Faster Care After Heart Attack Fails to Reduce Deaths
One of the most successful efforts in modern medicine, cutting the time it takes to treat heart-attack patients after they arrive at a hospital, has failed to deliver on its most highly anticipated benefit: saving lives.
A study of 96,738 patients experiencing a massive heart attack showed time to treatment was reduced 20 percent to 67 minutes from 2005 to 2009 because of improved coordination among hospital units and emergency workers. Still, about 5 percent of patients died in the hospital in 2009, almost the same as four years earlier when care was slower, according to research in the New England Journal of Medicine.
The findings suggest additional efforts to treat patients faster once they reach the hospital could be in vain and may lead to errors in care, said Daniel Menees, an interventional cardiologist at the University of Michigan Medical School. Instead, public efforts should focus on other approaches, including teaching patients to recognize symptoms and encouraging them to reach out for help more quickly.
“Intuitively, we’ve all believed that the sooner we take patients to the cath lab, the shorter we make those treatment times, the better our patients will do,†Menees said in a telephone interview. “That’s not necessarily true.â€
Previous studies that showed faster treatment times saved lives could reflect that patients treated quickly may have more straightforward cases, compared with slower care in people with other ailments that make the decision more complicated, Menees said. The focus on speed has also made the clock the most important element, he said.
Compromising Safety
Treatment teams activated to care for heart attack patients are false alarms as much as one-third of the time now, Eric Bates, from the University of Michigan, and Alice Jacobs, from Boston University Medical Center, wrote in an editorial accompanying the study. The rush to clear the artery can also short-circuit efforts to diagnose the problem, spot other conditions and get consent, possibly compromising safety, they wrote.
The issue is a critical one for hospitals. The time it takes from a patient’s arrival to get a clogged artery cleared, generally done with a balloon-tipped catheter that’s threaded into the blockage and inflated to open a path for oxygen-rich blood, is called the door-to-balloon time. It’s now considered a key measure of hospital quality and is tied to payments from the U.S. Medicare insurance plan for the elderly and disabled.
“The concept of door-to-balloon as a performance measure should at least raise some eyebrows,†said Menees, the lead researcher on the study released yesterday. “We should consider looking at this a little closer and evaluate it the way we do a new device or a drug.â€
250,000 Victims
More than 250,000 Americans each year suffer the most serious type of heart attack. The lack of blood and oxygen immediately starts to damage the heart muscle cells. With time, the cells die and cause irreparable scarring in the heart. While some patients die before getting help, hospitals have focused on quickly opening the arteries to salvage as much of the heart muscle as possible.
The nation’s hospitals have improved the door-to-balloon time since 2006 when health groups including the American Heart Association and the American College of Cardiology started an initiative to speed care. More than 83 percent of patients are now treated within the recommended 90 minutes, exceeding the original 75 percent goal and an increase from 60 percent four years earlier.
The study shows the success hospitals and doctors have had in speeding treatment, said John Harold, president of the American College of Cardiology. The results won’t change the guidelines, particularly because survival isn’t the only goal for fast care, he said.
Quality of Life
“We are also interested in recovery and quality of life after a heart attack,†he said in a statement. “Time is muscle, and the sooner treatment begins, the less muscle is damaged, which preserves functionality of the heart.â€
Ultimately, faster care may reduce the future risk of heart failure and improve quality of life, he said. The area is ripe for further studies, the researchers said.
An area that may yield bigger benefits is encouraging patients to seek medical care more quickly, which would reduce the time the heart spends without sufficient blood flow.
“Heart muscle is dying while a patient is thinking, ‘Is this real?’†said Hitinder Gurm, senior author of the paper and an interventional cardiologist at the University of Michigan. “We’re seeing a fair amount of delay in seeking treatment. That has been harder to fix.â€
The study findings don’t mean that heart attacks can be treated more casually, Menees said.
