Alcohol and the heart
There has always been a debate regarding advantages and disadvantages of alcohol. Some people believe that it is beneficial to heart while others believe that it harmful. What is the science behind it? What to expect from alcohol? Do we recommend alcohol to all? Or should be advice complete abstinence to all? Is there a dose response effect of alcohol? Do different types of alcohol differ in their effect?
STANDARD ALCOHOLIC DRINK (14-15g of alcohol ): 17.7ml of alcohol
| BEVARAGE TYPE | ALCOHOL BY VOLUME(ABV) IN % |
| BEER | 4.6 – 10%(DARK BEER) |
| WINE | 12-16% |
| WHISKEY/GIN/ RUM(80 -PROOF SPIRITS) | 40% |
| 100 –PROOF SPIRITS | 57.1% |
| ABSOLUTE ALCOHOL | 96% |
DEFINITIONS OF ALCOHOLIC DRINKING
• Moderate drinking – no more than 1 drink/ day for women and 2 drinks/day for men
• Heavy drinking – an avg. drinking of >2drinks/day for men and >1drink/day for women.
• Light drinking- no standard definition, presumably less than moderate drinking.
• Binge drinking - >4drinks on a single occasion for men; >3 drinks for women, achieving a blood alcohol concentration to ≥0.08%.
ALCOHOL AND HEALTH INFLUENCE ON TOTAL MORTALITY
• Light to moderate drinking on a daily basis significantly reduce the risk of CAD ( coronary heart disease) and all-cause mortality(death).
• Heavy intake -3rd leading cause of premature death among Americans.
• Health effects dependent on: amount, pattern of drinking.
• The benefits of alcohol in all studies so far is caused primarily by protective effects on coronary artery disease (prevention from heart attack), with the lowest mortality risk occurring at the level of 1-2 drinks per day.
• A statistical analysis of 34 studies recently published:
- >1million subjects studied
- J shaped relationship between alcohol intake and total mortality (decreased mortality at low doses and increased mortality at high doses)
- Lowest mortality was observed at 6g of alcohol per day.
- Up to 4 drinks/day in men and 2 drinks/day in women were protective.
- Overall decrease in mortality with moderate alcohol intake – 18% in both sexes.
• Benefits in women seen with lower alcohol dose.
• Rate of death for all cardiovascular disease was 30-40% lower for those who drink at least 1 drink/day compared with abstainers.
• Light drinkers were at lower risk of death from CAD, irrespective of baseline risk for CAD.
• INTERHEART study – regular alcohol consumption a/w reduced heart attack risk in both genders and in all adult age groups.
Light- mod drinking improves CV health equally in high- and low- risk pts
Thun MJ et al., New Engl J Med 1997;337:1705-1714
Klatsky AL et al. Alcohol and mortality. Ann Intern Med 1992;117:646-654
Yusuf S INTER-HEART study investigators. Lancet 2004;364:937-52
• This effect was seen across different races in diff countries, both genders and persisted after adjustment of all confounding factors.
• High risk patients (Diabetics, elderly, high cholesterol, high blood pressure) benefit more from moderate alcohol intake.
• Health Professionals Follow Up study – >8,000 men who never smoked, with normal body weight, regular exercise of 30 min per day and following a healthy diet were studied – 40-50% reduction in risk of heart attck with 1-2 drinks/day.
• Studies in men and women have shown daily intake provides superior health benefits than less frequent consumption.
• Earlier studies suggested red wine to be more cardio protective than other alcoholic beverages.
• A recent meta-analysis has shown it is the alcohol itself, rather than a specific component of wine, beer or spirits, that appears to confer cardio protection.
• Most recent studies show equal benefits from all types of alcohol.
Mechanism for benefit:
Increase in good cholesterol level
Makes bad cholesterol less damaging
Makes blood thin and prevent blood undue clotting
Makes your vessels healthy (increase nitric oxide levels in blood vessels)
Disadvantages of heavy drinking
• Heavy alcohol intake –a/w high blood pressure, irrespective of age, gender, beverage type.
• Heavy drinking a/w brain hemorrhage.
• Binge drinking more likely associated with brain hemorrhage.
Light drinking associated with reduced risk of sudden cardiac death
Heavy drinking causes increased risk of sudden cardiac death
Binge alcohol intake causes increased risk of electric disturbance in heart.
Alcohol and heart failure
Alcohol causes dilatation of heart, affects normal functioning of heart muscles, a disease called as ‘alcoholic cardiomyopathy’
Causes:
Direct toxic effect on heart
Nutritional deficiency
Effect on liver which secondarily affects heart
? Genetic susceptibility
Secondary to long term heavy alcohol consumption (of any beverage)
Alcohol in pregnancy
Increased risk of birth defects in child born to a mother who consumes alcohol during pregnancy.
Congenital heart diseases are most common of the birth defects reported.
SHOULD WE RECOMMEND ALCOHOL TO ALL?
• Alcohol consumption should NEVER be considered as a preventive measure for teens or young adults.
• Predicting an individual’s risk of developing alcoholism and its sequelae is difficult.
• Alcohol abuse is the 3rd largest preventable cause of death.
• Data on benefit of alcohol is based on epidemiological studies. There has been no large randomized clinical trial of alcohol conducted till date.
• A particular concern in women is the risk of breast cancer even at moderate levels of drinking.
American Heart Association Recommendations:
• Patients should NOT BE ADVISED TO INITIATE ALCOHOL (incl. wine) intake IF THEY ARE NON-DRINKERS for the sake of cardiovascular benefit, especially in women.
• Those who consume light to moderate alcohol daily can be asked to continue with the same amount.
• Those who consume heavy alcohol should be advised to cut down on their amounts, given the benefits of continued moderate drinking in heavy drinkers.
SAFE LIMITS OF DRINKING
| GROUP | AMOUNT OF ALCOHOL |
| MEN | ≤2 dr/day ≤14 dr/week ≤4 drinks on one occasion |
| WOMEN | 1dr/day ≤7 dr/week ≤3 drinks on one occasion |
| ELDERLY(>65 yrs) | ≤ 1 dr/day |
Cheers to life!!!!
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