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Does moderate drinking reduce heart failure risk?

NHS Choices - Behind the Headlines - Tue, 20/10/2015 - 12:10

"Seven alcoholic drinks a week can help to prevent heart disease," the Daily Mirror reports. A US study suggests alcohol consumption up to this level may have a protective effect against heart failure.

This large US study followed more than 14,000 adults aged 45 and older for 24 years. It found those who drank up to 12 UK units (7 standard US "drinks") per week at the start of the study had a lower risk of developing heart failure than those who never drank alcohol.

The average alcohol consumption in this lower risk group was about 5 UK units a week (around 2.5 low-strength ABV 3.6% pints of lager a week).

At this level of consumption, men were 20% less likely to develop heart failure compared with people who never drank, while for women it was 16%.

The study benefits from its large size and the fact data was collected over a long period of time.

But studying the impact of alcohol on outcomes is fraught with difficulty. These difficulties include people not all having the same idea of what a "drink" or "unit" is.

People may also intentionally misreport their alcohol intake. We also cannot be certain alcohol intake alone is giving rise to the reduction in risk seen.

Steps you can take to help reduce your risk of heart failure – and other types of heart disease – include eating a healthy diet, achieving and maintaining a healthy weight, and quitting smoking (if you smoke).

 

Where did the story come from?

The study was carried out by researchers from Brigham and Women's Hospital in Boston, and other research centres in the US, the UK and Portugal.

It was published in the peer-reviewed European Heart Journal.

The UK media generally did not translate the measure of "drinks" used in this study into UK units, which people might have found easier to understand.

The standard US "drink" in this study contained 14g of alcohol, and a UK unit is 8g of alcohol. So the group with the reduced risk actually drank up to 12 units a week.

The reporting also makes it seem as though 12 units – what is referred to in the papers as "a glass a day" – is the optimal level, but the study cannot not tell us this.

While consumption in this lower risk group was "up to" 12 units per week, the average consumption was about 5 units per week. This is about 3.5 small glasses (125ml of 12% alcohol by volume) of wine a week, not a "glass a day".

And the poor old Daily Express got itself into a right muddle. At the time of writing, its website is actually running two versions of the story. 

One story claims moderate alcohol consumption was linked to reduced heart failure risk, which is accurate. 

The other story claims moderate alcohol consumption protects against heart attacks, which is not accurate, as a heart attack is an entirely different condition to heart failure.

 

What kind of research was this?

This was a large prospective cohort study looking at the relationship between alcohol consumption and the risk of heart failure.

Heavy alcohol consumption is known to increase the risk of heart failure, but the researchers say the effects of moderate alcohol consumption are not clear.

This type of study is the best way to look at the link between alcohol consumption and health outcomes, as it would not be feasible (or arguably ethical) to randomise people to consume different amounts of alcohol over a long period of time.

As with all observational studies, other factors (confounders) may be having an effect on the outcome, and it is difficult to be certain their impact has been entirely removed.

Studying the effects of alcohol intake is notoriously difficult for a range of reasons. Not least is what can be termed the "Del Boy effect": in one episode of the comedy Only Fools and Horses, the lead character tells his GP he is a teetotal fitness fanatic when in fact the opposite is true – people often misrepresent how healthy they are when talking to their doctor.

 

What did the research involve?

The researchers recruited adults (average age 54 years) who did not have heart failure in 1987 to 1989, and followed them up over about 24 years.

Researchers assessed the participants' alcohol consumption at the start of and during the study, and identified any participants who developed heart failure.

They then compared the likelihood of developing heart failure among people with different levels of alcohol intake.

Participants came from four communities in the US, and were aged 45 to 64 years old at the start of the study. The current analyses only included black or white participants. People with evidence of heart failure at the start of the study were excluded.

The participants had annual telephone calls with researchers, and in-person visits every three years.

At each interview, participants were asked if they currently drank alcohol and, if not, whether they had done so in the past. Those who drank were asked how often they usually drank wine, beer, or spirits (hard liquor).

It was not clear exactly how participants were asked to quantify their drinking, but the researchers used the information collected to determine how many standard drinks each person consumed a week.

