Male sexual assault: Physical injury and vulnerability in 103 presentations.

OBJECTIVES: To i) describe the demographic and assault characteristics of males alleging recent sexual assault, ii) determine the severity and frequency of general body injury and the frequency of anal and genital injury, iii) identify vulnerability factors and assault characteristics associated with injury. DESIGN: Cross-sectional study. SETTING: Sexual Assault Resource Centre (SARC), Western Australia. PARTICIPANTS: Total of 103 post-pubertal males attending SARC from Jan-2009 to Dec-2016. METHODS: Men underwent a standardised medical examination and data collection by forensically trained doctors following consent for general body and/or ano-genital examination. Men were considered vulnerable if at least one of the following factors was present: current mental illness; intellectual or physical disability; alcohol intoxication; previous sexual victimization; living in prison or homeless (no fixed address), aged < 18 years. Statistical analysis was performed by Fisher exact test. An algorithm was used to classify general body injuries as mild, moderate or severe. RESULTS: At least one vulnerability factor was present in 88.3% of the 103 men. More than one factor was present in 54.4%. General body injury was observed in 58.0% (40/69) of men consenting to general body examination; 46.4%, 10.1% and 1.4% were classified as having respectively, mild, moderate and severe injuries. Three assault characteristics were associated with general body injury: the use of blunt force (p = 0.002), multiple assailants (p = 0.049) and deprivation of liberty (p = 0.040). Genital injury and anal injury was observed in, respectively, 6.5% (5/77) and 14.3% (11/77) of men consenting to ano-genital examination. Of the 49 men examined following completed penetrative anal assault, 18.4% (9/49) had anal injuries. In these 49 men, those assaulted by strangers were more likely to have an anal injury compared to non-stranger assaults (p = 0.019). No demographic, clinical or vulnerability characteristics of the sexually assaulted men were associated with general body, genital and/or anal injury. CONCLUSION: Although general body injuries were more frequent than genital and anal injuries, most of the body injuries were mild in severity. While the majority of men in our study presented with one or more vulnerabilities only assault characteristics (not vulnerabilities) were associated with injury.

Capturing sexual assault data: An information system designed by forensic clinicians and healthcare researchers.

BACKGROUND: The Sexual Assault Resource Center (SARC) in Perth, Western Australia provides free 24-hour medical, forensic, and counseling services to persons aged over 13 years following sexual assault. OBJECTIVE: The aim of this research was to design a data management system that maintains accurate quality information on all sexual assault cases referred to SARC, facilitating audit and peer-reviewed research. METHODS: The work to develop SARC Medical Services Clinical Information System (SARC-MSCIS) took place during 2007-2009 as a collaboration between SARC and Curtin University, Perth, Western Australia. Patient demographics, assault details, including injury documentation, and counseling sessions were identified as core data sections. A user authentication system was set up for data security. Data quality checks were incorporated to ensure high-quality data. RESULTS: An SARC-MSCIS was developed containing three core data sections having 427 data elements to capture patient's data. Development of the SARC-MSCIS has resulted in comprehensive capacity to support sexual assault research. Four additional projects are underway to explore both the public health and criminal justice considerations in responding to sexual violence. The data showed that 1,933 sexual assault episodes had occurred among 1881 patients between January 1, 2009 and December 31, 2015. Sexual assault patients knew the assailant as a friend, carer, acquaintance, relative, partner, or ex-partner in 70% of cases, with 16% assailants being a stranger to the patient. CONCLUSION: This project has resulted in the development of a high-quality data management system to maintain information for medical and forensic services offered by SARC. This system has also proven to be a reliable resource enabling research in the area of sexual violence.

Sexual assault and general body injuries: A detailed cross-sectional Australian study of 1163 women.