“A patient comes in with chest pain and a blocked artery, I’m going to open it as quickly as I can,†he said. “I’m not willing to say time to treatment doesn’t matter at all. But we can say the improvements that were made didn’t have the effects we hoped.â€
To contact the reporter on this story: Michelle Fay Cortez in Minneapolis at mcortez@bloomberg.net
To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net
One-quarter of deaths from heart disease, stroke avoidable, CDC says
In a study published Tuesday in the CDC's Morbidity and Mortality Weekly Report, researchers found that the rate of avoidable deaths from cardiovascular disease had dropped 29% from 2001 to 2010.
However, researchers found the pattern of decline differed by age, race and state of residence. They concluded that more could be done to address the problem.
"These findings are really striking. We're talking about hundreds of thousands of deaths that don't have to happen," CDC Director Dr. Tom Frieden said at a press briefing Tuesday. "It's possible for us to make rapid and substantial progress in reducing these deaths."
In the United States, roughly 800,000 people die of heart disease and stroke each year, the report says. That's nearly 30% of all U.S. deaths, every year. (Life expectancy for the entire U.S. population is currently 78.7 years.)
Although rates of avoidable death dropped most substantially for people age 65 to 74, it remained unchanged for people under the age of 65, according to lead study author and epidemiologist Linda Schieb and her colleagues.
Also, the avoidable-death rate among blacks was nearly twice that of whites, while counties with the highest avoidable-death rates were concentrated in the nation's Southern states.
In 2010, the states with the highest avoidable-death rates were primarily in the South, including Mississippi, Oklahoma, Tennessee, Louisiana and Washington, D.C.
"It's unfortunate, but your longevity may be more likely to be influenced by your ZIP code than by your genetic code," Frieden said.
Study authors speculated that some of the disaparities were the result of access to health insurance, and noted that Medicare eligibility begins at age 65.
"Many heart disease and stroke deaths could be avoided through improvements in lifestyle behaviors, treatment of risk factors, and addressing the social determinants of health (i.e. economic and social conditions that influence the health of individuals and communities)," study authors wrote.
"Unhealthy lifestyle behaviors (e.g. tobacco use, infrequent physical activity, poor diet and excessive alcohol use) coupled with uncontrolled hypertension, elevated cholesterol, and obesity account for 80% of ischemic heart disease mortality and approximately 50% of stroke mortality in high-income countries such as the United States."
Life expectancy gap growing between rich/poor world women: WHO
2 hours ago
Life expectancy for women at 50 has improved but the gap between poor and rich countries is growing and could worsen without better detection and treatment of cardiovascular disease and cancers, the World Health Organization (WHO) says in a new study.
The WHO study, one of the first to analyze the causes of death of older women, found that in wealthier countries deaths from noncommunicable diseases has fallen dramatically in recent decades, especially from cancers of the stomach, colon, breast and cervix.
Women over 50 in low and middle-income countries are also living longer, but chronic ailments, including diabetes, kill them at an earlier age than their counterparts, it said.
"The gap in life expectancy between such women in rich and poor countries is growing," the WHO researchers wrote.
"More women can expect to live longer and not just survive child birth and childhood. But what we found is that improvement is much stronger in the rich world than in the poor world. The disparity between the two is increasing," Dr. John Beard, director of WHO's department of aging and life course, said in an interview.
"What it also points to is that we need particularly in low and middle-income countries to start to think about how these emerging needs of women get addressed. The success in the rich world would suggest that is through better prevention and treatment of non-communicable diseases," Beard added.
"In women over 50, noncommunicable diseases (NCDs), particularly cancers, heart disease and strokes, are the most common causes of death, regardless of the level of economic development of their country," the report reads.
Health ministers from WHO's 194 member states agreed on a global action plan to prevent and control noncommunicable diseases at their annual ministerial meeting in May.
Developed countries have tackled cardiovascular diseases and cancers in women with tangible resu lts, the study found.
Fewer women aged 50 and older in rich countries are dying from heart disease, stroke and diabetes than 30 years ago and the improvements contributed most to increasing women's life expectancy at the age of 50, it said. An older woman in Germany can now expect to live to 84, and in Japan to 88, against 73 in South Africa and 80 in Mexico.
"That reflects two things: better prevention, particularly clinical prevention around control of hypertension and screening of cervical cancer, but it also reflects better treatment," Beard said.
