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Shrunken Brains vs. Healthier Hearts

The pluses and minuses for seniors who drink

THURSDAY, Sept. 6, 2001 (HealthDayNews) -- Don't start -- or stop -- drinking alcohol just yet. What some think is good for your heart may be bad for your brain.

Many studies have found that light drinking of red wine, beer or other alcohol may protect against heart disease to some extent. But a study just published in Stroke: Journal of the American Heart Association finds that drinking alcohol has both pluses and minuses when it comes to three types of brain abnormalities: silent strokes, brain atrophy and white matter lesions, all of which interfere with mental and neurological functioning.

Researchers led by Dr. Kenneth J. Mukamal, an internist at Beth Israel Deaconess Medical Center in Boston and an instructor at Harvard Medical School, looked at brain scans of 3,376 men and women, all over age 65, who were part of the Cardiovascular Health Study, a long-term national study of heart disease and other conditions of old age. Participants were asked how often they drank 12 ounces of beer, six ounces of wine or a shot of liquor (Each contains about one ounce of alcohol.) They were then divided into six categories: abstainers, former drinkers, less-than-one-drink weekly, one-to-six-drinks weekly, seven-to-14-drinks weekly and 15-or-more-drinks weekly.

Those who drank more than twice a day (at least 15 drinks a week) had a 41 percent lower risk for a silent stroke than abstainers, a finding in keeping with previous studies. Alcohol is a blood thinner and also is thought to raise levels of HDL (''good'') cholesterol to a certain extent.

Those who drank one to six drinks weekly (light drinkers) had fewer white matter lesions than either abstainers or people who drank more than 15 times a week. White matter lesions are tiny areas of scarring in brain tissue that have been linked to mental weakness and motor difficulties, such as trouble buttoning a shirt.

One surprising result was that the brain seems to shrink for all drinkers, and the more a person drank, the more the brain shrank. Previous studies of brain atrophy (shrinking partly because cells are dead or dying) tended to look at alcoholics, not occasional drinkers. "This changes somewhat what we have thought about alcohol," says Mukamal.

So should you drink more or less?

Mukamal says, "It's not clear which of these three conditions is the worst. If you had to choose between brain shrinkage and [silent] stroke, it's not clear. I don't think this by itself should lead anybody to change how much they drink. It highlights again that alcohol has a bewildering array of associations, and how all of those play out isn't so obvious from the start."

People also need to consider other health risks of alcohol, such as accidents, obesity and breast cancer. It's also important to note that the study's participants were healthier than the general population and didn't have any cerebrovascular disease.

"There's a push in neurology and cardiology literature to encourage people to have some wine, and this study raises the question. Alcohol may reduce the incidence of stroke and cardiac disease but may increase the likelihood of having brain atrophy," says Dr. Daniel Rosenbaum, professor of neurology at Albert Einstein College of Medicine and director of the Stern Stroke Center at Montefiore Medical Center in New York City.

He says, "You have to weigh the risk-benefit. Are people better off taking it or abstaining? It's a provocative article in terms of raising this question: Is alcohol, even in lower doses, as good as it's reportedly been pushed? I don't think you can say that this study shows definitively that low levels of alcohol lead to atrophy, but it's provocative and it raises the question."

What To Do

The American Heart Association has a more definite stance: If you don't drink, don't start. Drinking increases your risk of obesity, alcoholism, high blood pressure, breast cancer, suicide and other problems, the association says.

For more information about the brain visit Harvard University or the Brain Connection.

For more information about stroke, visit the American Stroke Association, the National Stroke Association or the National Institute of Neurological Disorders and Stroke.

SOURCES: Interviews with Kenneth J. Mukamal, M.D., internist, Beth Israel Deaconess Medical Center, Boston, Mass., and instructor, Harvard Medical School; Daniel Rosenbaum, M.D., professor of neurology, Albert Einstein College of Medicine, and director, Stern Stroke Center, Montefiore Medical Center, Bronx, N.Y. September 2001 Stroke: Journal of the American Heart Association
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