Alcohol and cardiovascular disease

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Total recorded alcohol per capita consumption, in litres of pure alcohol Alcohol by Country.png
Total recorded alcohol per capita consumption, in litres of pure alcohol

In a 2018 study on 599,912 drinkers, a roughly linear association was found with alcohol consumption and a higher risk of stroke, coronary artery disease excluding myocardial infarction, heart failure, fatal hypertensive disease, and fatal aortic aneurysm, even for moderate drinkers. [2] [ non-primary source needed ] The American Heart Association states that people who are currently non-drinkers should not start drinking alcohol. [3]

Contents

Excessive alcohol intake is associated with an elevated risk of alcoholic liver disease (ALD), heart failure, some cancers, and accidental injury, and is a leading cause of preventable death in industrialized countries. [4] Some studies have suggested that one drink per day may have cardiovascular benefits. However, these studies are controversial, [5] and the common view is that no level of alcohol consumption improves health. [6] There is far more evidence for the harmful effects of alcohol than for any beneficial effects. [7] It is also recognized that the alcohol industry may promote the unsubstantiated benefits of moderate drinking. [8]

Alcohol intake and cardiovascular disease

Some early reviews showed that light alcohol consumption may have a protective effect on cardiovascular health. For instance, a meta-analysis from 2010 found that patients with cardiovascular disease who were light to moderate alcohol consumers, were less likely to suffer from cardiovascular and all-cause mortality. [9] However, the researchers warned against encouraging cardiovascular patients who do not regularly consume alcohol to start drinking due to lack of controlled intervention studies and evidence. [9]

Several possible mechanisms have been suggested for the cardioprotective effect of alcohol. These include glucose control, lipid metabolism, and metabolism as a whole. [10] However, another possible explanation is that the cardioprotective effect is only a confounding research result. [11] A logical possibility is that some of the alcohol abstainers in research studies previously drank excessively and had undermined their health. After they quit they were categorized as non-drinkers, which in turn lead to more sick people in the non-drinkers category. To test this hypothesis, a 2019 meta analysis has recategorized people accordingly. As a result, no benefit was found for alcohol consumption of any dosage, moreover, alcohol was detrimental to health even at low doses. [12]

The American Heart Association states that drinking too much alcohol increases health risks including cardiovascular disease precursors such as obesity, high blood pressure, high triglycerides and also heart attacks and strokes. They warn that "We’ve all seen the headlines about studies associating light or moderate drinking with health benefits and reduced mortality. Some researchers have suggested there are health benefits from wine, especially red wine, and that a glass a day can be good for the heart. But there’s more to the story. No research has proved a cause-and-effect link between drinking alcohol and better heart health." [5]

Alcohol reduction

It is well known that alcohol consumption increases the risk of hypertension. Hence, many clinical trials examined the effect of reduction in alcohol consumption on blood pressure. Systematic review and meta-analysis have shown that effect of alcohol reduction on blood pressure is dose dependent. [13]

I. For people who consumed 2 or fewer drinks per day, blood pressure was not significantly decreased when they reduced alcohol consumption close to abstinence.
II. For people who consumed 3 or more drinks per day, blood pressure was significantly decreased when they reduced alcohol consumption close to abstinence.
III. For people who consumed 6 or more drinks per day, reduction rate on blood pressure was the strongest when they reduced alcohol consumption close to abstinence.
IV. The effect of alcohol reduction on blood pressure is still unclear for women and hypertensive patients who consume less than three drinks per day due to limited clinical trials.

History

In 2010, a systematic review reported that moderate consumption of alcohol does not cause harm to people with cardiovascular disease. However, the authors did not encourage people to start drinking alcohol in the hope of any benefit. [14]

See

Related Research Articles

<span class="mw-page-title-main">Alcoholism</span> Problematic excessive alcohol consumption

Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World Health Organization (WHO) estimated there were 283 million people with alcohol use disorders worldwide as of 2016. The term alcoholism was first coined in 1852, but alcoholism and alcoholic are sometimes considered stigmatizing and to discourage seeking treatment, so diagnostic terms such as alcohol use disorder or alcohol dependence are often used instead in a clinical context.

<span class="mw-page-title-main">Coronary artery disease</span> Reduction of blood flow to the heart

Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the cardiac muscle due to build-up of atherosclerotic plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, and myocardial infarction.

