Monday, October 2, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)
Physician Assistant - 0.25 AAPA hour(s) of Category I credit
IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit
This activity is intended for primary care clinicians, cardiologists, psychiatrists, nurses/nurse practitioners, pharmacists, and other clinicians who treat and manage adults who consume alcohol.
The goal of this activity is for members of the healthcare team to be better able to evaluate the potential relationships among alcohol consumption, neural network activity, and the risk for cardiovascular disease.
Upon completion of this activity, participants will:
Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.
Disclosures for additional planners can be found here.
This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.
College of Family Physicians of Canada Mainpro+® participants may claim certified credits for any AMA PRA Category 1 credit(s)™, up to a maximum of 50 credits per five-year cycle. Any additional credits are eligible as non-certified credits. College of Family Physicians of Canada (CFPC) members must log into Mainpro+® to claim this activity.
Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.
Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.
Medscape designates this continuing education activity for 0.25 contact hour(s) (0.025 CEUs) (Universal Activity Number: JA0007105-0000-23-289-H01-P).
Medscape, LLC has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid until 7/21/2024. PAs should only claim credit commensurate with the extent of their participation.
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability
and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.
Follow these steps to earn CME/CE credit*:
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it.
Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print
out the tally as well as the certificates from the CME/CE Tracker.
*The credit that you receive is based on your user profile.
CME / ABIM MOC / CE Released: 7/21/2023
Valid for credit through: 7/21/2024, 11:59 PM EST
processing....
Patients and clinicians can rightly be confused regarding the health effects of alcohol consumption. A study by Xi and colleagues, published in the August 22, 2017, issue of the Journal of the American College of Cardiology, provided context for this important health issue.[1] The authors studied more than 333,000 US adults who participated in 13 waves of the National Health Interview Survey, which was linked to National Death Index records to determine mortality data.
Light to moderate alcohol consumption was associated with a significant reduction in all-cause mortality compared with abstinence from alcohol, with the greatest improvement in mortality at 5 to 10 standard alcoholic drinks per week. However, this effect was counterbalanced by higher risks for all-cause and cancer mortality among heavy drinkers, as defined as more than 14 drinks/week among men and more than 7 drinks/week among women. In addition, binge drinking (defined by at least 5 drinks on 1 occasion) at least once per week was associated with higher risks for all-cause and cancer mortality.
The authors of the current study note several mechanisms that may help explain why light to moderate alcohol consumption can reduce the risk for cardiovascular events, including increased levels of high-density lipoprotein cholesterol, improved insulin sensitivity, and lower levels of fibrinogen. However, these changes do not fully explain the cardiovascular benefit of moderate alcohol consumption. The current research hypothesizes a link between alcohol consumption and a relaxation of neural networks as a mechanism for improved cardiovascular health.
A new study provides novel insights into why light to moderate alcohol consumption may be associated with reduced cardiovascular disease (CVD) risk.
The study shows that light to moderate drinking was associated with lower major adverse cardiovascular events (MACE), and this was partly mediated by decreased stress signaling in the brain.
In addition, the benefit of light to moderate drinking with respect to MACE was most pronounced among people with a history of anxiety, which is a condition known to be associated with higher stress signaling in the brain.
However, the apparent CVD benefits of light to moderate drinking were counterbalanced by an increased risk for cancer.
“There is no safe level of alcohol consumption,” senior author and cardiologist Ahmed Tawakol, MD, codirector of the Cardiovascular Imaging Research Center at Massachusetts General Hospital, Boston, told theheart.org | Medscape Cardiology.
“We see cancer risk even at the level that we see some protection from heart disease. And higher amounts of alcohol clearly increase heart disease risk,” Dr Tawakol said.
The study was published online June 12 in the Journal of the American College of Cardiology.[2]
Clear Mechanistic Link
Chronic stress is associated with MACE via stress-related neural network activity (SNA). Light to moderate alcohol consumption has been linked to lower MACE risk, but the mechanisms behind this connection remain unclear.
“We know that when the neural centers of stress are activated, they trigger downstream changes that result in heart disease. And we’ve long appreciated that alcohol in the short term reduces stress, so we hypothesized that maybe alcohol impacts those stress systems chronically, and that might explain its cardiovascular effects,” Dr Tawakol explained.
The study included roughly 53,000 adults (mean age, 60 years; 60% women) from the Mass General Brigham Biobank. The researchers first evaluated the relationship between light to moderate alcohol consumption and MACE after adjusting for a range of genetic, clinical, lifestyle, and socioeconomic factors.
During mean follow-up of 3.4 years, 1914 individuals experienced MACE. Light to moderate alcohol consumption (compared with none/minimal) was associated with lower MACE risk (hazard ratio [HR], 0.786; 95% CI, 0.717-0.862; P<.0001) after adjusting for cardiovascular risk factors.
The researchers then studied a subset of 713 individuals who had undergone previous positron emission tomography (PET) scan and a computed tomography (CT) scan brain imaging (primarily for cancer surveillance) to determine the effect of light to moderate alcohol consumption on resting SNA.
They found that light to moderate alcohol consumption correlated with decreased SNA (standardized beta, −0.192; 95% CI, −0.338 to −0.046; P=.010). Lower SNA partially mediated the beneficial effect of light to moderate alcohol intake on MACE risk (odds ratio [OR], −0.040; 95% CI, −0.097 to −0.003; P<.05).
Light to moderate alcohol consumption was associated with larger decreases in MACE risk among individuals with a history of anxiety (HR, 0.60 [95% CI, 0.50-0.72] vs HR, 0.78; 95% CI, 0.73-0.80; P interaction=.003).
The coauthors of an editorial say that the discovery of a “new possible mechanism of action” for why light to moderate alcohol consumption might protect the heart “deserves closer attention in future investigations.”[3]
However, Giovanni de Gaetano, MD, PhD, from the Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy, emphasizes that individuals who consume alcohol should not “exceed the recommended daily dose limits suggested in many countries and that no abstainer should start to drink, even in moderation, solely for the purpose of improving his/her health outcomes.”
Dr Tawakol and colleagues say that, given alcohol’s adverse health effects, such as heightened cancer risk, new interventions that have positive effects on the neurobiology of stress, but without the harmful effects of alcohol, are needed.
To that end, they are studying the effect of exercise, stress-reduction interventions such as meditation, and pharmacologic therapies on stress-associated neural networks, and how they might induce cardiovascular benefits.
Dr Tawakol told theheart.org | Medscape Cardiology that one “additional important message is that anxiety and other related conditions like depression have really substantial health consequences, including increased MACE. Safer interventions that reduce anxiety may yet prove to reduce the risk of heart disease very nicely.”
The study was supported by the National Institutes of Health. Dr Tawakol and Dr de Gaetano have disclosed no relevant financial relationships.
J Am Coll Cardiol. Published online June 12, 2023.[2]