"I think that is particularly true for breast cancer where women with breast cancer are much better managed these days in the rich world. That also explains the disparity," he added.
Low-income countries, especially in Africa, offer community services to treat diseases like AIDS or offer maternal care but many lack services to detect or treat breast cancer.
In many developing countries, there is al so limited access to high blood pressure medication to treat hypertension, one of the biggest risk factors for death, Beard said.
Women with cardiovascular disease and cancers need the kind of chronic treatment provided to those with the AIDS virus HIV, he said.
NYC concert deaths put spotlight on new drug "molly"
(CBS News) NEW YORK -- A designer drug made popular in song lyrics is blamed for causing two overdose deaths in New York over the weekend.
Olivia Rotondo (left) and Jeffrey Russ both died of apparent MDMA overdoses at the Electric Zoo festival in New York City over the Labor Day weekend.
/ Facebook
Those who take the drug may not realize how dangerous it is.
More than 100,000 fans expected a three-day dance party on New York's Randall's Island, but the mayor's office cut the Electric Zoo festival short after two concert goers overdosed and died.
"The Department of Health did not want to see a re-occurrence," said New York City Police Commissioner Ray Kelly.
The drug in question is MDMA, or "molly" -- a more pure, more potent form of ecstasy that police say claimed the lives of 23-year-old Rochester, N.Y., native Jeffrey Russ and 20-year-old Olivia Rotondo of Providence, R.I.
"Kids will often think of this as a very benign drug, and that is scary," said Dr. Damon Raskin, an addiction specialist.
Raskin said the drug lowers inhibitions, giving the user a sense of euphoria. This high gives way to a crash resulting in anxiety and depression.
"They will often mix ecstasy with other drugs, especially at p arties, like alcohol and marijuana," Raskin said. "I think that the combination of these drugs makes them all the more toxic."
The scene at Electric Zoo in New York City.
/ CBS News
In 2011, hospitals reported more than 22,000 MDMA-related emergency room visits -- a 120 percent increase from 2004, according to the Drug Abuse Warning Network.
The club drug has made its way back into popularity, thanks in part to its glamorization in music and youth culture.
This is the third death in less than a week. A 19-year-old New Hampshire woman overdosed in Boston last week at a Zedd concert. One of some 40 artists forced to cancel appearances on Sunday.
MDMA, nicknamed "molly," has become glorified in pop and youth culture.
UPDATE 1-Doctors get good and bad safety news on diabetes drugs
Mon Sep 2, 2013 3:22pm IST
* Astra/BMS and Takeda drugs do not raise heart attack risks
* Studies also clear Onglyza and Nesina on pancreatic safety
* But more heart failure hospitalisations seen with Onglyza
* Data won't alleviate pressures on DPP-4 class - analyst
By Ben Hirschler
AMSTERDAM, Sept 2 (Reuters) - Diabetes pills known as DPP-4 therapies got a mixed safety report on Monday as studies showed they did not raise the risk of heart attacks but might be linked to heart failure, where the heart fails to pump blood adequately.
Reassuringly, the medicines were not associated with increased rates of either inflammation of the pancreas or cancer - something that has been a worry in the past.
However, in the case of AstraZeneca and Bristol-Myers Squibb's approved drug Onglyza, there was a small increase in hospitalisations for heart failure.
"It is a little bit concerning," said Dr. Christopher Grainger of Duke University Medical Center, who was not involved in the research. "I'm sure the FDA (U.S. Food and Drug Administration) will want to know more about it."
Citigroup analyst Andrew Baum, who forecasts Onglyza sales of $2.47 billion in 2018, said the latest data would not ameliorate growing pressures on the DPP-4 drug class in terms of winning reimbursement and achieving wider use.
Doctors and regulators are wary of the cardiovascular safety profile of diabetes drugs following past problems, including with GlaxoSmithKline's Avandia pill, since patients with diabetes are at increased risk of heart troubles.
Researchers from Brigham and Women's Hospital in Boston, who studied Onglyza over two years in 16,492 patients, said the heart failure finding was unexpected and deserved further investigation.
AstraZeneca and Bristol had already given headline results from the study in June, showing Onglyza did not increase heart attack risk - although it did not reduce it either, as the companies had initially hoped.