<span class="mw-page-title-main">Hypertension</span> Long-term high blood pressure in the arteries

Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia. Hypertension is a major cause of premature death worldwide.

<span class="mw-page-title-main">Alcoholic liver disease</span> Medical condition

Alcoholic liver disease (ALD), also called alcohol-related liver disease (ARLD), is a term that encompasses the liver manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with liver fibrosis or cirrhosis.

The long-term effects of alcohol have been extensively researched. The health effects of long-term alcohol consumption on health vary depending on the amount consumed. Even light drinking poses health risks, but small amounts of alcohol may also have health benefits. Alcoholism causes severe health consequences which outweigh any potential benefits.

<span class="mw-page-title-main">Mediterranean diet</span> Diet inspired by the Mediterranean region

The Mediterranean diet is a diet inspired by the eating habits and traditional food typical of southern Spain, southern Italy, and Crete, and formulated in the early 1960s. It is distinct from Mediterranean cuisine, which covers the actual cuisines of the Mediterranean countries, and from the Atlantic diet of northwestern Spain and Portugal. While inspired by a specific time and place, the "Mediterranean diet" was later refined based on the results of multiple scientific studies.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

<span class="mw-page-title-main">Indapamide</span> Thiazide-like diuretic drug

Indapamide is a thiazide-like diuretic drug used in the treatment of hypertension, as well as decompensated heart failure. Combination preparations with perindopril are available. The thiazide-like diuretics reduce risk of major cardiovascular events and heart failure in hypertensive patients compared with hydrochlorothiazide with a comparable incidence of adverse events. Both thiazide diuretics and thiazide-like diuretics are effective in reducing risk of stroke. Both drug classes appear to have comparable rates of adverse effects as other antihypertensives such as angiotensin II receptor blockers and dihydropyridine calcium channel blockers and lesser prevalence of side-effects when compared to ACE-inhibitors and non-dihydropyridine calcium channel blockers.

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Brief intervention can often be referred to as screening and brief intervention (SBI) or, in England, identification and brief advice (IBA). Brief interventions are a technique used to initiate change for an unhealthy or risky behaviour such as smoking, lack of exercise or alcohol misuse. This page primarily describes brief interventions as applied to alcohol. As an alcohol intervention it is typically targeted to non-dependent drinkers, or drinkers who might be experiencing problems but are not seeking treatment. It is an approach which aims to prevent the acceleration or impact of alcohol problems, and/or to reduce alcohol consumption. It can be carried out in a range of settings such as in primary care, emergency or other hospital departments, criminal justice settings, workplaces, online, university/college settings, and other settings.

Alcohol has a number of effects on health. Short-term effects of alcohol consumption include intoxication and dehydration. Long-term effects of alcohol include changes in the metabolism of the liver and brain, several types of cancer and alcohol use disorder. Alcohol intoxication affects the brain, causing slurred speech, clumsiness, and delayed reflexes. There is an increased risk of developing an alcohol use disorder for teenagers while their brain is still developing. Adolescents who drink have a higher probability of injury including death.

<span class="mw-page-title-main">Health effects of wine</span> Potential health effects resulting from drinking wine

The health effects of wine are mainly determined by its active ingredient – alcohol. Preliminary studies found that drinking small quantities of wine, particularly of red wine, may be associated with a decreased risk of cardiovascular diseases, cognitive decline, stroke, diabetes mellitus, metabolic syndrome, and early death. Other studies found no such effects.

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In medicine, systolic hypertension is defined as an elevated systolic blood pressure (SBP). If the systolic blood pressure is elevated (>140) with a normal (<90) diastolic blood pressure (DBP), it is called isolated systolic hypertension. Eighty percent of people with systolic hypertension are over the age of 65 years old. Isolated systolic hypertension is a specific type of widened pulse pressure.

<span class="mw-page-title-main">Alcoholic cardiomyopathy</span> Medical condition

Alcoholic cardiomyopathy (ACM) is a disease in which the long-term consumption of alcohol leads to heart failure. ACM is a type of dilated cardiomyopathy. The heart is unable to pump blood efficiently, leading to heart failure. It can affect other parts of the body if the heart failure is severe. It is most common in males between the ages of 35 and 50.

