CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

July 14th, 2014

Selections from Richard Lehman’s Literature Review: July 14th

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

The BMJ 12 July 2014 Vol 349

Leucocyte Telomere Length and Risk of CVD: This issue of The BMJ makes me wonder if the words “telomere” and “Mendelian randomisation” are just ways of making readers’ eyes glaze over. Telomeres are the things at the end of your chromosomes that show how much longer you have left to live. They do not cause anything. A study here finds that “available observational data show an inverse association between leucocyte telomere length and risk of coronary heart disease independent of conventional vascular risk factors. The association with cerebrovascular disease is less certain.” Is this interesting? Well, maybe, in a spooky kind of way. Short telomeres=earlier death. Man with sickle has many blades. Hah!

Association Between Alcohol and CVD: Someone recently told me that the link between alcohol and reduced coronary disease is purely observational, and that therefore we should not recommend alcohol as part of the “Mediterranean” diet. I didn’t want to argue, but you could say much the same about smoking and cardiovascular disease. The evidence of benefit from alcohol is solid, robust, and repeatedly found wherever you look, but almost impossible to replicate experimentally for the very good reason that people who drink do so as part of their daily pleasure. Yet the several hundred authors of this paper have tried to do something even more impossible: make this evidence disappear by a Mendelian hat trick. I am completely baffled that they should (a) want to do it and (b) think this is good enough: “Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.” No it doesn’t.

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One Response to “Selections from Richard Lehman’s Literature Review: July 14th”

  1. H Robert Silverstein, MD says:
    July 14, 2014 at 7:00 pm

    In 1966, I was taught by world famous pathologist Emmerich Von Haam that alcohol was toxic to the heart, brain, and liver in any dose. And we too consistently forget that alcohol is both carcinogenic & a provocateur of violence particularly on the road & at home. 4 standard drinks a week OR LESS is likely the safe level of intake. HRS, MD, FACC