To date, researchers have been unable to identify any diabetes drug that is not only safe but actually beneficial to the heart.
Some doctors were disappointed that Onglyza and Takeda's rival drug Nesina did not reduce heart risks. However, Dr. Heinz Drexel, a heart specialist at Feldkirch Hospital in Austria and a spokesman for the European Society of Cardiology (ESC), said the idea of such a benefit from taking the medicines was "not logical".
Drexel said DPP-4s still offered several advantages, including a lack of weight gain seen with some other antidiabetics, which would offset the heart failure worries.
NO OVERALL INCREASE
Detailed results of the Onglyza study were presented at the ESC annual congress in Amsterdam, alongside a 5,380-patient study of Nesina. Both studies showing no overall increase in cardiovascular risks were published simultaneously in the New England Journal of Medicine.
The co-principal investigator on the Onglyza study, Dr. Deepak Bhatt, said he believed the heart failure issue seen with Onglyza was very likely a class effect common to all DPP-4s, adding it had probably not shown up in the Nesina trial because it was far smaller.
Still, he said the increase in heart-failure hospitalisations with Onglyza was small, affecting 3.5 percent of those taking the drug compared with 2.8 percent for the control group.
Dr. Anthony DeMaria, editor-in-chief of the Journal of the American College of Cardiology, said the absence of severe adverse events was reassuring but it might be that DPP-4s were best avoided for certain patients at high risk of heart failure.
Drugs like Onglyza and Nesina work by inhibiting dipeptidyl peptidase-4, or DPP-4, to enhance the body's ability to lower elevated levels of blood sugar.
DDP-4s are not the most powerful agents for lowering blood sugar levels but they are well tolerated and have proved an attractive option for doctors looking for new oral drugs.
The DPP-4 market is dominated by Merck's Januvia, which has annual sales of around $5 billion, including a related combination treatment called Janumet. But growth of the class has slowed this year, partly on concerns over pancreatic safety.
Onglyza, which had sales of $709 million in 2012, is a crucial product for AstraZeneca, which is banking on diabetes to help revive falling group sales due to patent expiries on several of its biggest-selling drugs.
Briggs Morrison, AstraZeneca's head of global medicines development, said the overall results of the latest trial were reassuring and the small increase in heart failure hospitalisations did not change the risk profile of the drug.
A similar heart study of Merck's Januvia in more than 14,000 patients is being conducted with results expected next year.
PHOENIX -- In early June, an Indian medical researcher traveled to Chicago to report seemingly astounding results from a decadelong study of cervical-cancer screening in the slums of Mumbai.
Using a simple, inexpensive vinegar test, researchers had cut the rate of death fro m cervical cancer by 31 percent, Dr. Surendra Shastri told more than 5,000 doctors at the American Society of Clinical Oncology's annual meeting.
"He has become one of my heroes," Dr. Sandra Swain, ASCO's president, told the gathering, hailing Shastri for results he said potentially could save 22,000 lives a year in India and 72,000 lives a year around the world.
But in widely reported videos and press releases trumpeting the results, neither the society nor Shastri delved into ethical and other questions that had been raised behind the scenes before the conference, in part as a result of earlier reporting by The Arizona Republic.
These included concerns about the findings, their broader relevance, and how they were achieved â€" and, in particular, why researchers put half of the women in their study, more than 76,000 â€" in a "control" group.
Those women were not screened or routinely treated for cervical cancer but were monitored as their ca ncers progressed, and at least 98 of them died. That is up from 15 deaths reported by The Republic six months ago.
In addition, the clinical-oncology society featured the study despite findings a year ago that women in the control group had not been properly informed and had not given adequate informed consent.
"It's very troubling," said Elizabeth Woeckner, president of Citizens for Responsible Care and Research,a New York non-profit that seeks better safeguards for human research subjects.
Why, Woeckner asked, would any woman agree to continue in an unscreened control group for a decade if the benefits of cervical-cancer screening were properly explained?
"If someone offers me the opportunity not to be treated, why am I going to go there?" she asked.
