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Alcohol and Heart Health: Navigating the Risks and Benefits

Last Updated: April 25, 2024 | Dr Reza Moazzeni

Introduction

Alcohol and heart health: a topic that’s been debated for years. You’ve probably heard conflicting advice – a glass of red wine is good for your heart, but too much alcohol can lead to severe problems. So, what’s the truth?
The answer isn’t black and white. Moderate alcohol consumption has been linked to ‘potential’ benefits, like increased “good” HDL cholesterol and reduced inflammation. However, excessive drinking can lead to high blood pressure, irregular heartbeat, and an increased risk of stroke.
In this post, we’ll explore the risks and benefits of alcohol consumption for heart health. We’ll look at what the science says, dispel common myths, and provide practical tips for maintaining a healthy relationship with alcohol. We will discuss some serious heart effects such as Alcohol-induced Cardiomyopathy.
Whether you’re a casual drinker or concerned about your heart health, this post will give you the information you need to make informed decisions.

The Potential Benefits of Moderate Alcohol Consumption

Alcohol-and-heart-health For years, researchers have investigated the potential link between moderate alcohol consumption and improved heart health. Moderate drinking is commonly defined as consuming up to one drink per day for women and up to two drinks per day for men. One drink is equivalent to 12 ounces (355 ml) of beer, 5 ounces (148 ml) of wine, or 1.5 ounces (44 ml) of spirits. This is equivalent to one bottle of beer, a small glass of wine, or 1.5 shots of spirits.

Several observational studies have suggested that moderate alcohol intake may offer some cardiovascular benefits. For example, a meta-analysis by Ronksley et al. (2011) found that light to moderate alcohol consumption was associated with a reduced risk of cardiovascular disease, coronary heart disease, and stroke compared to non-drinkers.

Another well-known study is the “French Paradox,” which suggests that the French population’s relatively low rates of heart disease, despite a diet high in saturated fats, may be partially attributed to their regular consumption of red wine (Ferrières, 2004).

However, it’s crucial to note that these potential benefits are not conclusive and come with important caveats:

  • Most studies on alcohol and heart health are observational, meaning they cannot prove causation. Other factors like lifestyle and genetics may affect the observed health outcomes (Holmes et al., 2014).
  • The potential benefits of moderate drinking may not apply to everyone. Factors such as age, sex, genetics, and overall health can influence how alcohol affects an individual’s cardiovascular system (Movva & Figueredo, 2013).
  • Some experts argue that the potential benefits of moderate alcohol consumption can be achieved through other, safer means, such as a balanced diet, regular exercise, and not smoking (Chikritzhs et al., 2015).

It’s crucial to approach the potential benefits of moderate alcohol consumption with caution. While some studies suggest possible advantages, the evidence is not conclusive, and individual factors play a significant role in determining alcohol’s impact on heart health.

Factors Influencing the Alcohol-Heart Health Relationship

While moderate alcohol consumption may offer potential benefits, heavy drinking can have severe consequences for heart health. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy drinking as more than 5 drinks per day or 15 drinks per week for men and more than 4 drinks per day or 8 drinks per week for women.

Excessive alcohol intake can lead to a range of cardiovascular problems, including:

High blood pressure (Hypertension):

Drinking too much alcohol can raise blood pressure levels, increasing the risk of hypertension and subsequent heart disease (Roerecke et al., 2017).

Alcohol-Induced-Cardiomyopathy-heart-failureAlcoholic cardiomyopathy (Alcohol-induced Heart Failure):

Long-term heavy drinking can weaken the heart muscle, leading to a condition known as alcoholic cardiomyopathy. This can result in heart failure and other serious complications (Piano, 2017).

Arrhythmias:

Heavy alcohol consumption can disrupt the heart’s electrical activity, causing irregular heartbeats or arrhythmias, such as atrial fibrillation (Voskoboinik et al., 2016).

Increased stroke risk:

Excessive alcohol intake is associated with a higher risk of both ischemic and hemorrhagic strokes (Larsson et al., 2016).

Furthermore, heavy drinking can contribute to other health problems that indirectly affect the heart, such as:

    • Liver disease: Alcoholic liver disease can lead to cirrhosis, liver failure, and an increased risk of liver cancer (Rehm et al., 2017).
    • Obesity: Alcohol is high in calories and can contribute to weight gain, which is a risk factor for heart disease (Traversy & Chaput, 2015).
    • Psychological disorders: Heavy alcohol consumption is linked to various mental health problems, including depression and anxiety, which can negatively impact overall health and well-being (Boden & Fergusson, 2011).

The risks of heavy alcohol consumption on heart health and overall well-being are well-documented. It is crucial for individuals to be aware of these risks and to drink responsibly, if at all.

