Alcohol and Your Heart: Is Any Amount Safe?

Everyone has heard — and many have long believed — the adage that a daily glass of red wine does the heart good. The reasoning? Antioxidants found in wine appear to increase high-density lipoprotein (HDL) cholesterol, called the “good” cholesterol. These antioxidants, known as polyphenols, may safeguard the lining of blood vessels in the heart.

“There’s certainly a layperson awareness of this,” says Andrew D. Bromley, M.D., a preventive cardiologist at the University of Miami Health System. “Alcohol comes up if not daily, then weekly, with patients asking about it.”

The link between the consumption of red wine (or any alcoholic drink) and better cardiovascular health is weak, partially because it’s difficult to draw a straight cause-and-effect line.

What’s more, cardiovascular disease (CVD) is “a broad umbrella” of many diseases, and not all are affected in the same way by alcohol, says Dr. Bromley.

The most often-cited study backing up the red wine theory is one published in the New England Journal of Medicine that analyzed the Mediterranean diet’s positive impact on the risk of heart disease. The diet is rich in fruits and vegetables, nuts, olive oil — and wine and alcohol. From that, scientists and the public extrapolated that moderate alcohol consumption was not, as Dr. Bromley puts it, “deleterious” and might help with its anti-inflammatory components.

A growing body of medical literature has shown that alcohol can raise a person’s risk of coronary heart disease. 

The most recent study suggests that even moderate drinking, defined as more than one drink per day — or as few as eight a week — can increase the risk of coronary heart disease, particularly for women. The extensive study, by Kaiser Permanent Northern California, was funded by the National Institutes of Health and the National Institute on Alcohol Abuse and Alcoholism. It received attention because it focused on women, and the use of alcohol among young and middle-aged women has been steadily increasing over the years, with the number of women’s alcohol-related deaths increasing faster than for men.

Many people are affected by coronary heart disease (when the heart’s arteries have plaque buildup and, therefore, cannot carry enough oxygen-rich blood to the organ). It is the most common type of heart disease in the country and the top disease killer of American women, according to the Centers for Disease Control and Prevention.

The Kaiser research, presented at the American College of Cardiology’s Annual Scientific Session earlier this year, found that women who drank eight or more alcoholic beverages per week were 33-51% more likely to develop coronary heart disease.

That risk skyrocketed for women who binge drink, defined as three alcoholic beverages per day.

Female binge drinkers were 68% more likely to develop coronary heart disease.

The strong link between alcohol and coronary heart disease was true for both men and women in the study, but the risk was considerably higher among women.

This does not surprise Dr. Bromley. In general, women face more adverse reactions from smoking and drugs because they tend to be smaller and weigh less. They also metabolize substances differently, he says.

The Kaiser research also underscored previous research that showed the direct effect of alcohol on heart health.  One meta-analysis, for example, found that the risk of a CVD event was higher within 24 hours of alcohol consumption.

Another review of hundreds of studies looked at the effects of alcohol on four kinds of major CVD sub-categories: Ischaemic Heart Disease and ischaemic stroke, hemorrhagic stroke, hypertension, atrial fibrillation, cardiomyopathy, and heart failure. Calling the relationship between heart disease and alcohol consumption “complex,” it concluded that “the beneficial associations tend to be overestimated” in most cases.

The sometimes conflicting messages from the research can be confounding for people.

So, Dr. Bromley gives his patients simple advice:  If you’re not a drinker, don’t start now. Your heart will thank you.

And if you’re drinking more than the recommendations from the Dietary Guidelines for Americans, you should cut back immediately.

The official recommendation for women is no more than one drink a day. (A drink is defined as 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of liquor with 40% alcohol.) For men, the recommendation allows for two drinks.

Dr. Bromley also details the negative impact of alcohol consumption. 

Alcohol can lead to high blood pressure, heart failure, stroke, and cardiomyopathy, a disease of the heart muscle.  

It should be viewed as a toxin to the cardiovascular system.

But there is good news. Some, but not all, of alcohol’s ill effects might be reversed when alcohol consumption is stopped or reduced. For example, blood pressure can improve when a person quits drinking. On the other hand, a condition known as cardiomegaly, the enlargement of the heart, cannot be reversed.

 “We know that [depending on age and the years of drinking] some of the risk can be reversed,” says Dr. Bromley.

This information can serve as sound guidance for anyone, woman or man, weighing the risk-benefit equation of drinking that second glass.

Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is an acclaimed author and journalist who has worked at The Miami Herald, The Miami News, and The Palm Beach Post.

Tags: Dr. Andrew Bromley, heart health in Miami, preventative cardiology, reduce your risk