<span class="mw-page-title-main">Binge drinking</span> Form of excessive alcohol intake

Binge drinking, or heavy episodic drinking, is drinking alcoholic beverages with an intention of becoming intoxicated by heavy consumption of alcohol over a short period of time, but definitions vary considerably.

<span class="mw-page-title-main">Myocardial infarction</span> Interruption of cardiac blood supply

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<span class="mw-page-title-main">Health effects of salt</span> Conditions associated with the consumption of either too much or too little salt

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References

  1. ↑ World Health Organization (2004). Global Status Report on Alcohol 2004 (PDF). Geneva. ISBN   978-92-4-156272-0.{{cite book}}: CS1 maint: location missing publisher (link)
  2. ↑ Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, et al. (2018). "Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies". The Lancet. 391 (10129): 1513–1523. doi:10.1016/S0140-6736(18)30134-X. PMC   5899998 . PMID   29676281.
  3. ↑ "Alcohol and Heart Health". American Heart Association. August 15, 2014.
  4. ↑ Centers for Disease Control and Prevention (CDC) (2004). "Alcohol-attributable deaths and years of potential life lost--United States, 2001". MMWR. Morbidity and Mortality Weekly Report. 53 (37): 866–870. PMID   15385917.
  5. 1 2 American Heart Association (2020). "Is drinking alcohol part of a healthy lifestyle?". American Heart Association.
  6. ↑ Burton, Robyn; Sheron, Nick (September 2018). "No level of alcohol consumption improves health". The Lancet. 392 (10152): 987–988. doi: 10.1016/S0140-6736(18)31571-X . PMID   30146328. S2CID   52075453.
  7. ↑ Fekjær, Hans Olav (December 2013). "Alcohol—a universal preventive agent? A critical analysis". Addiction. 108 (12): 2051–2057. doi: 10.1111/add.12104 . ISSN   0965-2140. PMID   23297738.
  8. ↑ Casswell, Sally (April 2013). "Vested interests in addiction research and policy. Why do we not see the corporate interests of the alcohol industry as clearly as we see those of the tobacco industry?: Alcohol corporate interests compared with tobacco". Addiction. 108 (4): 680–685. doi:10.1111/add.12011. PMID   23496067.
  9. 1 2 Costanzo, S; Di Castelnuovo, A; Donati, MB; Iacoviello, L; de Gaetano, G (2010). "Alcohol consumption and mortality in patients with cardiovascular disease: a meta-analysis". Journal of the American College of Cardiology. 55 (13): 1339–1347. doi:10.1016/j.jacc.2010.01.006. PMID   20338495.
  10. ↑ Fragopoulou, E; Choleva, M; Antonopoulou, S; Demopoulos, CA (2018). "Wine and its metabolic effects. A comprehensive review of clinical trials". Metabolism: Clinical and Experimental. 83: 102–119. doi:10.1016/j.metabol.2018.01.024. PMID   29408458. S2CID   29149518.
  11. ↑ Roerecke, Michael; Rehm, Jürgen (2014-10-21). "Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers". BMC Medicine. 12 (1): 182. doi: 10.1186/s12916-014-0182-6 . ISSN   1741-7015. PMC   4203905 . PMID   25567363.
  12. ↑ Stockwell, Tim; Zhao, Jinhui; Panwar, Sapna; Roemer, Audra; Naimi, Timothy; Chikritzhs, Tanya (March 2016). "Do "Moderate" Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality". Journal of Studies on Alcohol and Drugs. 77 (2): 185–198. doi:10.15288/jsad.2016.77.185. ISSN   1938-4114. PMC   4803651 . PMID   26997174.
  13. ↑ Roerecke, M; Kaczorowski, J; Tobe, SW; Gmel, G; Hasan, OSM; Rehm, J (2017). "The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis". The Lancet. Public Health. 2 (2): e108–e120. doi:10.1016/S2468-2667(17)30003-8. PMC   6118407 . PMID   29253389.
  14. ↑ Costanzo S, Di Castelnuovo A, Donati MB, Iacoviello L, de Gaetano G (2010). "Alcohol consumption and mortality in patients with cardiovascular disease: a meta-analysis". J. Am. Coll. Cardiol. 55 (13): 1339–1347. doi:10.1016/j.jacc.2010.01.006. PMID   20338495.
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