By Chris Woolston, M.S.
"God in His goodness sent the grape to cheer both great and small. Little fools drink too much and great fools none at all."
Ask a doctor about preventing heart disease, and you'll hear a lot of clear-cut advice. Saturated fat: bad. Smoking: very bad. Exercise: excellent. Ask a doctor about alcohol and the heart, however, and the easy answers disappear. Depending on how it's used, alcohol can either protect the heart or destroy it. So if you like alcohol, you may be able to add years to your life by learning the difference between a healthy indulgence and a life-threatening habit.
How does heavy drinking harm the heart?
For starters, large amounts of alcohol (more than two drinks a day) can raise your blood pressure to unhealthy levels. If, for example, you drink the equivalent of a six-pack of beer, a pint of whiskey, or a bottle and a half of wine every day for 10 years, that drinking will almost certainly damage parts of your heart. The result is often cardiomyopathy, a condition in which the heart muscle becomes weakened. In fact, after blocked arteries, alcohol is the second most common cause of cardiomyopathy in the United States.
Damaged hearts can't pump efficiently. They're also susceptible to blood clots and strange rhythms (arrhythmia), especially during alcohol binges. (Some doctors call these arrhythmia episodes "holiday heart.") If you keep drinking, the consequences are severe. About half of all alcoholics who keep drinking after developing cardiomyopathy die within four years.
The good news is that much of the damage is reversible. When alcoholics with cardiomyopathy abstain from drinking, blood pressure drops and the heart can quickly grow stronger. Best of all, more than 90 percent of them will still be alive four years later.
Heavy drinking -- usually described as three or more drinks a day -- over long periods of time has also been linked to hypertension (high blood pressure), stroke, cardiac arrhythmia, and sudden death.
How does moderate drinking protect the heart?
Most drinkers stop far short of a pint of whiskey or six-pack of beer every day. That's a good thing, because moderate drinking may be an effective weapon against heart disease. More than 60 studies suggest that moderate alcohol consumption is associated with a reduced risk of coronary heart disease. If you drink moderately, in fact, you are 40 percent less likely to develop coronary heart disease than nondrinkers are.
The federal government defines moderate drinking as up to two drinks a day for men and up to one drink a day for women. The different recommendations reflect the fact that women's bodies break down alcohol more slowly than men's do.
Alcohol does several favors for the heart. Most important, it boosts the amount of HDL ("good") cholesterol in the blood. This compound helps prevent the buildup of LDL ("bad") cholesterol, the artery-clogging fat that provides the raw material for a heart attack. However, the American Heart Association (AHA) points out that regular physical activity also raises HDL cholesterol -- so going to the gym instead of reaching for a drink would probably be a good choice. Alcohol also thins the blood, lowering the risk of dangerous blood clots. Small amounts of alcohol may slightly lower blood pressure as well, but probably not enough to make a difference.
Are some types of alcohol better than others?
The evidence isn't clear, but some studies suggest that wine -- especially red wine -- may be slightly better for the heart than other alcoholic beverages. Red wine contains antioxidant compounds, including one called resveratrol, that may protect arteries from damage by reducing platelet clumping. (Such clumping can increase the risk of the blood becoming too thick and forming clots.) According to the AHA's advisory on wine and heart disease, however, there's no conclusive indication that red wine is really more beneficial for the heart than white wine, beer, or other alcoholic drinks. (The AHA also advises that if wine does turn out to be especially beneficial, the same benefits can probably be obtained through grape juice.)
Should nondrinkers start drinking?
No, according to the AHA. In fact, the organization does not recommend drinking alcohol at all to gain any of its potential benefits. The AHA stresses that there is no scientific proof that alcohol can replace a healthy diet or exercise when it comes to your heart's health.
Teetotalers may be able to cut their risk of a heart attack by drinking beer, wine, or spirits -- but at what cost? Some may have a good reason to avoid alcohol: A few glasses of wine "for the heart" may uncover a hidden vulnerability to alcoholism, with potentially disastrous consequences. Furthermore, even moderate amounts of alcohol can increase the risks of car accidents, certain cancers (including breast and colon cancer), and, when consumed by pregnant women, birth defects.
If you don't drink alcohol now, talk to your doctor before filling up your glass. For someone at low risk for heart disease -- for instance, a young person with no family history of heart trouble -- the risks of drinking may far outweigh the benefits.
You should also talk to your doctor if you're a man with a long history of consuming more than two drinks each day or a woman whose daily long-term consumption has been more than one drink. Even if you aren't drinking enough to develop cardiomyopathy, you could be endangering your health. Protecting your heart is a good idea -- but not at the expense of the rest of your body.
American Heart Association http://www.americanheart.org/heart_andStroke_A_Z_Guide/alcohol.html
American Heart Association. Alcohol, Wine and Cardiovascular Disease.
Moderate alcohol intake and lower risk of coronary heart disease. Rimm, EB et al. British Medical Journal. 319: 1523-1528.
Muntwyler J et al. Mortality and light to moderate alcohol consumption after myocardial infarction. The Lancet. 352: 1882-1885.
Goldberg, Ira J., et al. Wine and your heart: an American Heart Association science advisory. Circulation: 2001; 103; 472.
Last Updated: March 11, 2013
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