Alcohol and Heart Disease: Myths and Facts

Most people don't think of alcohol as a drug... but it is. Alcohol abuse has destroyed more lives,broken apart more families...

Written by Dr Upendra Kaul | Published:April 18, 2009 11:32 pm

Most people don’t think of alcohol as a drug… but it is. Alcohol abuse has destroyed more lives,broken apart more families,caused more diseases and contributed to more auto fatalities than any other drug. It is also the major contributing factor in the growing epidemic of domestic violence.

Lately,a lot of interest has been generated between alcohol consumption and heart disease. There is some epidemiological data suggesting that moderate alcohol consumption may protect individuals against a heart attack and cardiovascular problems. Prof Upendra Kaul clarifies some of these views.

Cardiovascular diseases with ischemic heart problems (stable angina,unstable angina,acute myocardial infarction,heart failure) top the list of causes of death in most societies. The underlying cause is the narrowing of blood vessels supplying the heart muscle due to cholesterol and fatty depositions.

Brain stroke is another important cause of death.

The cause in around 80 per cent cases is blockage of blood vessels supplying the brain (Ischemic stroke). In the remaining 20 per cent cases,it is rupture of a blood vessel in the brain (Haemorrhagic stroke).

Other cardiovascular diseases include peripheral vascular disease (due to blockages of arteries supplying the limbs) and other diseases affecting the structure and functioning of the heart.

High blood pressure or hypertension is a major risk factor for both heart attacks and strokes.

Research till date has shown that the relationship between alcohol and cardiovascular disease is complex and not necessarily straightforward. There are some reported risks and also some benefits as seen in population-based studies.

The ultimate outcome does not depend only on the amount of alcohol consumed over time but also on the pattern of drinking and the age and gender of the person.

Harmful effects: Long-term heavy drinking is associated with high blood pressure,strokes,and cardiomyopathy (weakness of the heart muscle,making pumping of blood inefficient). A heavy drinking bout or a holiday binge (Holiday Heart Syndrome) can result in chaotic and irregular heart rhythm,leading to breathlessness,change in blood pressure,syncope and even sudden death.

Beneficial effects: There is strong evidence that regular intake of relatively small amounts of alcohol reduces the risk of ischemic heart disease middle-age onwards. The benefit comes mainly from the ethanol component of the alcohol and not the type of beverage consumed.

This protective effect does not increase by taking alcohol in larger amounts. In fact,larger amounts are deleterious for the heart and can lead to heart failure and risk of death from other causes.

Alcohol also increases HDL cholesterol level in blood,which is cardio-protective and also reduces the stickiness of platelets in the blood,thus reducing heart attacks and strokes because of less clot formation in blood vessels.

Which type of alcoholic drink is most beneficial?

There had been much speculation in recent years about which type of alcohol is most beneficial. Red wine was supposed to be better than other forms of alcohol. It has,however,been suggested now that alcohol in general is associated with a lower risk of coronary disease. There is no evidence suggesting that red wine in particular may provide protection.

There is also some support for the speculation that drinking with meals may be more beneficial.

What is moderate drinking?

Men should drink no more than two to three units of alcohol a day. Women should drink no more than one to two units of alcohol a day.

One unit of alcohol is a small glass of wine or half a pint of normal strength lager,cider or beer or one pub measure of spirits.

These guidelines apply whether you drink every day,once or twice a week or occasionally. If you drink too much,avoid alcohol for 48 hours to give your body time to recover.

Points to remember

Heart attacks and related problems:

While there is some evidence regarding protective effect of alcohol on reducing heart attacks,this applies only to older people.

Older people who are non-drinkers,can protect themselves using other lifestyle measures like exercise,no smoking and heart healthy diet. You do not have to start consuming alcohol if you have not been taking it.

Strokes:

It is very clear that heavy drinking is a risk factor for both types of strokes (Ischemic and Haemorrhagic). Evidence regarding the effect of moderate or low-risk drinking is not very clear. It however appears that there could be some benefit in reducing ischemic strokes but haemorrhagic strokes could increase.

High blood pressure:

The risk of high blood pressure increases with heavy drinking and reducing drinking helps in better control of blood pressure. At lower levels of drinking,the picture is not clear and more data is required to ascertain whether moderate drinking has any potential benefits in reducing vascular complications.

Cardiomyopathy:

Long-term drinking,especially in excessive amounts,is known to weaken the heart muscles and reduces the efficiency of its functioning and is a known cause of heart failure.

Recommendations:

• Consult a physician for an assessment of risks and benefits of alcohol consumption. Persons with a personal or family history of alcoholism,high triglyceride levels,pancreatitis,liver disease,certain blood disorders,heart failure,and uncontrolled hypertension,as well as pregnant women and persons on certain medications that interact with alcohol,should not consume any alcohol.

• If no contra-indications to alcohol consumption are present,moderate consumption of alcohol (one or two drinks per day) may be considered safe.

• Alcohol should never be consumed when operating machinery or motor vehicles.

• The risks and benefits of alcohol consumption should be reviewed periodically as part of regular medical care. In the event of excess consumption,problem drinking,or deleterious consequences of drinking,recommendations for alcohol consumption should be revised.

• Adolescents and young adults should be targeted for assessment and advice before potentially deleterious habits of consumption become established.

The writer is Executive Director,Cardiology,Escorts Heart Institute and Research Centre and Fortis Hospital,Vasant Kunj,New Delhi

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