OBJECTIVES: To describe the frequency and severity of general body injury in women alleging recent sexual assault and then identify demographic and assault characteristics associated with injury severity. DESIGN: Cross-sectional study. SETTING: Sexual Assault Resource Centre (SARC), Western Australia. PARTICIPANTS: Total of 1163 women attending SARC from Jan-2009 to Mar-2015. METHODS: Women underwent a standardised medical examination and data collection by forensically trained doctors. Multivariate ordinal logistic regression analyses were performed. An algorithm was used to classify general body injuries as mild, moderate or severe. RESULTS: General body injury was observed in 71% of women; 52%, 17% and 2% were classified as having respectively, mild, moderate and severe injuries. Moderate or severe injury was observed in 30.4% of women assaulted by intimate partners, 16.4% of women assaulted by strangers and 14.9% of women assaulted by friends/acquaintances. In regression analysis, an interaction between mental illness and assailant type existed after adjusting for age, intellectual disability, time-to-examination, number of assailants and location. Mental illness was an independent predictor for lower injury severity (adjusted odds ratio=0.5, 95% CI 0.3, 0.9) in women assaulted by strangers and higher injury severity in women assaulted by a friend/acquaintance (adjusted odds ratio=2.4, 95% CI 1.6, 3.6). While women assaulted by intimate partners had more frequent moderate-to-severe injuries than other women their current mental illness status was not associated with risk of injury severity. CONCLUSION: This study highlights the increased injury severity in women assaulted by intimate partners. The risk of moderate/severe injury for women with mental illness assaulted by their acquaintances was unexpected and requires further investigation.

Genital and anal injuries: A cross-sectional Australian study of 1266 women alleging recent sexual assault.

OBJECTIVES: To describe the frequency of genital and anal injury and associated demographic and assault characteristics in women alleging sexual assault. DESIGN: Cross-sectional study. SETTING: Sexual Assault Resource Centre (SARC), Western Australia. PARTICIPANTS: Total of 1266 women attending SARC from Jan-2009 to Mar-2015. METHODS: Women underwent a standardised data collection procedure by forensically trained doctors. Multivariate logistic regression analyses were performed. MAIN OUTCOME MEASURES: (1) Frequency of genital and anal injuries by type of sexual assault. (2) Identification of independent factors associated with genital and anal injuries following, respectively, completed vaginal and anal penetration. RESULTS: Genital injury was observed in 24.5% of all women with reported completed vaginal penetration; in a subset with no prior sexual intercourse 52.1% had genital injury. Genital injury was more likely with no prior sexual intercourse (adjusted odds ratio [adj. OR] 4.4, 95% confidence interval [95%CI] 2.4-8.0), multiple types of penetrants (adj. OR 1.5, 95%CI 1.0-2.1), if general body injury present and less likely with sedative use and delayed examination. Anal injury, observed in 27.0% of reported completed anal penetrations, was more likely with multiple types of penetrants (adjusted OR 5.0, 95%CI 1.2-21.0), if general body injury present and less likely with delayed examination. CONCLUSION: This study separately quantifies the frequency of both genital and anal injuries in sexually assaulted women. Genital injuries were absent in a large proportion of women regardless of prior vaginal intercourse status. It is anticipated that findings will better inform the community, police and medico-legal evidence to the criminal justice system.

Dementia onset, incidence and risk in type 2 diabetes: a matched cohort study with the Fremantle Diabetes Study Phase I.

AIMS/HYPOTHESIS: The study aimed to assess the incidence, age of onset, survival and relative hazard of dementia in well-categorised community-based patients with type 2 diabetes compared with a matched cohort of individuals without diabetes. METHODS: A longitudinal observational study was undertaken involving 1291 participants with type 2 diabetes from the Fremantle Diabetes Study and 5159 matched residents without documented diabetes. Linkage with health-related databases was used to detect incident dementia. Relative hazards were assessed using both cause-specific and subdistribution proportional hazards models. RESULTS: During 13.8 ± 5.8 years of follow-up, incident dementia occurred in 13.9% and 12.4% of the groups of participants with and without diabetes, respectively (p = 0.15). With type 2 diabetes, the incidence of dementia was higher (incidence rate ratio [IRR] 1.28, 95% CI 1.08, 1.51), as was the competing risk of death (IRR 1.50, 95% CI 1.38, 1.64). The ages when dementia was first recorded and when death with dementia occurred were both earlier with diabetes, by 1.7 (95% CI 0.6, 2.9) and 2.3 (95% CI 1.1, 3.6) years, respectively (both p ≤ 0.004). Type 2 diabetes was associated with an adjusted subdistribution HR of 1.18 (95% CI 1.00, 1.39), and a cause-specific HR of 1.51 (95% CI 1.27, 1.78) for all-cause dementia. CONCLUSIONS/INTERPRETATION: Type 2 diabetes is associated with an increased incidence of dementia, and dementia onset occurs at a younger age. The relative hazards of both dementia and premature mortality are increased and, as a consequence, the increased risk of dementia in type 2 diabetes is not as marked as suggested by cause-specific HRs.