Alternatives to Alcohol for Heart Health

While some studies suggest that moderate alcohol consumption may have potential benefits for heart health, it’s important to remember that these benefits can be achieved through other, safer methods. Here are some practical alternatives to promote a healthy heart:

  • Balanced diet: Adopting a heart-healthy diet, such as the Mediterranean diet, can significantly reduce the risk of cardiovascular disease (Estruch et al., 2018). Focus on consuming plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats like olive oil and nuts.
  • Regular physical activity: Regular exercise has numerous benefits for heart health, including lowering blood pressure, improving cholesterol levels, and maintaining a healthy weight (Nystoriak & Bhatnagar, 2018). Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with muscle-strengthening activities at least twice a week (WHO, 2020).
  • Stress management: Chronic stress can take a toll on heart health, contributing to high blood pressure, inflammation, and unhealthy coping mechanisms (Wirtz & von Känel, 2017). Practice stress-reducing techniques such as deep breathing, meditation, yoga, or engaging in hobbies you enjoy.
  • Quitting smoking: Smoking is a major risk factor for heart disease, and quitting can significantly reduce your risk (Hackshaw et al., 2018). If you currently smoke, consider seeking support from a healthcare professional or using nicotine replacement therapy to help you quit.
  • Maintaining a healthy weight: Being overweight or obese increases the risk of heart disease, stroke, and other cardiovascular problems (Khan et al., 2018). However, following a balanced diet and engaging in regular physical activity can help you maintain a healthy weight and reduce your risk of heart disease.

Remember, the key to a healthy heart is a combination of lifestyle factors, not just one single component. By focusing on a balanced diet, regular exercise, stress management, and avoiding tobacco, you can effectively promote heart health without relying on alcohol consumption.

When to Seek Professional Help

While moderate alcohol consumption may be part of a healthy lifestyle for some individuals, it’s crucial to recognize when drinking habits become problematic. Alcohol abuse and dependence can have severe consequences for both physical and mental health, including an increased risk of heart disease, liver damage, and psychological disorders (Rehm, 2011).

If you or someone you know is experiencing any of the following signs of alcohol abuse or dependence, it’s essential to seek professional help:

    • Inability to control or reduce alcohol consumption
    • Continuing to drink despite negative consequences on health, work, or relationships
    • Experiencing withdrawal symptoms when not drinking, such as tremors, sweating, or anxiety
    • Neglecting responsibilities or hobbies in favour of drinking
    • Developing a tolerance to alcohol, requiring more to achieve the same effect
    • Engaging in risky behaviours while under the influence, such as driving or operating machinery

Seeking professional help for alcohol-related problems is a sign of strength, not weakness. There are many resources available to support individuals in their journey towards recovery:

    • General Practitioners: Your doctor can provide an initial assessment, offer guidance, and refer you to appropriate specialists or treatment programs.
    • Mental health professionals: Psychologists, psychiatrists, and counsellors specializing in addiction can provide therapy and support to address the underlying causes of alcohol abuse and develop coping strategies.
    • Support groups: Organizations like Alcoholics Anonymous (AA) offer peer support and a sense of community for individuals seeking to overcome alcohol dependence.
    • Rehabilitation centres: Inpatient or outpatient rehabilitation programs provide structured treatment, including medical detox, therapy, and aftercare planning to support long-term recovery.

Remember, recovery from alcohol abuse or dependence is a process, and setbacks are a normal part of the journey. With the right support and resources, it is possible to overcome alcohol-related problems and improve overall health and well-being.

If you or someone you know is struggling with alcohol abuse or dependence, don’t hesitate to reach out for help. The following resources can provide more information and support:

A Case of Alcoholic Cardiomyopathy (Alcohol-induced Heart Failure)

I recently treated a 56-year-old carpenter who presented with severe exertional breathlessness and orthopnea (Shortness of breath when lying down). His symptoms had become so debilitating that he could no longer perform his job, forcing him to seek medical attention despite his aversion to doctors.

Upon further investigation, I discovered that he had been drinking an astonishing 60 beers a week for the past 40 years. To put this into perspective, approximately 41,000 liters of beer and about 1,200 kg of pure alcohol, consumed over four decades!

The echocardiogram below shows his cardiac function at presentation. His left ventricle (main heart chamber) function is severely impaired, and there is severe leaking of the Mitral Valve called Mitral Regurgitation.

Play Video about Alcoholic-cardiomyopathy-heart-failure-pre-treatment

Remarkably, his coronary arteries were normal, and he was in sinus rhythm. The diagnosis was clear: alcoholic cardiomyopathy.

Faced with this life-altering diagnosis, he made the courageous decision to quit drinking immediately. After one year of complete abstinence from alcohol and adherence to heart failure medical therapy, his LV function significantly improved, and the mitral regurgitation nearly resolved, as shown in the echocardiogram below. Twelve months after treatment and abstaining from Alcohol, there is a significant improvement in cardiac function with near-complete resolution of the mitral valve regurgitation.

