How demographic changes in Brazil impact health and excessive alcohol use

Population aging, an unprecedented global phenomenon, has become a major public health concern, significantly impacting disease epidemiology and placing a burden on healthcare systems. A recent study revealed that in 2017, 51% of the global burden of disease in adults was age-related, especially cardiovascular diseases and neoplasms [1]. Aging can lead to progressive loss of physical, mental and cognitive integrity, resulting in impaired functions and greater vulnerability to disease and death.

Using data from 2000 to 2020, the study "Demographic shifts and health dynamics: Exploring the impact of aging rates on health outcomes in Brazilian capitals" [2] investigated the relationship between demographic changes, particularly population aging, and health outcomes in Brazilian capitals. The study explores how population aging and other socioeconomic variables influence health indicators, such as mortality from chronic non-communicable diseases (NCDs) and hospitalizations for “primary care sensitive conditions” (PCSC), that is, health conditions that can be treated in basic health units and which, if they are not available, can lead to hospitalization; a common example of PCSC is hypertension.

The results showed that among men, population aging rates were associated with greater occurrences of excess weight and diabetes, while in women, several factors, including smoking, excessive alcohol consumption, hypertension, diabetes and obesity, were associated with higher rates of population aging.

The increase observed in population aging rates in all Brazilian regions, mainly in the South and Southeast, reflects an intense demographic transformation. Capitals with a greater aging population also have higher rates of mortality from NCDs and hospitalizations from  PCSC. Health inequalities between Brazilian capitals are also increasing, with poorer cities experiencing worse health outcomes.

This trend reflects global patterns already highlighted by the United Nations, indicating potential strains on public health and healthcare systems as populations age. Implementing public health policies aimed at meeting the needs of the elderly population is a major challenge in this scenario. With the expansion of the elderly population, there will be an increase in demand for health services. Social security systems may also face pressure as the disparity between workers and retirees widens. Political preparation is essential to face these issues. Investments in preventive health care for seniors, along with workforce development initiatives, can help alleviate the impact of an aging population.

References:

Chang, A. Y., Skirbekk, V. F., Tyrovolas, S., Kassebaum, N. J., & Dieleman, J. L. (2019). Measuring population ageing: An analysis of the Global Burden of Disease Study 2017. The Lancet Public Health, 4(3), e159–e167. https://doi.org/10.1016/S2468-2667(19)30019-2

Holiday Heart Syndrome: The Impact of Excessive Alcohol Consumption on Cardiac Arrhythmias

Studies indicate that excessive alcohol consumption is directly linked to cardiac arrhythmias such as atrial fibrillation (AF) (1). Understand how this affects young and healthy individuals and the challenges in treatment.

Excessive alcohol consumption has complex effects on cardiovascular health, influencing the risk of conditions such as hypertension, coronary artery disease, stroke, peripheral artery disease, and cardiomyopathy. These associations are shaped by various factors, including behavioral, genetic, and biological variations. Additionally, the dose and pattern of alcohol consumption also seem to play a crucial role in modulating this relationship (2). Consuming five or more drinks within a two-hour period can have serious health consequences, including for the heart.

"Holiday Heart Syndrome" (HHS) is named for its association with the occurrence of cardiac arrhythmias triggered by episodes of excessive alcohol consumption, which often occur during weekends and holidays, periods marked by increased relaxation and celebrations. Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia among patients with HHS. AF is widely known for increasing the risk of morbidity and mortality, primarily due to strokes (CVA) and heart failure, representing a significant burden on healthcare systems.

Atrial fibrillation caused by excessive alcohol consumption occurs due to various mechanisms that disrupt the heart's functioning. Alcohol can interfere with calcium regulation inside cardiac cells, disrupting its release and causing electrical changes that may lead to irregular heartbeats (3). Additionally, a hangover increases the activity of the nervous system, making the heart more sensitive and decreasing the time it needs to recover between beats, which facilitates arrhythmias (4). Alcohol also causes the loss of important electrolytes due to its diuretic effect and can damage heart cells through the accumulation of toxic substances, contributing to the development of AF (5).

Treatment of Holiday Heart Syndrome goes beyond initial stabilization in the emergency room. It is essential to understand the reasons behind excessive alcohol consumption, and evaluation with a mental health professional is recommended. Reducing the effects of alcohol consumption can only be achieved with the collaboration of a well-coordinated interdisciplinary team (6).

References:

1. Voskoboinik A, Prabhu S, Ling LH, Kalman JM, Kistler PM. Alcohol and Atrial Fibrillation: A Sobering Review. J Am Coll Cardiol. 2016 Dec 13;68(23):2567–76. 
2. Piano M. R. (2017). Alcohol's Effects on the Cardiovascular System. Alcohol research : current reviews, 38(2), 219–241.
3. Yan, J., Thomson, J. K., Zhao, W., Gao, X., Huang, F., Chen, B., Liang, Q., Song, L. S., Fill, M., & Ai, X. (2018). Role of Stress Kinase JNK in Binge Alcohol-Evoked Atrial Arrhythmia. Journal of the American College of Cardiology, 71(13), 1459–1470. https://doi.org/10.1016/j.jacc.2018.01.060
4. Marcus, G. M., Dukes, J. W., Vittinghoff, E., Nah, G., Badhwar, N., Moss, J. D., Lee, R. J., Lee, B. K., Tseng, Z. H., Walters, T. E., Vedantham, V., Gladstone, R., Fan, S., Lee, E., Fang, C., Ogomori, K., Hue, T., Olgin, J. E., Scheinman, M. M., Hsia, H., … Gerstenfeld, E. P. (2021). A Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Alcohol to Assess Changes in Atrial Electrophysiology. JACC. Clinical electrophysiology, 7(5), 662–670. https://doi.org/10.1016/j.jacep.2020.11.026
5. Tonelo, D., Providência, R., & Gonçalves, L. (2013). Holiday heart syndrome revisited after 34 years. Arquivos brasileiros de cardiologia, 101(2), 183–189. https://doi.org/10.5935/abc.20130153
6. Jain A, Yelamanchili VS, Brown KN, et al. Holiday Heart Syndrome. [Updated 2024 Jan 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537185/