Non-fatal strangulation in sexual assault: A study of clinical and assault characteristics highlighting the role of intimate partner violence.

OBJECTIVE: To describe the prevalence, risk factors, signs and symptoms of non-fatal strangulation (NFS) in women referred to a Sexual Assault Resource Centre (SARC) following recent sexual assault. METHODS: A cross-sectional study using data routinely collected at time of forensic examination of women (age ≥ 13 years) referred to the Western Australian SARC between Jan-2009 and Mar-2015 alleging a recent sexual assault. Data on demographics, assault characteristics and forensic findings were available. RESULTS: A total of 1064 women were included in the study; 79 (7.4%) alleged NFS during the sexual assault. The prevalence of NFS varied significantly by age-group and assailant type. Of women aged 30-39 years 15.1% gave a history of NFS compared to less than 8.2% in all other age groups. Of women assaulted by an intimate partner, 22.5% gave a history of NFS compared to less than 6% of women assaulted by other assailant types. Of all sexual assaults with NFS, intimate partners were the assailant in 58.2% of cases, whereas in sexual assault cases without NFS, intimate partners were the assailant in 15.9% of cases. Odds of NFS were 8.4 times higher in women sexually assaulted by an intimate partner compared to women assaulted by an acquaintance/friend and 4.9 times higher compared to women assaulted by a stranger. When considering both age and assailant type the highest proportion of NFS (33.9%) was in women aged 30-39 years sexually assaulted by an intimate partner. Other factors associated with NFS during sexual assault included deprivation of liberty, verbal threats, being assaulted in the woman's home and use of additional blunt force. External physical signs of NFS were absent in 49.4% of all NFS sexual assault cases. CONCLUSIONS: This study identifies and quantifies NFS risk factors in female sexual assault and highlights the strong association with intimate partner sexual assault. Greater awareness of NFS in sexual assault should lead to improvement in medical screening, forensic management and safety risk assessment by sexual assault and domestic violence services, emergency departments and police.

The effects of alcohol on ambulatory blood pressure and other cardiovascular risk factors in type 2 diabetes: a randomized intervention.

OBJECTIVE: Although prospective studies suggest light-to-moderate chronic alcohol intake protects against coronary artery disease in type 2 diabetic patients, the balance of effects on individual cardiovascular risk factors needs further assessment. We examined the effects of alcohol consumption on 24-h ambulatory blood pressure (BP) and heart rate (HR), high-density lipoprotein cholesterol, fibrinogen, C-reactive protein, homocysteine, and glycaemic control in well controlled type 2 diabetes. METHODS: Twenty-four participants aged 49-66 year were randomized to a three-period crossover study with women drinking red wine 230  ml/day (∼24  g alcohol/day) and men drinking red wine 300  ml/day (∼31  g alcohol/day), or equivalent volumes of dealcoholized red wine (DRW) or water, each for 4 weeks. Ambulatory BP and HR were monitored every 30  min for 24  h at the end of each period. Home blood glucose monitoring was carried out twice weekly throughout. RESULTS: Red wine increased awake SBP and DBP relative to water by 2.5 ±â€Š1.2 /1.9 ±â€Š0.7  mmHg (P = 0.033, P = 0.008, respectively), with a similar nonsignificant trend relative to DRW. Asleep DBP fell with red wine relative to DRW (2.0 ±â€Š0.8  mmHg, P = 0.016) with a similar nonsignificant trend relative to water. Red wine increased 24-h, awake and asleep HR relative to water and DRW. Relative to DRW, red wine did not affect glycaemic control or any other cardiovascular risk factor. CONCLUSION: In well controlled type 2 diabetic individuals 24-31  g alcohol/day (∼2-3 standard drinks) raises awake BP and 24-h HR and lowers asleep BP but does not otherwise favourably or adversely modify cardiovascular risk factors.

Severe psychiatric disorders in mid-life and risk of dementia in late- life (age 65-84 years): a population based case-control study.

