterol and it can decreased fibrinogen levels2
7 : oooh okay2 ,3ll remember that2
A : Okay5 becareful on the way2 -ee you soon2