A drink in this study was considered to be 14g of alcohol. In the UK, 1 unit is 8g of pure alcohol, so this drink would be 1.75 units in UK terms.

People developing heart failure were identified by looking at hospital records and national death records. This identified those recorded as being hospitalised for, or dying from, heart failure.

For their analyses, the researchers grouped people according to their alcohol consumption at the start of the study, and looked at whether their risk of heart failure differed across the groups.

They repeated their analyses using people's average alcohol consumption over the first nine years of the study.

The researchers took into account potential confounders at the start of the study, including:

  • age
  • health conditions, including high blood pressure, diabetes, coronary artery disease, stroke and heart attack
  • cholesterol levels
  • body mass index (BMI)
  • smoking
  • physical activity level
  • educational level (as an indication of socioeconomic status)

 

What were the basic results?

Among the participants:

  • 42% never drank alcohol
  • 19% were former alcohol drinkers who had stopped
  • 25% reported drinking up to 7 drinks (up to 12.25 UK units) per week (average consumption in this group was about 3 drinks per week, or 5.25 UK units)
  • 8% reported drinking 7 to 14 drinks (12.25 to 24.5 UK units) per week
  • 3% reported drinking 14 to 21 drinks (24.5 to 36.75 UK units) per week
  • 3% reported drinking 21 drinks or more (36.75 UK units or more) per week

People in the various alcohol consumption categories differed from each other in a variety of ways. For example, heavier drinkers tended to be younger and have lower BMIs, but be more likely to smoke.

Overall, about 17% of participants were hospitalised for, or died from, heart failure during the 24 years of the study.

Men who drank up to 7 drinks per week at the start of the study were 20% less likely to develop heart failure than those who never drank alcohol (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.68 to 0.94).

Women who drank up to 7 drinks per week at the start of the study were 16% less likely to develop heart failure than those who never drank alcohol (HR 0.84, 95% CI 0.71 to 1.00).

But at the upper level of the confidence interval (1.00), there would be no actual difference in risk reduction.

People who drank 7 drinks a week or more did not differ significantly in their risk of heart failure compared with those who never drank alcohol.

Those who drank the most (21 drinks per week or more for men, and those drinking 14 drinks per week or more for women) were more likely to die from any cause during the study.

 

How did the researchers interpret the results?

The researchers concluded that, "Alcohol consumption of up to 7 drinks [about 12 UK units] per week at early middle age is associated with lower risk for future HF [heart failure], with a similar but less definite association in women than in men."

 

Conclusion

This study suggests drinking up to about 12 UK units a week is associated with a lower risk of heart failure in men compared with never drinking alcohol.

There was a similar result for women, but the results were not as robust and did not rule out the possibility of there being no difference.

The study benefits from its large size (more than 14,000 people) and the fact it collected its data prospectively over a long period of time.

However, studying the impact of alcohol on outcomes is fraught with difficulty. These difficulties include people not being entirely sure what a "drink" or a "unit" is, and reporting their intakes incorrectly as a result.

In addition, people may intentionally misreport their alcohol intake – for example, if they are concerned about what the researchers will think about their intake.

Also, people who do not drink may do so for reasons linked to their health, so may have a greater risk of being unhealthy.

Other limitations are that while the researchers did try to take a number of confounders into account, unmeasured factors could still be having an effect, such as diet.

For example, these confounders were only assessed at the start of the study, and people may have changed over the study period (such as taking up smoking). 

The study only identified people who were hospitalised for, or died from, heart failure. This misses people who had not yet been hospitalised or died from the condition.

The results also may not apply to younger people, and the researchers could not look at specific patterns of drinking, such as binge drinking.

Although no level of alcohol intake was associated with an increased risk of heart failure in this study, the authors note few people drank very heavily in their sample. Excessive alcohol consumption is known to lead to heart damage.

The study also did not look at the incidence of other alcohol-related illnesses, such as liver disease. Deaths from liver disease in the UK have increased 400% since 1970, due in part to increased alcohol consumption, as we discussed in November 2014.

The NHS recommends that:

  • men should not regularly drink more than 3-4 units of alcohol a day
  • women should not regularly drink more than 2-3 units a day
  • if you've had a heavy drinking session, avoid alcohol for 48 hours

Here, "regularly" means drinking this amount every day or most days of the week.