Play Video about Alcoholic-cardiomyopathy-heart-failure-post-treatment

This case serves as a powerful reminder of the profound impact that our lifestyle choices can have on our cardiovascular health. It also highlights the incredible resilience of the human body and its ability to recover when given the opportunity.

Understanding Alcoholic Cardiomyopathy Alcoholic cardiomyopathy (ACM) is a form of heart muscle disease caused by long-term heavy alcohol consumption. It is characterized by a weakening and enlargement of the heart muscle, particularly the left ventricle, leading to reduced contractility and impaired pumping function (Guzzo-Merello et al., 2014). To diagnose ACM, a person should have been consuming 80-90 grams of daily ethanol (equivalent to 8-10 beers or 1 liter of wine) for at least 10-15 years. This criterion is crucial, as, without this level and duration of alcohol consumption, ACM becomes less likely. Other diagnostic criteria include the absence of obstructive coronary artery disease, primary valvular disease, or long-standing tachyarrhythmias, such as atrial fibrillation, which can all cause dilated cardiomyopathy similar to ACM.

Symptoms of alcoholic cardiomyopathy may include:

  • Shortness of breath, especially during physical activity or when lying down
  • Fatigue and weakness
  • Swelling in the legs, ankles, and feet
  • Palpitations or irregular heartbeat
  • Chest pain or discomfort

The exact mechanisms by which alcohol damages the heart muscle are complex and not fully understood. However, it is believed that alcohol’s toxic effects, along with nutritional deficiencies and other alcohol-related factors, contribute to the development of alcoholic cardiomyopathy (Piano, 2017).

The most effective treatment for alcoholic cardiomyopathy is complete abstinence from alcohol, along with standard heart failure management, which may include medications, lifestyle modifications, and close monitoring by a healthcare provider. In some cases, the heart muscle may recover and regain some of its function, as demonstrated by my patient’s remarkable progress.

Conclusion: Navigating the Alcohol-Heart Health Connection

Navigating the relationship between alcohol and heart health can feel like walking a tightrope – one misstep, and you might lose your balance. While moderate drinking may offer potential benefits, the risks outweigh any positive effects.

The key takeaway: If you choose to drink, moderation is crucial. 

If you find yourself struggling to control your alcohol intake, know that seeking professional help is a brave and crucial step towards reclaiming your health and well-being. Your health is in your hands; your choices, from what you eat to your habits, significantly affect your health. By making informed decisions and prioritizing self-care, you can reduce your risk of heart disease and live a healthier life.

References and further reading

  • Chikritzhs,  et al. (2015). Has the leaning tower of presumed health benefits from ‘moderate’ alcohol use finally collapsed?. Addiction, 110(5), 726-727.
  • Ferrières, J. (2004). The French paradox: lessons for other countries. Heart, 90(1), 107-111.
  • Holmes, M. V., et al. (2014). Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. BMJ, 349, g4164.
  • Movva, R., & Figueredo, V. M. (2013). Alcohol and the heart: to abstain or not to abstain?. International journal of cardiology, 164(3), 267-276.
  • Ronksley, et al. (2011). Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ, 342, d671.
  • Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106(5), 906-914.
  • Larsson, et al. (2016). Differing association of alcohol consumption with different stroke types: a systematic review and meta-analysis. BMC Medicine, 14(1), 178.
  • Piano, M. R. (2017). Alcohol’s effects on the cardiovascular system. Alcohol research: current reviews, 38(2), 219.
  • Rehm, J., et al. (2017). The relationship between different dimensions of alcohol use and the burden of disease—an update. Addiction, 112(6), 968-1001.
  • Roerecke, M., et al. (2017). Sex‐specific associations between alcohol consumption and incidence of hypertension: A systematic review and meta‐analysis of cohort studies. Journal of the American Heart Association, 7(13), e008202.
  • Traversy, G., & Chaput, J. P. (2015). Alcohol consumption and obesity: an update. Current obesity reports, 4(1), 122-130.
  • Voskoboinik, et al. (2016). Alcohol and atrial fibrillation: a sobering review. Journal of the American College of Cardiology, 68(23), 2567-2576.
  • Estruch, R., et al. (2018). Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine, 378(25), e34.
  • Hackshaw, A., et al. (2018). Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ, 360, j5855.
  • Khan, S. S., et al. (2018). Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiology, 3(4), 280-287.
  • Nystoriak, M. A., & Bhatnagar, A. (2018). Cardiovascular effects and benefits of exercise. Frontiers in cardiovascular medicine, 5, 135.
  • WHO (2020). Physical activity. World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/physical-activity
  • Wirtz, P. H., & von Känel, R. (2017). Psychological stress, inflammation, and coronary heart disease. Current cardiology reports, 19(11), 1-10.
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