Questions arise
The Republic first reported in February on questions about the Mumbai study and another cervical-cancer study in rural India that included 31,000 women w ho were tracked but not screened or routinely treated.
Sixty-four women in the second study's control group had died of cervical cancer as of 2009, the most recent figures released.
Both studies were U.S.-funded: the Mumbai study by the National Cancer Institute, the other study by the Gates Foundation. The foundation declined to comment.
As The Republic reported, investigators for the federal Office for Human Research Protections determined last year that researchers at Mumbai's Tata Memorial Hospital didn't adequately inform the women in their control group about alternatives for getting cervical-cancer screening and that the women didn't give adequate informed consent â€" a keystone requirement for medical research involving human subjects.
The Republic noted that 15 women in the Mumbai control group had died of cervical cancer by 2009, the most recent data reported at the time. But new data Shastri reported in Chicago show 6 1/2 tim es that many deaths by the end of last year.
Medical researchers raised other questions about the study:
• Whether having an unscreened control group was scientifically necessary
• Why the NCI and Tata included an unscreened control group when similar cervical-cancer studies in Pakistan, Guatemala, South Africa, Zimbabwe, the Philippines, China and other developing countries did not rely on unscreened control groups
• Whether all women in the Mumbai control group should have been screened after a vinegar-screening study in India's Dindigul district published results in 2007 showing that such screening cut cervical-cancer death rates by 35 percent.
• How relevant the results of the Mumbai trial are for other developing countries, given that a score of other acetic-acid studies from such countries showed highly variable results.
Stakes are enormous
An estimated 72,000 women die of cervical cancer in India each year, m ore than a quarter of the estimated 276,000 annual deaths from the disease, said a May report by the Cervical Cancer Free Coalition, a U.S.-based advocacy group.
India's cervical-cancer death rate is seven times that of the United States, where Pap tests and screening for human papillomavirus, which causes nearly all cervical cancers, are routine.
Some researchers, including Shastri, argue that the costs of Pap and HPV tests are a barrier in India.
"We do not have the funds, cytopathologists and laboratories to provide Pap smear screening to these poor women," Shastri wrote in an email to The Republic. He wrote that the purpose of the Mumbai study was to see whether the method known as visual inspection with acetic acid, or VIA, could provide a viable alternative in developing countries.
In VIA screening, a trained worker swabs an acetic-acid solution on the cervix, then looks for abnormalities (such as precancerous lesions), which turn white w hen exposed to vinegar. The Mumbai study divided more than 151,000 women into two groups. Women in the study group underwent four rounds of screening with acetic acid over eight years. They were provided free treatment at Tata for any abnormalities detected.
Shastri said the women in the control group were offered cancer education at the time they were recruited. All the women signed or placed thumbprints on consent forms.
The original grant application said that although researchers would follow-up and track cancer cases among women in the control group, "no further education on prevention or early detection will be imparted."
Tata provided an English-language version of the model consent form the women signed to the National Cancer Institute in a 2005 grant request.
The Republic obtained it through a Freedom of Information Act request. The form stated: "The standard screening procedures for cervix and breast cancers are Pap smear and Mammogr aphy, in developed countries. Such facilities are also available in some centres in India and you may choose to undergo these tests on your own, if you do not wish to participate in this study."
Complaints filed
But in a July 2012 letter to Tata, the federal Human Research Protections Office director of compliance oversight, Kristina Borror, noted that, among other issues, "a translated copy of the informed consent document actually used in the study that we were provided did not include this language."
A consent form from 2000 obtained by The Republic through a FOIA request also lacks that language.
Tata researchers said women were educated andinformed verbally, but Borror wrote: "We believe that subjects were not provided with adequate information to understand the differences between the research procedures and mammography and Pap smears. Understanding what their alternatives are is key to the subjects' ability to make an informed d ecision about whether or not to participate in a research study."
Dr. Eric Suba, a San Francisco-based pathologist who runs a Pap-based cervical-cancer screening program in Vietnam, filed the complaint in May 2011 that led the Human Research Protections Office to investigate the Mumbai study.
"How do you maintain an unscreened control group for 15 years without keeping these women in the dark about basic biological facts?" he asked in a telephone interview.
