According to the study individuals with alcoholic liver disease are at an increased risk to die from liver-related causes, but not cardiovascular-related or overall mortality.
"Long-term alcohol use has synergistic effects with other causes of chronic liver disease to accelerate progression of liver disease. For example, patients with Hepatitis C who regularly consume alcohol experience an accelerated progression to fibrosis, and a higher incidence of cirrhosis and hepatocellular carcinoma (HCC)"
Mortality associated with alcohol-related liver disease
Alimentary Pharmacology & Therapeutics
* Article first published online: 28 JUL 2013 DOI: 10.1111/apt.12432
Summary
Background
Excessive alcohol use has been reported to be responsible for 80 000 annual deaths in the United States. However, the exact cause of death related to the excessive use of alcohol has not been fully explored.
Aim
To assess the effect of alcoholic liver disease (ALD) on all-cause, liver-related and cardiovascular mortality using population-based data.
Methods
Data were obtained from the Third National Health and Nutrition Examination Survey (NHANES III) Linked Mortality Files. Alcohol consumption was estimated as grams per day. Multivariate Cox proportional hazards model was utilised to assess the effects of ALD on follow-up time to mortality from all causes, cardiovascular disease and liver disease. Results A total of 8,306 participants were included [ALD (n = 148)]. Mortality follow-up data were available for a median time of 178.27 months. Participants with ALD had increased risk for liver-related mortality [adjusted hazard ratios or aHR 7.06 (2.09–23.79)], but not for overall mortality [aHR 1.14 (0.70–1.85)] or cardiovascular mortality [aHR 0.61 (0.11–3.25)].
Conclusion
Alcoholic liver disease increases the risks for liver-related mortality but not for cardiac or overall mortality.
Introduction Only
Full Text Available Online :
Alimentary Pharmacology & Therapeutics
Excessive alcohol consumption and alcohol dependence are a chronic, relapsing disease, which affects nearly 10% of the population in the United States and Europe.[1] In the United States, significant healthcare costs and the development of chronic disease comorbidities are associated with alcohol consumption. More than half of the US adult population has consumed alcohol in the last 30 days, and 5% of the American adult population is reported to consist of heavy drinkers.[2] Excessive alcohol use was responsible for 80 000 deaths in the United States annually from 2001 to 2005.[3] However, even small amounts of alcohol consumption after the onset of liver disease are associated with increased mortality.[1]
Alcoholic liver disease (ALD) is an important cause of cirrhosis and a direct consequence of excessive alcohol use. ALD encompasses a broad spectrum of liver pathology, from simple steatosis to alcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma.[4-8] Long-term alcohol use has synergistic effects with other causes of chronic liver disease to accelerate progression of liver disease.[1] For example, patients with Hepatitis C who regularly consume alcohol experience an accelerated progression to fibrosis, and a higher incidence of cirrhosis and hepatocellular carcinoma (HCC).[9] In the United States, alcohol-related liver deaths account for 48% of cirrhosis-associated deaths.[4] However, the impact of alcoholic liver disease on overall and cause-specific mortality in the US general population is not fully understood. The aim of this study was to assess the impact of ALD on overall mortality, liver-related mortality and cardiovascular mortality as ALD can be considered an entirely preventable disease through screening and appropriate treatment strategies.[1, 7, 10]
Discussion Only
Full Text Available Online :
Alimentary Pharmacology & Therapeutics
This study used population data collected for NHANES III to assess the impact of ALD on overall mortality and cause-specific mortality in the US general population. These data show that patients with ALD are at increased risk for liver-related mortality, but not for overall mortality or cardiovascular mortality. In this population-based analysis, subjects with ALD were more likely to be of age 55–64 (non-ALD had a higher proportion of >65), male, and have Mexican American and non-Hispanic white ethnicity than controls.
Despite the increased prevalence of vascular risk factors such as smoking, insulin resistance and hypertension, liver disease proved to be the most common cause of death in the ALD population, accounting for 18.5% of all deaths. This is different from a similar population-based analysis of patients with non-alcoholic fatty liver disease (NAFLD).[17] Using the same NAHNES III database, NAFLD patients have been shown to have a higher overall mortality compared with the general population, with cardiovascular disease being the primary cause of death, accounting for 25% of all deaths.[18] Our study showed that the ALD population did not have an increased risk for overall mortality or cardiovascular mortality, but only liver-related mortality.
One possible explanation for the cardiovascular outcomes noted in this trial is the previously observed benefit of alcohol consumption and the reduction in cardiovascular events.[19, 20] A recent meta-analysis showed the minimal dose of wine at which maximal protection could be obtained for cardiovascular mortality to be 24 g/day, with similar findings for beer consumption.[19] A more recent study found that the possible mechanistic reason for the cardioprotective effect of a moderate use of alcohol was related to the AKT and nuclear factor (NRF2) mechanism to regulate the oxidative stress response.[10] As ALD was presumed in participants who reported alcohol use greater than 20 g/day with elevated liver enzymes, we can assume that the ALD population in this study would experience the potential benefits described. Also, in the largest prospective study of alcohol use and mortality, the greatest reduction in mortality from coronary artery disease occurred among drinkers who had the presence of heart disease, stroke or other pre-existing risk of cardiovascular disease at enrolment, which were characteristics with a high prevalence in ALD cohort.[21]
In patients at risk for liver disease, any possible benefit from a cardiovascular perspective seems to be countered by the significantly higher risk of liver-related mortality. Of the patient characteristics associated with a higher risk of liver-related mortality, only advanced age proved to be statistically significant.
Despite its long-term follow-up and in-depth clinical and mortality data, our study does have some weaknesses. The most important weakness is the relative small sample size of patients with ALD, which may have led to our inability to show some important potential associations as well as being responsible for the large confidence interval seen in some of the hazard ratios. Nevertheless, the long-term follow-up mortality data make this study quite unique and important. It is also important to recognise that the NHANSES III database is based on a complex multistage probability sample design. The sampling weights incorporate the differential probabilities of selection and include adjustments for noncoverage and nonresponse. Different weights may be associated with each individual in the survey. After applying weights in the analysis, the same observed events may end up with different estimated rates.[15]
In summary, our study finds that patients with ALD are at an increased risk for liver-related mortality. This recognition of ALD as an important cause of preventable mortality at the population level should prompt the availability of resources to address this important public health issue both nationally and globally.
http://onlinelibrary.wiley.com/doi/10.1111/apt.12432/full
http://onlinelibrary.wiley.com/doi/10.1111/apt.12432/full
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