The amount of alcohol consumed in the study group with the reduced risk was within the UK's recommended maximum consumption limits.

But it is generally not recommended that people take up drinking alcohol just for any potential heart benefits. If you do drink alcohol, you should stick within the recommended limits.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Seven alcoholic drinks a week can help to prevent heart disease, new research reveals. Daily Mirror, January 20 2015

A drink a day 'cuts heart disease risk by a fifth' researchers claim...so don't worry about having a dry January. Mail Online, January 19 2015

A drink a night 'is better for your heart than none at all'. The Independent, January 19 2015

Glass of wine a day could protect the heart. The Daily Telegraph, January 20 2015

Daily drink 'cuts risk' of middle-age heart failure. The Times, January 20 2015

Drinking half a pint of beer a day could fight heart failure. Daily Express, January 20 2015

Links To Science

Gonçalves A, Claggett B, Jhund PS, et al. Alcohol consumption and risk of heart failure: the Atherosclerosis Risk in Communities Study. European Heart Journal. Published online January 20 2015

Categories: NHS Choices

No proof 'alcohol will make you more gorgeous'

NHS Choices - Behind the Headlines - 11 hours 28 min ago

"How having just the one drink can make you look more gorgeous, according to science," The Independent reports. But the "science" turns out to be an experiment carried out under highly artificial conditions.

The headline comes from a small study looking at whether drinking alcohol makes people more physically attractive to others. It found photographs of those who had consumed a "low-dose" alcoholic drink (a large glass of wine) were rated as more attractive than images of sober individuals.

But photographs of people who went on to have a second drink were not rated as more attractive than those who drank nothing, and the apparent effect of alcohol on perceived attractiveness was only slight. 

The point of this small study is unclear, although the authors say they are interested in the relationship between alcohol and risky sexual behaviour.

If the researchers do go on to find a relationship between alcohol and risky sexual behaviour, the results would hardly be surprising.

It may well be true that a small amount of alcohol can help someone relax and therefore appear more approachable, but whether we needed a taxpayer-funded study to tell us this is debatable.

 

Where did the story come from?

The study was carried out by researchers from the University of Bristol and Macquarie University, Australia.

It was funded by a European Research Advisory Board grant. The Medical Research Council paid for the article to be published on an open-access basis.

It was published in the journal Alcohol and Alcoholism, and is free to access online. It should be noted that this journal does not have a peer review process.

Both The Independent and the Mail Online's headlines failed to make clear the highly artificial nature of this study: it didn't involve people speed dating in a wine bar, just students looking at photos.

Both news outlets deserve some praise, however, for making it clear that the alleged effects of alcohol on attractiveness were limited to only one drink.

But the Mail's claim that the study found "wine and other alcohol can dilate pupils, bring on rosy cheeks and relax facial muscles to make a person appear more approachable" is misleading.

This was the speculation of the authors of the study, but the study itself did not look at what mechanisms might increase facial attractiveness after consuming alcohol.

 

What kind of research was this?

This study set out to examine whether alcohol consumption leads to the consumer being rated as more attractive than sober individuals.

The authors point out that alcohol consumption can cause mild flushing and also result in facial changes that may indicate changes of mood, sexual arousal or expectancy of sex, making people more attractive.

Alcohol consumption is known to be associated with sexual behaviour, particularly risky sexual behaviour, and they say it is important to understand the mechanism through which alcohol might influence such behaviours.

While previous studies have looked at whether drinking alcohol leads the consumer to rate others as more attractive, the effects on the attractiveness of the consumer have not been explored.

 

What did the research involve?

Researchers recruited 40 people aged between 18 and 30, half of them women. The participants were all heterosexual students who typically consumed between 10 and 50 units of alcohol a week (males) and between five and 35 units a week (females). They were all required to be in good physical health and to not be using illicit drugs (except cannabis).

They were asked to look at photographs of around 36 students. These students were all in a heterosexual relationship, and each partner participated in the study because the researchers say there are "strong correlations observed between the attractiveness of romantic partners".