OBJECTIVE: To examine the association of mid-life exposure to several psychiatric disorders with the development of late-life dementia. METHODS: A matched case-control study using Western Australian state-wide hospital inpatient, outpatient mental health and emergency records linked to death records. Incident dementia cases (2000-2009) aged 65 to 84 years were sex- and age-matched to an electoral roll control. Records as far back as 1970 were used to assess exposure to medical risk factors before age 65 years. Candidate psychiatric risk factors were required to be present at least 10 years before dementia onset to ensure direction of potential causality. Odds ratios were estimated using conditional logistic regression. RESULTS: 13, 568 dementia cases (median age 78.7 years, 43.4 % male) were matched to a control. Depression, bipolar disorder, schizophrenia, anxiety disorder and alcohol dependence were found to be significant and independent risk factors for late-life dementia after adjusting for diabetes, heart disease, cerebrovascular disease and smoking risk factors. The effect of a history of depression, schizophrenia and alcohol dependency on dementia risk varied with age, being strongest for earlier onset late-life dementia and waning at older ages. CONCLUSION: Severe depression, anxiety disorder, bipolar disorder, schizophrenia and alcoholic dependency disorder treated by specialists in psychiatric facilities in mid-life are important risk factors for late-life dementia. These psychiatric conditions need to be considered in future studies of the risk and prevention of late-life dementia.

Australian population trends and disparities in cholinesterase inhibitor use, 2003 to 2010.

BACKGROUND: The Australian Pharmaceutical Benefits Scheme (PBS) first subsidized cholinesterase inhibitors (CEIs) for Alzheimer's disease in 2001, introducing a novel therapy for a previously untreatable common condition. This study aims to determine Australian rates of CEI use and to assess equality of access to treatment based on socioeconomic status and geographic remoteness. METHODS: Pharmaceutical claims records were used to identify all Australians prescribed CEIs between January 2003 and December 2010. Age-standardized and sex-adjusted index prescription rates were derived using the total Australian population as the denominator to examine temporal trends and the impacts of socioeconomic and geographic disadvantage on CEI index prescription rates. RESULTS: Index prescription rates peaked in 2004 at 92.5 per 100,000 person-years, declining to between 70.2 and 73.5 for years 2006 to 2010. Rates were highest in the 85- to 89-year age group and 2.6-fold higher in the least socioeconomic disadvantaged population when compared with the most disadvantaged population. In major cities in Australia, index prescription rates were 1.4 to 1.7 times greater compared with remote areas. CONCLUSIONS: Increasing geographic remoteness and socioeconomic disadvantage are associated with lower CEI index prescription rates, indicating inequities in the management of Alzheimer's disease in Australia.

Clinical epidemiology and in-patient hospital use in the last year of life (1990-2005) of 29,884 Western Australians with dementia.

Dementia-related healthcare planning requires accurate information on dementia patient characteristics and hospitalization trends at a population level. This population-based retrospective cohort study was designed to evaluate factors associated with total hospital length-of-stay (tLOS) in the last year of life (1990-2005) in Western Australians with dementia. Using linked hospital and death records, 29,884 dementia cases were identified. The average tLOS in the last year of life for all cases was 31.8 days. tLOS was longer for vascular dementia than Alzheimer's disease (41 versus 28 days; Rate Ratio (RR) 1.4; 95% CI 1.3-1.6). After multivariate adjustment, tLOS was longer for males than females (RR 1.4; 95% CI 1.3-1.4); longer for remote (RR 1.7; 95% CI 1.4-2.0) and very remote (RR 3.0; 95% CI 2.4-3.9) compared to metropolitan areas; and shorter with increasing age. 62% of admissions were emergency admissions. "Problems accessing alternative medical facilities" and "problems related to care provider dependency" accounted for a total of 16.4% of all bed days. In conclusion, people with dementia spend a considerable period of time in the hospital during their last year of life. Consideration of geographic isolation and accessibility to non-hospital facilities in dementia-related healthcare planning may liberate in-patient beds for more elective and acute care admissions.

Linkage of hospital and death records increased identification of dementia cases and death rate estimates.

BACKGROUND/AIM: To use health record data linkage to improve case ascertainment and death rate estimates of deaths with dementia. METHODS: Retrospective population study. Western Australians older than 20 years who died between 1990 and 2005 with a dementia diagnosis in Western Australian hospitals and/or death records using the Western Australian Data Linkage System were classed as having a lifetime history of dementia. Cases with dementia documented on death certificates were classified as having dementia as a contributory cause of death (COD). Age-standardized death rates (ASDR) were estimated. RESULTS: 29,884 decedents were identified with a lifetime history of dementia. 88.2% had hospital records and 55.9% had death records indicating dementia. The ASDRs for dementia as a contributory COD increased from 50 to 81 per 100,000 person-years from 1990 to 2005. ASDR for lifetime history of dementia increased from 80 to 140 per 100,000 person-years over the same time period. In 2005, 50.1% (95% confidence interval: 47.2-53.1) of all females and 39.2% (35.8-42.7) of all males aged 85+ years died with dementia. CONCLUSION: Data linkage nearly doubled case ascertainment of deaths with dementia because people hospitalized with dementia often lacked dementia documentation at death. These results have important implications for strategic healthcare planning. Data linkage methodology could improve studies of hospitalisation trends in dementia.

