High Alcohol Consumption and the Heart

Let’s look at the effect of high alcohol consumption and the heart:

There has been much written about the risks and benefits of low alcohol consumption (e.g. ≤ 2-3 drinks per week) versus moderate (≤ 1 drink per day for women and ≤ 2 drinks per day for men) and high alcohol consumption (e.g. more than 7 drinks per week for women and 14 drinks per week for men, and/or binge drinking, i.e. ≥ 4 or 5 drinks over 2 hours for women and men, respectively ).
The amount of alcohol consumed habitually generally determines its positive or negative effects on health, including cardiac health. The potential benefits versus adverse effects of alcohol on cardiovascular risk certainly depend on the amount of alcohol consumed, drinking frequency, and the pattern of consumption (e.g. consistent versus binge consumption).

Several studies have concluded that low alcohol consumption has cardiovascular benefits.
In a study of more than 50,000 adults with a median age of 60 years, light-to-moderate drinkers (≤ 1 drink/day for women, ≤ 1-2 drinks/day for men) had a reduced risk of major adverse cardiovascular events (e.g. stroke, heart attack).
The investigators attributed this risk reduction to decreased stress based on brain scans. Several other studies have also shown that light/moderate alcohol consumption is associated with cardiovascular benefits compared with abstinence.

Possible explanations for the cardiovascular benefits of light/moderate alcohol consumption include increased HDL (“good”) cholesterol, adiponectin, and insulin sensitivity, and anti-anxiety and stress reduction effects.

A meta-analysis of 107 cohort studies involving nearly 5 million participants concluded that low alcohol consumption conferred neither benefit nor harm. Women appear to have a higher risk of all-cause mortality with moderate consumption than men.

A recent study concluded that more than one drink per day can increase cardiovascular risk (e.g.coronary artery disease), especially in women. The study evaluated data from more than 430,000 people with an average age of 44 years and no pre-existing heart disease.

Notably, even low alcohol consumption can increase the risk of breast, liver, colon, head and neck, and esophageal cancers. This must be weighed against the reduced cardiovascular risk associated with low alcohol use.

What can we conclude from these studies?
There appears to be minimal or no risk of overall mortality associated with up to 1 drink per day. There may be a benefit due to factors such as increased HDL cholesterol and reduced stress. It seems likely that 2-3 drinks per week is without risk of mortality in most people.

Next, we will have a look at the effects of moderate-to-high alcohol consumption.

Note: Although I am a physician, the content in this article is not meant to diagnose, treat, cure or prevent illness or disease in the reader – it is for educational purposes only.

References

1. Mezue K, Osborne MT, Abohashem S, et al. Reduced stress-related neural network activity mediates the effect of alcohol on cardiovascular risk. J Amer Coll Cardiol 2023;81(24), https://www.sciencedirect.com/science/article/pii/S0735109723054256?via%3Dihub
2. Di Castelnuovo A, Costanzo S, Bagnardi V, et al. Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med. 2006;166:2437–2445.
3. Zhao J, Stockwell T, Naimi T, et al. Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: A Systematic Review and Meta-Analyses. JAMA Netw Open 2023;6:e236185.