Each volunteer had been photographed three times:

  • when sober – they had not had an alcoholic drink
  • after the consumption of 0.4 g/kg of alcohol – equivalent to a large glass of wine (250 ml) at 14% alcohol by volume for a 70kg individual 
  • after the consumption of a further 0.4 g/kg of alcohol (a total dose of 0.8 g/kg of alcohol)

All photos were taken with applicants in the same position, from the same angle and distance, and with a neutral expression.

When sober, participants were asked to complete an attractiveness rating task where they were presented with pairs of colour photographs of the same person displayed on a monitor, comprising either:

  • facial images of them sober and after one alcoholic drink, or
  • facial images of them sober and after two alcoholic drinks

Participants were then asked to decide which image was more attractive and to what extent, using the number keys 1 to 8 on the computer.

Values 1 to 4 indicated that the face on the left was preferred (1 = strongly prefer, 2 = prefer, 3 = slightly prefer, 4 = guess), while 5 to 8 indicated the face on the right was preferred (5 = guess, 6 = slightly prefer, 7 = prefer, 8 = strongly prefer).

They had previously completed a validated questionnaire rating their mood.

 

What were the basic results?

Researchers found images of individuals who had consumed one alcoholic drink (a "low dose") were rated as more attractive than images of them sober.

The preference for an "intoxicated" face (of someone who had had one drink) over the "sober" face was slight (mean preference 54%, 95% confidence interval [CI] 50-59%).

However, when comparing someone who had not had a drink with someone who had had two drinks (the "high dose"), there was a slight tendency to prefer the "sober" face over the "intoxicated" face (mean preference 47%, 95% CI 43-51%).

They also found that in those who had one alcoholic drink, the skin tone in facial images was slightly redder and darker compared to the sober state, but no different when comparing sober with high-dose or low and high doses. 

 

How did the researchers interpret the results?

The researchers say their study suggests alcohol consumption increases the attractiveness of the consumer to others, and they may therefore receive "greater sexual interest" from potential mates.

The mechanism for this apparent increase in attractiveness is unknown, although they suggest it is driven by a change in appearance after low alcohol consumption – a flushing of the skin and a relaxation of facial muscles. 

"Understanding the mechanisms through which alcohol influences social behaviour, including factors that may impact on the likelihood of engaging in risky sexual behaviour, is important if we are to develop evidence-based public health messages," they argue.

 

Conclusion

This small study found a slight increase in the perceived attractiveness of people who had consumed (on average) one large glass of wine, compared with images of those who had consumed no alcohol. But what this finding adds to our knowledge of alcohol and risky sexual behaviour is unclear.

All kinds of factors might influence whether someone is considered attractive, including the mood and preferences of the onlooker, as well as the mood of those being photographed.

Also, the sample was drawn from a student population and the results might not be generalisable to other groups. It is also highly likely that the student participants recognised the students in the photographs, which could have influenced the results.

The official NHS guidelines on alcohol consumption are:

  • men should not regularly drink more than 3-4 units of alcohol a day
  • women should not regularly drink more than 2-3 units a day
  • to avoid alcohol for 48 hours after a heavy drinking session

Three units is the equivalent of a large glass of wine (alcohol content 12%) or a pint of higher strength beer, lager or cider. Read more about alcohol units.

Regularly drinking above these limits can lead to alcohol misuse problems. Alcohol misuse can trigger a range of health issues, such as weight gain, impotence (in men), jaundice, and various types of cancers.

Read more advice about how to enjoy alcohol responsibly.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

How having just the one drink can make you look more gorgeous, according to science. The Independent, March 4 2015

How drinking ONE glass of wine improves your looks: Booze can make you beautiful - but stay away from that second glass. Mail Online, March 3 2015

Links To Science

Van Den Abbeele J, Penton-Voak IS, Attwood AS, et al. Increased Facial Attractiveness Following Moderate, but not High, Alcohol Consumption. Alcohol and Alcoholism. Published online February 25 2015

Categories: NHS Choices

People with gout have lower risk of Alzheimer’s disease

NHS Choices - Behind the Headlines - 12 hours 58 min ago

"Gout could help prevent Alzheimer's, research shows," The Independent reports. Researchers think that uric acid, which causes gout, may have a protective effect against Alzheimer's disease.

