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This study examines cardiovascular parameters and alcohol\u2010related phenotypes associated with two groups of alcohol drinkers: high\u2010risk and low\u2010risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from 520 high\u2010risk and 586 low\u2010risk non\u2010smoking alcohol drinkers were analyzed. Generalized linear models analyzed the relationship between AUD\u2010related outcomes (Alcohol Dependence Scale, number of DSM Alcohol Dependence criteria, Clinical Institute Withdrawal Assessment for Alcohol, Revised, and Penn Alcohol Craving Scale) and cardiovascular measures (mean arterial pressure, heart rate, QTcF, QRSD, and PR intervals, and QRS, P\u2010wave, and T\u2010wave axes). Multiple logistic regression examined associations of sociodemographic and cardiovascular variables with the odds of being a high\u2010risk drinker. Statistically significant cardiovascular variables were retained as explanatory variables in Tweedie regression models for alcohol\u2010related phenotypes. Interaction effects of risk group by cardiovascular measure were included in each model testing the association between cardiovascular parameters and alcohol\u2010related phenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Higher mean arterial pressure (MAP) and heart rate (HR) were associated with increased odds of high\u2010risk drinking, while greater P\u2010wave axis was associated with increased odds of low\u2010risk drinking. Compared with low\u2010risk drinkers, alcohol outcomes for those who engaged in high\u2010risk drinking were not only significantly greater but also significantly less dependent on MAP and HR variations. The P\u2010wave axis was significantly associated with low\u2010risk drinking; however, it showed no significant association with any other alcohol outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings from this study suggest that MAP, HR, and an abnormal P\u2010wave axis can be useful signals for detecting increasing and potentially harmful alcohol drinking among patients who do not yet meet the threshold for high\u2010risk drinking. Early, objective, and targeted identification can improve the current undertreatment of this population at risk by decreasing the interval between onset of AUD and initial clinical care and treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acer.70099","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T15:00:26Z","timestamp":1754060426000},"page":"1704-1715","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Early signs of cardiovascular abnormalities in patients with alcohol misuse"],"prefix":"10.1111","volume":"49","author":[{"given":"Lisa A.","family":"Farinelli","sequence":"first","affiliation":[{"name":"Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research National Institutes of Health  Baltimore and Bethesda Maryland USA"},{"name":"Office of the Clinical Director National Institute on Drug Abuse, NIH  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Garrick","family":"Sherman","sequence":"additional","affiliation":[{"name":"Office of the Clinical Director National Institute on Drug Abuse, NIH  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daria","family":"Piacentino","sequence":"additional","affiliation":[{"name":"Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research National Institutes of Health  Baltimore and Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie L.","family":"Schwandt","sequence":"additional","affiliation":[{"name":"Office of the Clinical Director National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, NIH  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie Espinal","family":"Abreu","sequence":"additional","affiliation":[{"name":"Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research National Institutes of Health  Baltimore and Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"Cooper","sequence":"additional","affiliation":[{"name":"Office of Research Services, National Institutes of Health Library National Institutes of Health  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7284-8754","authenticated-orcid":false,"given":"Lorenzo","family":"Leggio","sequence":"additional","affiliation":[{"name":"Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research National Institutes of Health  Baltimore and Bethesda Maryland USA"},{"name":"Office of the Clinical Director National Institute on Drug Abuse, NIH  Baltimore Maryland USA"},{"name":"Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies Brown University School of Public Health  Providence Rhode Island USA"},{"name":"Division of Addiction Medicine, Department of Medicine Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Neuroscience Georgetown University Medical Center  Washington DC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890423349"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/opo.12131"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/alcalc\/agm156"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1006\/jmcc.1998.0812"},{"key":"e_1_2_8_7_1","first-page":"208","article-title":"Defining alcohol\u2010related phenotypes in humans. 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