Association between Alcohol Use and Cardiovascular Self-Care Behaviors among Male Hypertensive Veterans Affairs Outpatients: A Cross-Sectional Study

Abstract

Background Alcohol use is associated with health behaviors that impact cardiovascular outcomes in patients with hypertension, including avoiding salt, exercising, weight management, and not smoking. This study examined associations between varying levels of alcohol use and self-reported cardiovascular health behaviors among hypertensive Veterans Affairs (VA) outpatients. Methods Male outpatients with self-reported hypertension from seven VA sites who returned mailed questionnaires (n=11,927) were divided into five levels of alcohol use: non-drinking, low-level use, and mild, moderate, and severe alcohol misuse based on AUDIT-C scores (0, 1-3, 4-5, 6-7 and 8-12, respectively). For each category, adjusted logistic regression models estimated the prevalence of patients who self-reported avoiding salt, exercising, controlling weight, or not smoking, and the composite of all four. Results Increasing level of alcohol use was associated with decreasing prevalence of avoiding salt, controlling weight, not smoking, and the combination of all four behaviors (p-values all <0.001). A linear trend was not observed for exercise (p=0.83), which was most common among patients with mild alcohol misuse (p=0.01 relative to non-drinking). Conclusions Alcohol consumption is inversely associated with adherence to cardiovascular self-care behaviors among hypertensive VA outpatients. Clinicians should be especially aware of alcohol use level among hypertensive patients.

Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population

“…These AUDIT‐C risk groups were used for Aim 2 analyses of changes in AUDIT‐C, instead of continuous AUDIT‐C scores, because use of all 13 possible AUDIT‐C scores (0–12) would have resulted in 169 different possible combinations of baseline and follow‐up scores, making results imprecise and difficult to interpret. AUDIT‐C risk groups were selected based on prior research demonstrating: poorer outcomes in patients with no alcohol use compared to low level use ; validated screening thresholds for mild alcohol misuse ; and AUDIT‐C thresholds for health risks .…”

“…As AUDIT‐C scores increase, average alcohol consumption increases from 0 to 18 drinks a day, and the risk of DSM‐IV alcohol dependence increases from 0 to 65% . However, despite demonstration of the criterion , discriminative and predictive validity of the AUDIT‐C in research settings, AUDIT‐C scores may have lower validity when documented in electronic health records (EHRs) as part of routine clinical practice (‘clinical screening’) .…”

Cardiovascular risks and benefits of moderate and heavy alcohol consumption

“…148 Hypertensive subjects should be advised to avoid high-dose alcohol, and clinicians should be especially aware of the level of alcohol use in hypertensive patients. 149,150 Diabetes Alcohol consumption affects glucose metabolism in diabetic and nondiabetic individuals. 21,151 Light-to-moderate drinking (10-30 g per day) inhibits both gluconeogenesis and glycogenolysis, and improves insulin sensitivity, 107 resulting in a lower incidence of type 2 diabetes mellitus, 152,153 whereas excessive alcohol intake abolishes these favourable effects, resulting in a U-shaped or J-shaped association between alcohol intake and diabetes incidence.…”

Exploring Factors Impacting Veterans' Hypertension Control

“…Results of race (61.3% Caucasian) was consistent with a previous HTN study (Rittmueller et al, 2015), and the proportion of African-Americans (20.3%) of this study was consistent with another previous HTN study result (Gosmanova, Molnar et al, 2015 Per HTN control conceptual framework (see Figure 2), the lifestyle dimension included tobacco use and alcohol abuse. This study shows 20.6% current tobacco and 13.2% current alcohol users, consistent with a previous study results with 22% selfreported smoker and 11% positive screen for mild alcohol misuse by AUDIT-C (Rittmueller et al, 2015). Results of the parallel comparison of two studies indicate a well-represented sampling in the lifestyle dimension.…”