A reduction in alcohol consumption is associated with reduced plasma F2-isoprostanes and urinary 20-HETE excretion in men.

There is considerable evidence that chronic moderate-to-high alcohol consumption increases blood pressure. The mechanisms by which this occurs are not clear. Alcohol consumption can induce oxidative stress and cytochrome P450 (CYP450) isoforms that are associated with oxidative stress and may influence vascular tone. To study the role of such mechanisms we examined whether reducing alcohol intake in moderate-to-heavy drinkers (40-110 g/day) resulted in changes in urinary excretion of 20-HETE, a CYP450 metabolite of arachidonic acid, and plasma and urinary F(2)-isoprostanes as markers of lipid peroxidation. After a 4-week run-in period during which healthy men maintained their usual drinking pattern they were randomized to a two-way crossover intervention study. In each of the 4-week treatment periods subjects either substituted their usual alcohol intake with a 0.9% alcohol beer or maintained their usual alcohol intake. Plasma and urinary F(2)-isoprostanes and urinary 20-HETE were measured by gas chromatography mass spectrometry, and serum gamma-glutamyl transpeptidase (gamma-GT) was measured as a biomarker of alcohol consumption, at the end of each study period. Sixteen healthy men age 51.0+/-2.7 years and with a BMI of 26.4+/-0.61 kg/m(2) completed the study. The reductions in alcohol intake (72.4+/-5.0 vs 7.9+/-1.6 g/day, p<0.001) and serum gamma-GT (geometric mean 24.4 U/L (95% CI 19.7, 30.2) vs 18.6 U/L (95% CI 15.5, 22.2, p<0.01) were accompanied by a significant fall in blood pressure as well as urinary 20-HETE excretion (158+/-23 vs 109+/-19 pmol/mmol creatinine, p<0.001) and plasma F(2)-isoprostanes (3438+/-158 vs 2929+/-145 pmol/L, p=0.01). A substantial reduction in alcohol consumption in healthy men lowered plasma F(2)-isoprostanes and urinary 20-HETE. Increased oxidative stress and 20-HETE production may be linked, at least in part, to the pathogenesis of alcohol-related hypertension.

Red wine and beer elevate blood pressure in normotensive men.

A positive relationship between alcohol consumption and blood pressure (BP) is well-established but the relative effect of specific alcoholic beverages is controversial. This study aimed to determine whether red wine may improve vascular function and have less of an impact on blood pressure because of its high content of antioxidant vasodilator polyphenolic compounds. Healthy normotensive men entered a 4-period crossover study comparing in random order 4 weeks of control-abstinence with similar periods of daily consumption of red wine (375 mL; 39 grams alcohol), de-alcoholized red wine (375 mL), or beer (1125 mL; 41 grams alcohol). Ambulatory systolic BP and diastolic BP and heart rate (HR) were measured together with vascular function as assessed by flow-mediated dilatation (FMD) and glyceryl trinitrate-mediated (GTNMD) dilatation of the brachial artery. The systolic and diastolic BP and HR were not different between control-abstinence and de-alcoholized red wine. However, compared with control-abstinence, both red wine and beer increased awake systolic BP (2.9 and 1.9 mm Hg, respectively; P<0.05) and asleep HR (5.0 and 4.4 bpm; P<0.05). There were no specific effects of red wine, de-alcoholized red wine, or beer on FMD or GTNMD. Daily consumption of approximately 40 grams alcohol as either red wine or beer for 4 weeks results in similar increases in systolic BP and HR. De-alcoholized red wine did not lower BP, and neither red wine nor de-alcoholized red wine influenced vascular function, suggesting that red wine polyphenolics do not have a significant role in mitigating the blood pressure-elevating effects of alcohol in men.

The effect of alcohol intake on insulin sensitivity in men: a randomized controlled trial.