"Once you tell women about what cervical cancer is and what screening can do for them, they demand screening services."
In his complaint, Suba raised the informed-consent questions and argued that using women's deaths as the yardstick for success was scientifically gratuitous and unethical â€" that extensive results from studies around the world already demonstrated that screening is better than not screening.
But the research-protections office declined to present the mortality-rate allegat ionsto NCI and Tata, Borror said in a July 18 letter, "because there did not appear to be violation of the HHS human subject protections regulations." HHS is the Department of Health and Human Services.
Women not screened would likely seek treatment for cervical cancer only once their symptoms, such as pelvic pain or vaginal bleeding, become obvious. By that point, cervical cancer has reached an advanced stage.
As The Republic reported, Sarah Kobrin, NCI's program director for the study, said that it wasn't sufficient to show that acetic-acid screening detected cancer sooner than in women referring themselves because of symptoms and that the study needed to continue "until we could see a statistically significant difference" in mortality rates between the control group and the screened group.
In a recent interview, Shastri told Global Oncology, a Harvard-based cancer-research non-profit, that "since the standard of care for cervical-cancer screening in India is no screening, we were ethically justified in having a no-screening control" group.
In an email to The Republic, Shastri said women in the control group were made aware that they could leave the study and receive free screening at Tata. It isn't clear how many understood. Study data reported that fewer than 5 percent of the women recruited were literate; in the control group, fewer than one in 500 sought screening.
Shastri also noted the Human Research Protections Office's final determination: Borror said corrective actions taken by Tata, including offering screening now to all subjects in the control group and informing them about other options such as Pap smears, adequately addressed the department's concerns.
On Friday, the Indian Parliament's committee on health and human welfare, in a report criticizing a separate U.S.-funded HPV vaccine study, reiterated that obtaining proper informed consent from study subjects in any medical stud ies "is a fundamental requirement ... to ensure that the human rights of the study subjects" are protected.
Relative standard of care
That Human Research Protections Office determination played a key part in discussions at the clinical-oncology society, said Dr. Douglas Yee, an oncologist and the chairman of the society's scientific program committee. "We were aware of the concerns brought to OHRP," he said. "We spent a lot of time delving into that particular matter."
In the end, the committee agreed that not offering screening was the standard of care because "this was a population that doesn't have access to health care."
Standard of care helps define researchers' obligations to their human test subjects.
In the United States or Europe, where screening is routine, including an unscreened control group would be barred by regulation. Some researchers argue that ethical standards shouldn't be relative.
But the oncology society comm ittee agreed with Shastri that researchers' obligation was merely to provide the women the local standard of care, even if that was no care.
"I agree that no screening in most parts of the world would not be appropriate," Yee said.
"Dr. Shastri made it clear in his presentation that no screening is the standard of care for a huge part of the population," so the oncology society agreed with "the NCI peer review of the original grant that the control arm of no screening was appropriate."
Yee said the committee was aware of the lack of adequate informed consent but decided that because the Human Research Protections Office said the issue had been addressed,it was no longer an impediment.
He said the committee considered the 2007 Dindigul study, which found a 35 percent drop in mortality after one round of acetic-acid screening, but they decided that while "the Dindigul study was another important piece of data to support VIA screening … it was also imp ortant to further demonstrate the magnitude of mortality reduction as done in the Mumbai study."
Statistically, the results Shastri reported in Chicago in June, after four rounds of VIA screening, differ markedly from the study's results after one, two or three rounds, as published in the International Journal of Cancer in 2010.
After two rounds of screening vs. monitoring the control group, more cancers had been confirmed through self-referrals in the control group, 28, than in the similar-size screened group, 12.
After three rounds, more women had died of cervical cancer in the screening group, 17, than in the control group, 15. But after more than eight years and four rounds of screening, as more of the women in the control group succumbed to their cancers, cervical-cancer deaths rose to 98 in the control group vs. 67 in the screening group.
Shastri, in an email, said the study held "the highest level of merit in terms of both science and me dical ethics," and it shows that acetic-acid screening is a feasible, affordable strategy in places where other forms of screening aren't affordable or available.
