Alcohol Dosing and the Heart: Updating Clinical Evidence

Abstract

The consequences of heavy or irregular alcohol drinking have long been known. Recently, consistent information has been provided in support of an association between light/moderate alcohol consumption and protection from vascular and all-cause mortality, ischemic stroke, peripheral arterial disease, congestive heart failure, and recurrence of ischemic events. After reviewing the information with respect to major aspects of cardiovascular pathophysiology, to potential confounders and to underlying mechanisms, several concepts emerge. First, the recommended amounts of "safe alcohol drinking" in healthy individuals are up to two standard drinks (~20 g/d) for a man and up to one drink (10 g/d) for a nonpregnant woman. The overall balance for young premenopausal women, but not for older women, would be unfavorable for drinking. The risk of cancer would not outweigh potential benefits of alcohol on heart disease. Second, within the frame of a balanced pattern of dietary energy intake, patients with cardiovascular disease who drink alcohol should not exceed one or two standard drinks per day for women or up to two or three drinks per day for men. Third, the low rates of coronary heart disease among the Mediterranean people may be related to their pattern of drinking wine every day during meals. Regular drinking is associated with better outcomes than occasional (binge)/weekly drinking. Fourth, wine (ethanol with antioxidants) exhibits significantly higher anti-inflammatory effects than gin (ethanol without polyphenols), and thus in general wine should be preferred to liquor or beer.

Trends in Substance Abuse Preceding Stroke Among Young Adults

“…In our study both black race and male gender had increased association with overall use of substances (current smoking, alcohol, and street drug use combined). Alcohol intake at small amounts appears to be protective against cardiovascular events, while consumption at higher amounts is associated with increased risk of atrial fibrillation, ventricular fibrillation, dilated cardiomyopathy, hypertension, dyslipidemia, and a systemic anti-coagulant effect 27, 28 , all of which increase the risk of stroke. A analysis of a national survey reported an increased use of cocaine among men and blacks 29 and the Baltimore – Washington Young Stroke Study found more street drug use among blacks (but no gender differences).…”

The Good, the Bad, and the Ugly with Alcohol Use and Abuse on the Heart

“…Furthermore, clinical findings also suggest that low alcohol consumption also protects against peripheral artery disease and ischemic stroke. These outcomes were specifically found among people that drink light/moderate amounts of alcohol every day during meals, as opposed to binge drinking on a weekly basis (Di Minno et al., ).…”

Identifying high-risk individuals for cardiovascular disease: similarities between venous and arterial thrombosis in perspective. A 2011 update

“…Finally, rosuvastatin, a statin known to play a dominant role in the prevention of arterial events, prevents, in a time-dependent fashion, VTE [23]. Furthermore, fish, fruit, and vegetable intakes are related to a lower incidence of arterial events as much as they are with respect to VTE [24]; regular sports activities decreases the risk of arterial, as much as of venous thrombosis [25]; and moderate alcohol consumption reduces the risk of arterial events [26], as much as venous events [27]. All such observations strongly support the likelihood of an underlying pathogenetic link between venous and arterial thrombosis.…”