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To Drink or Not to Drink

Critics question new study that says even heavy drinking can benefit the heart

TUESDAY, Feb. 5, 2002 (HealthDayNews) -- The latest study to confirm alcohol is good for some hearts is already drawing fire from critics who claim the results are misleading.

A group of Massachusetts researchers found drinking won't increase your risk of heart failure, and it may help protect even heavy drinkers from heart failure. The study appears in the current issue of the Annals of Internal Medicine.

However, experts say the results could lead some astray, particularly drinkers who may be at risk for alcohol-related heart failure and don't know it. At least one form of heart failure -- known as alcoholic cardiomyopathy -- can result from heavy drinking.

The researchers saw their mission this way: "Little is known about the effect of alcohol consumption on the incidence of heart failure in the general population," the study says. Their goal was to "examine the possibility of a relationship."

There is a relationship, says heart-failure expert Dr. Milton Packer, but it's not always a good one. In some, but not all, people who abuse alcohol, excessive drinking damages the heart's ability to pump blood, he explains. The danger is people who drink and are at risk for heart failure often don't know it until the damage is done, he adds.

"This is my problem with a study that shows alcohol consumption does not increase heart failure, because for those who are at risk for alcoholic cardiomyopathy, it definitely does. And often, those people are within the general population and don't know that they are at risk," says Packer, director of the Heart Failure Center at Columbia Presbyterian Medical Center in New York City.

Indeed, in a second article also published in the current issue of Annals of Internal Medicine, researchers found that limiting alcohol consumption in those who have heart failure shows positive results.

That research -- a joint project between doctors in Spain and those at Jefferson Medical College in Philadelphia -- found that limiting alcohol consumption to four drinks a day or less can promote improvement in people already diagnosed with alcohol-induced heart failure.

Heart failure, also known as cardiomyopathy, develops when the heart's pumping action can't meet the body's demands for circulation. Thus, blood destined for other organs instead backs up behind the heart. This leads to fluid accumulation in the lungs and other tissues, causing a kind of congestion. That's why it's often referred to as "congestive heart failure."

In the first study, the researchers were from the National Heart, Lung, and Blood Institute's Framingham Heart Study, which began in 1948. Their new analysis included the original 5,000 Framingham participants and an additional 5,000 of their offspring.

All 10,000 were checked at two-year intervals, with regular monitoring for signs of heart failure, as well as any form of cardiac disease. All health information and lifestyle habits were continually updated. This included questions about weekly consumption of cocktails containing 1.5 ounces of alcohol, as well as 12-ounce cans of beer and 4-ounce glasses of wine. All contain approximately the same amount of alcohol -- about 13 grams each, the study says.

The new analysis, however, also sought out only those people able to provide what the researchers termed "complete" information on alcohol consumption at their entry examination. To identify former drinkers, the researchers also looked for those people who had had an exam six to 10 years before their entry into the original Framingham study, to document their history of alcohol use or abuse.

In addition, those who reported having one drink or less a week were further divided into sub-groups, depending on whether they were former drinkers who simply cut down or quit, or had never consumed any significant amounts of alcohol.

The researchers' conclusion: "Among men, the risk of congestive heart failure was lower at all levels of alcohol consumption compared with non-drinkers" -- up to 75 percent less in some cases.

This, they say, was true even after the results were adjusted to compensate for other risk factors, such as smoking, excess weight, diabetes, high blood pressure, heart disease and age.

Indeed, even men who consumed more than 15 drinks a week still maintained nearly one-half the risk of heart failure than non-drinkers.

In women, the benefits of alcohol were slightly more modest. Those who consumed from one to seven drinks a week reduced their risk of heart failure by a little more than one-third compared to non-drinkers. Those who consumed from three to seven drinks a week reduced their risk by slightly more than half.

Unlike men, however, women who consumed larger amounts of alcohol -- more than eight drinks a week -- seemed to lose some of the protective edge, dropping their risk profile to just under that of non-drinkers.

The researchers credit the protective effects of alcohol to its ability to decrease the risk of cardiovascular disease, the leading cause of heart failure.

However, they caution that drinkers should remember that alcohol has well-documented negative health effects, including cirrhosis of the liver.

"What we can take home from this study is that for people not at risk for alcohol-related heart failure, drinking can have protective effects on the heart. But for those who are at risk -- and it's difficult to tell who those people are -- drinking in any amount can prove harmful," Packer says.

What To Do: To learn more about congestive heart failure, visit MedicineNet. You can also go to the The American Heart Association. And read what the association has to say about alcohol and heart disease.

SOURCES: Interview with Milton Packer, M.D., director, Heart Failure Center, Columbia Presbyterian Medical Center, New York City; Feb. 4, 2002, Annals of Internal Medicine
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