Wine Toast

How Much Alcohol is Good for Your Heart?

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Wine ToastYou’ve probably heard the benefits of red wine touted. That’s because red wine contains a powerful antioxidant known as resveratrol, which has been associated with lower incidences of cancer and cardiovascular disease, as well as cholesterol-lowering and anti-inflammatory properties.

Over the years, numerous studies have been conducted on the potential benefits of alcohol consumption. In “Alcohol and the Heart: An Ounce of Prevention,” published in the journal Current Treatment Options in Cardiovascular Medicine, the authors reviewed a wealth of research dealing with alcohol’s effect, particularly on the cardiovascular system.[1]

While many positive benefits were associated with alcohol, which we will cover in a moment, a common theme emerged with regard to the amount of alcohol consumed, leading the authors to point out that the challenge here might be in recommending the “right doses.” You see, just like a little alcohol may help to mend a broken heart, drink too much of it and it has quite a different (and potentially dangerous) effect.

As we go through the alcohol-related research, keep in mind that while the definition of what constitutes a “light,” “moderate” or “heavy” drinker may vary slightly from study to study, in general, “one drink” refers to a 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5 ounces of liquor (either straight up or in a mixed drink).

Alcohol and Cholesterol

Alcohol has been linked to several well-known changes in lipoproteins, and moderate alcohol intake has been associated with reduced LDL (“bad”) cholesterol and increased HDL (“good”) cholesterol. In fact, one study showed that one to two drinks per day increased HDL by 12% on average, which is similar to the increase seen with exercise programs and fibric acid medications.

This is especially good news when you consider that a separate study estimated that about half of the decrease in coronary heart disease risk may be attributed to an increase in plasma HDL, while only 20% was attributed to a reduction in plasma LDL.

Alcohol and Cardiomyopathy

Cardiomyopathy is a serious disease in which the heart muscle becomes inflamed and doesn’t work as it should, and among other things, it can be brought on by prolonged heavy drinking (5-15 years). However, research suggests that moderate alcohol intake could have the opposite effect.

One study reported a 59% lower risk of heart failure among men who consumed 8-14 drinks per week compared to those who didn’t drink. (Sorry, ladies, no statistically significant association was observed in women.)

In another study, adults age 65 years or older who consumed 7-13 drinks per week had a 34% lower risk of heart failure.

Alcohol and Sudden Cardiac Death

Moderate alcohol intake has also been associated with a decrease in sudden cardiac death in healthy adults. In a study of 85,067 women without reported cardiovascular disease, light-to-moderate intake of alcohol was associated with a 36% lower risk of sudden cardiac death as compared to those who abstained from alcohol.

And a study of 22,071 apparently healthy male physicians showed that men who consumed light-to-moderate amounts of alcohol (two to six drinks per week) had up to an 80% lower risk of sudden cardiac death compared to non-drinkers.

This is great news for the occasional drinker, but here’s a scary finding: When it comes to people who drank more than six alcoholic beverages a day, the risk of sudden death was increased more than twofold.

Alcohol and Coronary Artery Disease

According to the authors, research over the past 30 years has consistently shown the protective effect of moderate alcohol consumption on fatal and non-fatal coronary artery disease (CAD). However, some studies show a protective effect at moderate levels and increasing mortality at higher levels, while others show that protection does not decrease with heavy drinking (more than four to five drinks per day).

Here, drinking frequency may be more important than quantity. One study showed a similar risk of incidence of CAD in men who drank as much as three to four drinks per day if they consistently drank over five to seven days per week and in light drinkers (one drink per day) as long as it was spread over seven days.

The cardio-protective benefits were similar in women, with the caveat being that heavy drinking had a negative impact. For women, the benefits became muted after two drinks per day and became a statistically significant risk factor after four to five drinks per day, regardless of days spent drinking each week.

It does seem as though women get the short end of the stick when it comes to the heart benefits of alcohol, and researchers have developed theories around this, including that women are more susceptible to cirrhosis than men, and this can lead to decreased levels of HDL.

So far we’ve discussed the effects of alcohol on healthy adults, but are there also benefits for those who already have coronary artery disease or CAD risk factors?

Studies showed a statistically significant reduction (15%-25%) of all-cause mortality for subjects with pre-existing CAD who drank moderately, relative to non-drinkers. And researchers who analyzed data from the US Cancer Prevention II Study involving 490,000 men and women, found that regular drinkers with cardiovascular-related conditions (CAD, stroke, diabetes, hypertension) had a greater reduction in CAD mortality versus a similar group of non-drinkers.

The Good and Bad News

So it seems we can confidently say that research points to the protective heart benefits of moderate drinking, especially for men.

To sum up, the authors concluded: “From available studies, the majority of evidence indicates that moderate alcohol consumption (typically defined as <30 g of ethanol or less than 2 drinks per day) does provide an all-cause mortality benefit. Specifically, a moderate level of alcohol intake has been associated with decreased CAD-associated mortality in patients with pre-existing CAD or CAD risk-factors, regardless of gender. Likewise, there is a decreased risk of heart failure, sudden cardiac death, and an improved lipid profile with increased HDL and decreased LDL in adults who drink moderate amounts of alcohol.”

Now the bad news …

The authors also were careful to point out the risks of alcohol, which include greater incidence of ear, nose and throat cancer, and colorectal cancer at moderate levels, and cirrhosis even at light levels. Furthermore, heavy drinking has been linked with alcoholic cardiomyopathy, atrial fibrillation, blood pressure elevation and, as we mentioned, a more than twofold increase in sudden cardiac death.

So, as with most things in life, it would seem that moderation is the key.

[1] Eapen D et al. Alcohol and the Heart: An Ounce of Prevention. Current Treatment Options in Cardiovascular Medicine. 2011 May 12: DOI 10.1007/s11936-011-0131-z.

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