Alcohol and cardiovascular diseases: where do we stand today?

Abstract

Abstract. Klatsky AL (Northern California Kaiser Permanente, Oakland, CA, USA). Alcohol and cardiovascular diseases: where do we stand today?. (Review). J Intern Med 2015;278: 238-250.For centuries, multiple medical risks of heavy alcohol drinking have been evident with simultaneous awareness of a less harmful or sensible drinking limit. The increased risks of heavy drinking, defined as three or more standard-sized drinks per day, are both cardiovascular (CV) and non-CV. The CV risks include the following: (i) alcoholic cardiomyopathy (ACM), (ii) systemic hypertension, (iii) atrial arrhythmias, (iv) haemorrhagic stroke and, probably, ischaemic stroke. By contrast, modern epidemiological studies have shown lower morbidity and mortality amongst light-moderate drinkers, due mostly to a reduced risk of coronary artery disease (CAD), with contributions from ischaemic stroke and heart failure (HF). A low level of alcohol drinking has no clear relation to increased risk of any CV condition, except for haemorrhagic stroke. There is good evidence that supports the existence of mechanisms by which alcohol might protect against CAD, but the mechanisms for other alcohol-CV associations remain unclear. Interrelationships amongst the CV conditions affect the individual alcohol-disease relationships; for example, lower CAD risk in lightmoderate drinkers is to a large extent responsible for the reduced HF risk. International comparison data plus the presence of proposed beneficial nonalcohol components in wine (particularly in red wine) suggest that this beverage type might afford extra CAD protection. However, the effect of beverage choice is confounded by a healthier drinking pattern and more favourable risk traits in wine drinkers. Debate persists about methodological and public health issues related to the epidemiology of alcohol-related CV disease.

Cardiac manifestations in alcoholic liver disease

“…Acute alcohol consumption also decreases atrial current densities 41. Symptoms in patients with alcoholic cardiomyopathy include arrhythmias and heart failure, and are in accordance with reduced cardiac output 11. Even moderate alcohol consumption represents a risk factor for atrial fibrillation 43.…”

“…Between 23% and 40% of patients with cardiomyopathy develop the condition due to alcohol 39. It is estimated that significantly less chronic alcoholics develop alcoholic cardiomyopathy than the 15%–20% that develop liver cirrhosis 11. It has also been reported that alcoholic heart disease and alcoholic liver disease coexist in 10%–20% of patients with cirrhosis 4 5.…”

“…It has also been reported that alcoholic heart disease and alcoholic liver disease coexist in 10%–20% of patients with cirrhosis 4 5. Pathophysiology of alcoholic cardiomyopathy remains unclear 11. Mechanism comprised in pathophysiology of alcoholic cardiomyopathy include oxidative stress, cell apoptosis, calcium ion homeostasis impairment, mitochondrial dysfunction, fatty acid metabolism derangement and impaired transportation together with accelerated protein catabolism and autophagy 39.…”

“…Excessive alcohol consumption is associated with an increased risk of cardiovascular diseases, which includes alcoholic cardiomyopathy, elevated blood pressure, atrial arrhythmias, such as paroxysmal atrial fibrillation,11 as well as haemorrhagic and ischaemic stroke, with J-shaped association between alcohol intake and stroke morbidity and mortality 12. Supraventricular arrhythmias are usually induced by binge drinking, while systemic hypertension can be reversed by abstinence 11.…”

“…Supraventricular arrhythmias are usually induced by binge drinking, while systemic hypertension can be reversed by abstinence 11. However, light drinking has positive effect by reducing ischaemic stroke, heart failure and inducing higher levels of high-density lipoprotein (HDL) with subsequent reduction of coronary artery disease risk through removal of lipids on arterial walls and prevention of low-density lipoprotein (LDL) tissue oxidation 11…”