But Woeckner, of Citizens for Responsible Care and Research, said she's not convinced.
"Asking, 'Does it work in this city or town?' â€" that's a marketing trial, not a genuine scientific question," said Woeckner, whose mother died of cervical cancer.
She said she keeps thinking about the women in the control group being monitored as they sickened and died.
"You can't let people die to show something you already know," she said.
Could A Daily Dose Of Red Wine Reduce One's Risk Of Depression?
(Photo credit: Wikipedia)
An enticing new study from BMC Medicine reports that people over 55 who drink a little alcohol, averaging about a glass â€" generally of wine â€" per day, are less likely to be clinically depressed than those who drink more and those who don’t drink at all. The study comes in direct contrast to many earlier studies that have found an opposite effect: That drinking is more often associated with increased risk for depression. While are some legitimate reasons that wine could have some slight beneficial effects on depression risk, before you go picking up the habit if it’s not already there, it’s important to understand not only the reasons behind the connection, but also the risks involved.
The new study followed 5,000 Spanish men and women between 55 and 80 for about seven years, periodically querying them about their lifestyle habits via questionnaires and doctor visits. No one suffered from depression or alcohol use disorders at the beginning of the study. At the end of the seven years, about 443 people had become depressed.
It turned out that low-to-moderate alcohol consumption was linked to reduced risk of depression: People who drank between two and seven glasses of wine per week seemed to derive the greatest benefit, having a third the risk of being depressed as people who did not drink. Moderate drinkers also had lower risk of depression, but it wasn’t as large as the low-to-moderate group. The results held true even after multiple lifestyle factors were controlled for, such as smoking, marital status, age, physical activity level, and diet, which can all influence depression risk. Heavy drinkers seemed to have an increased risk of depression, although there were too few of these people in the study to say for sure.
If the connection really does exist, one explanation might have to do with the neuroprotective effects of the antioxidants in wine, like resveratrol, which has gotten a lot of attention in recent years. “Lower amounts of alcohol intake might exert protection in a similar way to what has been observed for coronary heart disease,†said author Miguel A. MartÃnez-González in a statement. “In fact, it is believed that depression and coronary heart disease share some common disease mechanisms.†The mechanisms MartÃnez-González mentions have to do with inflammation, which is known to be a central cause of heart disease, and there is increasing evidence for its role in depression as well. The polyphenol antioxidants in wine could help repair inflammatory damage to the brain that has contributed to depression.
“Previous investigations suggest that the hippocampal complex may play a role in the development of major depression,†say the authors. “This neuroprotection applied to the hippocampus may prevent moderate wine drinkers from developing depression.â€
Another explanation, which is unrelated to the content of wine, might have to do with social factors, which have long been known to influence depression risk. People who enjoy a glass of wine or two might be more likely to be doing so in a crowd of people. Write the authors, the study’s cohort “includes an older, traditional Spanish Mediterranean population, that consumed chiefly wine, and mainly in a context of socialization with family or friends.†Enjoying a rich social life has been well illustrated to reduced depression risk, and could easily influence the results seen here.
Finally, also important to keep in mind is the large body of evidence suggesting that alcohol and depression are linked adversely, with one increasing the risk of the other. It may also be the case that some people, because of genes and environment, are predisposed to problems with both â€" so in essence there could be a third variable at play, which might increase one’s likelihood of alcohol use and of depression.
For all of these reasons, the results should be taken with caution. This is especially true since they were, after all, derived from a relatively restricted sample of people in a Spanish Mediterranean population, none of whom had ever had depression, and who were all over 55 years old. So how the results would relate, if at all, to a more inclusive sample is largely unknown.
As with most studies looking at a particular ingestible item â€" wine, coffee, sugar, fat â€" to look for a single answer is perhaps naïve. Alcohol does not likely reduce the risk of depression across the board, since there are so many other variables, like quantity, type, and existing health and mental health conditions. So the best advice might be that if you enjoy a glass of red wine every now and then, you might do well to continue for the health of your heart and brain. But if you’re not a fan, it’s not worth picking up the habit, since it carries with it a number of risks that just aren’t worth messing around with.
