Alcohol: Part of a Heart-Healthy Lifestyle?

Summer is here and we’re enjoying barbeques—which means beer, lighter wines, along with gin and tonics. So I’d like to tackle a somewhat controversial question: Is alcohol OK to drink? What if you have heart problems? And how much is acceptable?

First, I have to point out straightaway that too much alcohol can cause major toxicity to the body—particularly to the liver, the brain and yes, the heart.  In fact, there is a type of heart dysfunction that we call alcoholic cardiomyopathy.  People who develop organ toxicity from alcohol usually consume vast amounts, though. So, the question I am asking this week is whether lower levels of drinking are consistent with good health in general, and heart health in particular.

The answer is “Yes”, but I must add an important caveat.  If you have a personal history of alcoholism, it is best to abstain from alcohol completely. And if you have a family history of alcoholism—particularly in first degree relatives—consider carefully whether you should start if you haven’t previously been an alcohol drinker before. One of my patients this past week related to me—after I had told her at her previous visit that she can have one drink of alcohol a day—that “No, I CAN’T have one drink a day. I just can’t stop there.” For people like her, total abstinence is the only safe option.

With those warnings in place, let’s talk about how alcohol can potentially be beneficial to the heart. Alcohol in moderate amounts—and we’ll define what that means shortly—can raise HDL cholesterol (the “good” cholesterol) and has some blood-thinning effects that can lower the tendency to form clots, which are a component of how heart attacks occur. Furthermore, studies suggest—but don’t prove, as they are not “randomized controlled trials”—that mild to moderate alcohol consumption lowers the risk of heart attacks and dying.

Furthermore, some of the ingredients that alcohol comes “packaged” with may have health benefits of their own. In particular, red wine—due to the molecules in the skin of grapes—has anti-oxidative and anti-inflammatory properties that likely provide further health benefits on top of the alcohol itself. Beer may also have similar attributes.

So how do we define “moderate” alcohol consumption? It is 1-2 alcoholic beverages a day for men and 1 for women. Because women don’t metabolize alcohol as quickly as men, it takes less to have a beneficial (but also toxic) effect. One alcoholic beverage means 1.5 oz of liquor, 5 oz of wine or 12 oz of beer. Each of these has about the same amount of alcohol in it. But—for my weekend warriors: NO binge-drinking. You can’t “save up” your alcohol allotment and drink 7-14 drinks in 2-3 days!

Who else should be careful of alcohol? People with cardiomyopathies (weakened hearts), as alcohol can have a deleterious effect on heart function. As suggested earlier, anyone with a cardiomyopathy caused by alcohol should abstain completely. Those who have cardiomyopathies from another cause should consider abstaining or cut the volume I recommended above in half. Of note, I have seen patients with alcoholic cardiomyopathies—whose function was half of expected—return to normal after ceasing intake of alcohol.

Alcohol can raise the blood pressure, so avoid alcohol if your blood pressure is not under control. And, while alcohol can lower the risk of ischemic stroke (caused by a blocked artery), just as it does the risk of a heart attack, too much alcohol can increase the risk of hemorrhagic stroke (caused by a ruptured blood vessel). Thus, if you already have had a hemorrhagic stroke, ask your doctor if it’s safe to drink in small amounts. And finally, remember that alcohol and driving are not safe in any combination.

Thus, drinking alcohol is consistent with a heart-healthy lifestyle. And it can be pleasurable, in terms of enjoying the flavors, as well as the fun in sharing it in social situations.  But drink wisely and safely!

Greg Koshkarian, MD, FACC

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Gregory Koshkarian, MD, FACC