Transcript Related Journal Club Presentation

Journal Club
Alcohol, Other Drugs, and Health: Current Evidence
July-August 2007
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Featured Article
Smoking, alcohol consumption, and
Raynaud’s phenomenon in
middle age
Suter LG, et al. Am J Med. 2007;120(3):264–271.
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Study Objective
To determine whether…
• smoking and drinking are associated
with Raynaud’s phenomenon
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Study Design
• Data came from the community-based
Framingham Heart Study Offspring Cohort.
• Subjects included 1602 men and 1840 women
who were white and had a mean age of about
62 years.
• Researchers used a validated survey to classify
Raynaud’s status.
• Analyses were adjusted for key confounders
(e.g., cardiovascular disease, body mass index).
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Assessing Validity of an
Article About Harm
• Are the results valid?
• What are the results?
• How can I apply the results to
patient care?
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Are the Results Valid?
• Did the investigators demonstrate similarity in all
known determinants of outcomes? Did they
adjust for differences in the analysis?
• Were exposed patients equally likely to be
identified in the two groups?
• Were the outcomes measured in the same way in
the groups being compared?
• Was follow-up sufficiently complete?
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Did the investigators demonstrate similarity in
all known determinants of outcomes? Did they
adjust for differences in the analysis?
• Subjects were excluded if they used occupational vibrational
tools.
• Most subjects were free of any connective tissue disease.
• The following covariates associated with Raynaud’s or
smoking and alcohol use were measured and adjusted for:
–
–
–
–
Age and Body Mass Index
Use of Antihypertensive Medications
Cardiovascular Disease
Menopausal and Hormonal Status
• Antinuclear antibody (ANA) testing was not performed.
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Were exposed patients equally likely
to be identified in the two groups?
 All subjects received similar surveillance for
the exposures of interest (smoking and
drinking).
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Were the outcomes measured in the
same way in the groups being compared?

All subjects received similar surveillance for
the outcome of interest (Raynaud’s
phenomenon).

The study was not blinded.
–
The large number of variables and outcomes
measured in this cohort makes bias due to lack of
blinding unlikely.
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Was follow-up sufficiently complete?
• Histories of the exposures and the outcome
were measured simultaneously, precluding a
cause-effect determination.
• No information on the length of the
exposures was presented.
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What are the Results?
• How strong is the association between
exposure and outcomes?
• How precise is the estimate of the risk?
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What are the Results?
• Approximately 6% of women and 4% of men had
Raynaud’s phenomenon.
• Regular smoking in the past 12 months, versus not
smoking, was significantly associated with an increased
risk of Raynaud’s in men (odds ratio [OR], 2.59) but
not in women.
• Moderate drinking, versus not drinking,* was
significantly associated with a decreased risk in men
(OR, 0.51) but not in women.
*Not drinking is about <2 drinks per week; moderate drinking is ≥2 to ≤7 drinks per week for women and
≥2 to ≤14 drinks for men
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What are the Results? (cont.)
• However, drinking red wine (≈1 glass or more per week),
versus no red-wine drinking, appeared to…
– lower risk for both men (OR, 0.30) and
women (OR, 0.59).
• Heavier drinking, versus not drinking, was associated with...
– increased risk in women (OR, 1.69) but not in men.
*Heavier drinking is >7 drinks per week for women and >14 drinks for men.
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How strong is the association between
exposure and outcome?
Behavior
Regular smoking
Adjusted Odds Ratios and
95% Confidence Intervals
Women: NA*
Men: 2.59 (1.11-6.04)
Moderate drinking
Women: 0.89 (0.57-1.40)
Men: 0.51 (0.29-0.89)
Heavier drinking
Women: 1.69 (1.02-2.82)
Men: 0.85 (0.42-1.70)
Wine drinking
Women: 0.59 (0.36-0.96)
Men: 0.30 (0.15-0.62)
*There was no association between smoking and Raynaud’s among women in bivariate
analyses; therefore, in multivariable analyses involving women, only drinking was
included.
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How precise is the estimate of the risk?
• The confidence intervals are fairly wide
because of the low prevalence of the disorder
among the general population.
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How Can I Apply the Results to
Patient Care?
• Were the study patients similar to the patients in
my practice?
• Was the duration of follow-up adequate?
• What was the magnitude of the risk?
• Should I attempt to stop the exposure?
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Were the study patients similar to the
patients in my practice?
• Subjects were white, in their early 60’s, and had
a mean BMI close to 30.
• 12%-13% currently smoked.
• 31%-40% were abstinent from alcohol.
• 14%-15% met criteria for heavy drinking.
• 14%-32% had a history of cardiovascular
disease.
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Was the duration of follow-up adequate?
• Histories of the exposures and the outcome
were assessed simultaneously.
• The timing of the exposure in relation to the
development of the outcome was not
presented.
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What was the magnitude of the risk?
• In men, the adjusted odds ratio for smoking
(2.59) is substantial.
• In men and women, the protective effect of
moderate wine consumption (adjusted ORs, 0.30.6) is also notable.
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Should I attempt to stop the exposure?
• According to these data, Raynaud’s can be added to
the list of adverse effects of…
– smoking in men and
– heavier alcohol consumption in women.
• Also, a lower risk of Raynaud’s can be added to the list
of potential benefits of moderate wine consumption for
both men and women.
• However, this study does not support a role for alcohol
consumption in general to decrease Raynaud’s risk.
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