Uric acid is a waste product that is normally passed out of the body. In cases of gout, the acid builds up around one or more joints, forming tiny crystals. This can then trigger the symptoms of gout, which are typically a sudden severe pain and swelling around the affected joint(s).

Previous research has found that uric acid is also an antioxidant (which helps to protect against cell damage), so researchers wanted to see if uric acid protected against Alzheimer’s.

The researchers used information from a UK database of more than 3.7 million patients. They matched people aged over 40 who developed gout with controls who did not, and followed them, on average, for five years to see how many were diagnosed with Alzheimer’s disease. They took multiple factors into account when analysing the results, such as medication use and age.

They found that 309 out of the 59,224 people with gout (0.5%) developed Alzheimer’s disease, compared to 1,942 out of 238,805 people without gout (0.8%), which translates into a 24% reduction in risk.

The study does not prove that gout is protective against Alzheimer’s, as there could be unmeasured factors that affected the results.

 

Where did the story come from?

The study was carried out by researchers from Boston University School of Medicine, Harvard Medical School, Harvard School of Public Health, and the University of British Columbia. It was funded by these institutes and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

The study was published in the peer-reviewed medical journal Annals of the Rheumatic Diseases.

In general, the media reported the story accurately, though did not discuss the limitations of this type of study – that it can look for associations, but not prove cause and effect. The Independent helpfully provided expert opinion from Dr Laura Phipps from Alzheimer’s Research UK, who is reported to have said: "while this work does suggest a positive impact of gout on brain health, many of the risk factors related to gout, including obesity and diabetes, are also linked to increased dementia risk. Current evidence suggests that the best ways to maintain a healthy brain are to keep a healthy weight, exercise regularly, not smoke, eat a balanced diet, drink in moderation, and keep blood pressure and cholesterol in check."

 

What kind of research was this?

This was a case-controlled cohort study, which aimed to see if people with gout were less likely to develop Alzheimer’s disease.

Gout is a type of arthritis that most commonly affects the big toe, causing swelling and inflammation. It is due to a build-up of uric acid crystals in the blood. Uric acid is a breakdown product of purines, which are in all cells in the body and consumed in the diet, especially in beer, seafood, oily fish and liver.

However, uric acid is also an antioxidant and has previously been thought to protect against some neurodegenerative conditions, such as Parkinson’s disease and dementia. The researchers wanted to specifically see if higher levels of uric acid were associated with a reduced risk of Alzheimer’s disease.

This is an appropriate style of study to assess any link between higher levels of uric acid (people with gout) and risk of Alzheimer’s disease. Deliberately giving people an intervention to increase uric acid levels would be unethical, as this could lead to painful symptoms and joint damage.

 

What did the research involve?

The researchers compared the incidence of Alzheimer’s disease in people with and without a new diagnosis of gout during the study period.

The researchers used data from the Health Improvement Network database, which holds medical records from 580 GP practices in the UK. All the data is anonymised, so no personal data was provided to researchers.

The study period started in 1995 and the data for more than 3.7 million people aged 40 or more with no history of gout or dementia were eligible to be included in the study. When someone then had a diagnosis of gout, they entered the study. Five people of the same age and body mass index (BMI) who did not have gout entered the study at the same time, to act as controls. The researchers then followed these people up to 2013, comparing the incidence of Alzheimer’s disease between the two groups.

They took the following potential confounding factors into account when analysing the results:

  • age and sex
  • history of ischaemic heart disease, stroke, hypertension, hyperlipidaemia and diabetes
  • BMI
  • smoking status
  • alcohol consumption
  • social deprivation
  • use of cardiovascular medication
  • use of non-steroidal anti-inflammatory drugs (NSAIDs)

They repeated the process for people who developed osteoarthritis as a control, to see if the process was robust, as there has been no previous link between these diseases. 

 

What were the basic results?

There was a 24% reduced risk of developing Alzheimer’s for people with gout compared to those without, after adjusting for the potential confounders listed above (hazard ratio (HR) 0.76, 95% confidence interval (CI) 0.62 to 0.87).

Alzheimer’s disease occurred in:

  • 309 out of the 59,224 people with gout (0.5%)
  • 1,942 of the 238,805 people without gout (0.8%)

The average age was 65 in both groups and 71% were male. They were followed up for an average of five years.