OBJECTIVE: Population data suggest that alcohol consumption may influence the risk of diabetes in a biphasic manner, but this has not been tested by any controlled interventions. The object of this study was to determine whether reducing alcohol intake in moderate-to-heavy drinkers (40-110 g/day) results in improvement in insulin sensitivity. RESEARCH DESIGN AND METHODS: A 4-week run-in period where subjects maintained their usual drinking pattern was followed by randomization to a two-way cross-over intervention study. In each of two 4-week treatment interventions, subjects either substituted their usual alcohol intake with a 0.9% alcohol beer or maintained their usual alcohol intake. At the end of each 4-week period, insulin sensitivity as determined by the low-dose insulin glucose infusion test and the homeostasis model assessment (HOMA) score, and biomarkers of alcohol consumption (gamma-glutamyl transpeptidase [gamma-GT] and HDL cholesterol) were measured. RESULTS: A total of 16 healthy men aged 51.0 +/- 2.7 (mean +/- SEM) years with a BMI of 26.4 +/- 0.61 kg/m(2) completed the study. There was a large reduction in alcohol intake (72.4 +/- 5.0 vs. 7.9 +/- 1.6 g/day, P < 0.001) and significant reductions in gamma-GT (geometric mean 24.4 units/l [95% CI 19.7-30.2] vs. 18.6 units/l [15.5-22.2], P < 0.01) and HDL cholesterol (1.36 +/- 0.07 vs. 1.13 +/- 0.07 mmol/l, P < 0.001). There was no effect of alcohol on insulin sensitivity index (ISI), fasting insulin, glucose, or HOMA score. CONCLUSIONS: A substantial reduction in alcohol intake from 7.2 to 0.8 standard drinks per day in healthy men did not change insulin sensitivity as measured by ISI or HOMA score.

Alcohol and cardiovascular disease--more than one paradox to consider. Alcohol and type 2 diabetes--another paradox?

The French Paradox relates to the observation that mortality rates due to coronary heart disease are relatively low in France despite a diet rich in saturated fats. Another paradox linked to alcohol is the diverse associations of acute and chronic alcohol use with respect to insulin resistance, incidence of type 2 diabetes and incidence of cardiovascular disease in type 2 diabetes. Reports consistently suggest that the acute affects of alcohol induce a state of insulin resistance following either an oral and/or intravenous glucose load. Contrary to the acute alcohol studies is a large body of epidemiological evidence from cross-sectional studies which suggests that long-term exposure to alcohol is associated with an improvement in insulin sensitivity. Furthermore, a substantial number of prospective studies point to a protective role for light to moderate chronic alcohol intake against the development of diabetes as well as a protective effect of regular mild to moderate drinking against coronary artery disease in type 2 diabetic subjects.

Effects of alcohol intake on endothelial function in men: a randomized controlled trial.

BACKGROUND: Regular light consumption of alcohol appears to reduce the risk of cardiovascular disease, whereas in heavier drinkers the opposite effect is seen. This biphasic relationship could partly be due to contrasting actions of low and high alcohol intake on endothelial function. OBJECTIVE: To determine whether reducing alcohol intake in moderate-to-heavy drinkers (40-110 g/day) would improve conduit artery endothelial function as assessed by post-ischaemic brachial artery flow-mediated dilatation (FMD). METHODS: In a two-way cross-over study, 16 healthy men either substituted their usual alcohol intake with a 0.9% alcohol beer or maintained their usual alcohol intake during sequential 4-week periods. At the end of each period of FMD and glyceryl trinitrate-induced brachial artery dilatation, blood pressure, plasma lipids, homocysteine and biomarkers of alcohol consumption (gamma-glutamyl transpeptidase) and endothelial function (E-selectin, von Willebrand factor, endothelin-1) were assessed. RESULTS: The participants reduced their alcohol intake from 72.4 to 7.9 g/day. This self-reported reduction in alcohol intake was corroborated by significant decreases in gamma-glutamyl transpeptidase (24%). The decrease in alcohol intake resulted in reductions in total cholesterol (5%), high-density lipoprotein cholesterol (17%), homocysteine (9%) and systolic and diastolic blood pressure [5 mmHg (P = 0.01) and 4 mmHg (P = 0.003), respectively]. There was no effect of alcohol on FMD (6.23 +/- 0.75% compared with 6.24 +/- 0.71%, P = NS), glyceryl trinitrate-induced vasodilatation, E-selectin, endothelin-1 and von Willebrand factor. CONCLUSION: Substantial reduction in alcohol intake in healthy moderate-to-heavy drinkers does not improve endothelial function as measured by post-ischaemic flow-mediated dilatation of the brachial artery or biomarkers of endothelial function.