Is alcohol a risk for heart attack even in small amounts? Here’s separating fact from fiction

With studies flawed, understand your safety limits

Alcohol can cause irregular heartbeats or arrhythmia. (Photo: Getty Images/Thinkstock)

How many times have you read that red wine is good for the heart and that it might be the safest option for you even after you have developed a condition? So many of my patients plead with me about being allowed to drink moderately, citing studies on the subject. Truth is alcohol is a no-no for anybody with a heart condition or in the high risk group, considering that Indians are genetically more prone to heart attacks than any other population and have co-morbidities like diabetes.

None of these studies ever established cause and effect and there were few randomised trials that actually show alcohol to be safe for the heart. Many studies in Southeast Asia, in fact, showed that alcohol was damaging. And now a latest review of all studies on the subject, published in the Journal of Studies on Alcohol and Drugs, shows that such studies were based on flawed scientific research.

HOW DOES ALCOHOL AFFECT THE HEART?

Alcohol can cause irregular heartbeats or arrhythmia. That’s because it breaks down in the body and releases ketones, a type of acid that forms when the body breaks down fat for energy. This causes electrolyte imbalance that interferes with the electrical impulses in the heart.

Since alcohol is toxic for tissues, drinking large amounts can trigger alcohol-induced cardiomyopathy, a condition where heart tissue is weakened. The heart then doesn’t pump oxygenated blood as effectively. Regular drinking pushes up blood pressure, which stresses out the heart muscle and increases your risk of heart attack and stroke.

If you have alcohol in small doses, then the calories produced are never regulated or metabolised by the body. Each drink contains 100-150 empty calories, which get converted to body fat. So having alcohol is like having unregulated sugar resulting in obesity. Alcohol contains around 7 kcal per gram. In comparison, carbohydrates contain 4 kcal per gram.

I AM DRINKING MODERATELY, SO I AM SAFE

If you drink regularly and think you are in control, it means you have developed a tolerance to some of the effects. This is usually the beginning of addictive behaviour. So if you have co-morbidities like diabetes, cholesterol and high blood pressure, quit at this stage.

Also Read | How to exercise after a heart attack and blood clots

WHY ARE FRENCH WINE DRINKERS NOT AT HIGH RISK?

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This is called the French paradox, a situation where the French report lower numbers of heart disease while having cheese in their diet. This is because the French offset damages by being very disciplined about diet, walking and exercise. Most of them sip a very small amount of wine through their meal, eat clean and healthy (like the Mediterranean diet), and almost never eat dinner but supper.

Many argue that red wine has a heart-protective compound like resveratrol. But its benefits were only seen in a mice study. One would have to drink many glasses of red wine daily to get an amount equivalent to the doses that improved health in mice. Besides, studies in the Italian wine region of Chianti found no link between resveratrol and heart disease, cancer or death. So a good lifestyle may be their shield instead.

(Dr Shetty is interventional cardiologist at Manipal Hospitals, Bengaluru)