There was no association between osteoarthritis and Alzheimer’s disease.

 

How did the researchers interpret the results?

The researchers concluded that their "findings provide the first population-based evidence for the potential protective effect of gout on the risk of AD [Alzheimer’s disease] and support the purported neuroprotective role of uric acid." They say that "if confirmed by future studies, a therapeutic investigation that has been employed to prevent progression of PD [Parkinson’s disease] may be warranted".

 

Conclusion

This population-based study has found that people with gout had a 24% reduced risk of developing Alzheimer’s disease. It was a well-designed study, in that there were large numbers of people in each group and multiple potential confounding factors were taken into account. The validation of the study was also valuable in showing the expected lack of a link between osteoarthritis and Alzheimer’s disease.

However, there are some limitations with this type of study, with a major one being that it cannot prove cause and effect. While some potential confounding factors were accounted for in the statistical analysis, there could be others which influenced the results.

The study participants were followed for an average of five years, so there will be a number of cases of early Alzheimer’s disease that would not have been picked up or fully diagnosed.

Gout was used as a proxy for increased levels of uric acid. However, gout is an inflammatory type of arthritis and some people only have one attack, or attacks that are spread out over a number of years. Therefore, it is not clear that a high level of uric acid caused the results seen.

It is not advisable that you try to increase your levels of uric acid through your diet, as this could increase your risk of developing gout, which is a very painful condition. The best way to reduce the risk of Alzheimer’s and other types of dementia are all the usual suspects: stop smoking, drink alcohol within recommended limits, be physically active, eat a balanced diet, reduce weight if you are overweight or obese, and keep blood pressure and cholesterol down.

Read more about reducing your dementia risk

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.

Links To The Headlines

Gout could help prevent Alzheimer's, research shows. The Independent, March 4 2015

Gout sufferers 'have less chance of developing Alzheimer's': Sufferers risk of developing condition is reduced by quarter. Mail Online, March 5 2015

Gout sufferers are a quarter less likely to develop Alzheimer's. Daily Mirror, March 4 2015

Links To Science

Lu N, Dubreuil M, Zhang Y, et al. Gout and the risk of Alzheimer's disease: a population-based, BMI-matched cohort study. Annals of the Rheumatic Diseases. Published online March 4 2015

Categories: NHS Choices

McDonald's USA to phase out human antibiotics from chicken supply

Reuters UK Business News - 21 hours 22 min ago
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China aims for around 7 percent economic growth in 2015-Premier Li

Reuters UK Business News - 23 hours 22 min ago
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Asia stocks slip, euro languishes at 11-year low before ECB

Reuters UK Business News - 23 hours 26 min ago
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McDonald's USA to phase out human antibiotics from chicken supply

Reuters UK Business News - Wed, 04/03/2015 - 23:19
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Apple to delay larger iPad production till September - report

Reuters UK Business News - Wed, 04/03/2015 - 22:43
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Reuters UK Business News - Wed, 04/03/2015 - 22:00
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Reuters UK Business News - Wed, 04/03/2015 - 21:39
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Reflationist BOJ newcomer no pushover for more Japanese easing

Reuters UK Business News - Wed, 04/03/2015 - 21:08
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China parliament to debate painful reforms as economy slows

Reuters UK Business News - Wed, 04/03/2015 - 21:03
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Cypriot president bids to take part in ECB's QE programme

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Reuters UK Business News - Wed, 04/03/2015 - 19:41
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UK gives oligarch 7 days to justify keeping North Sea fields

Reuters UK Business News - Wed, 04/03/2015 - 19:25
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Bank of England to hold HSBC bosses' 'feet to the fire' in bank's transformation

Reuters UK Business News - Wed, 04/03/2015 - 19:22
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Reuters UK Business News - Wed, 04/03/2015 - 18:49
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Reuters UK Business News - Wed, 04/03/2015 - 18:46
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UK gives oligarch Fridman 7 days to argue against forced North Sea asset sale

Reuters UK Business News - Wed, 04/03/2015 - 18:44
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Exclusive - ZF, TRW set to win EU approval for $13.5 billion deal

Reuters UK Business News - Wed, 04/03/2015 - 18:26
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