To Drink or Not to Drink? That Is the Question

Abstract

Abstract-Numerous studies have used a J-shaped or U-shaped curve to describe the relationship between alcohol use and total mortality. The nadir of the curves based on recent meta-analysis suggested optimal benefit at approximately half a drink per day. Fewer than 4 drinks per day in men and fewer than 2 per day in women appeared to confer benefit. Reductions in cardiovascular death and nonfatal myocardial infarction were also associated with light to moderate alcohol intake. Although some studies suggested that wine had an advantage over other types of alcoholic beverages, other studies suggested that the type of drink was not important. Heavy drinking was associated with an increase in mortality, hypertension, alcoholic cardiomyopathy, cancer, and cerebrovascular events, including cerebrovascular hemorrhage. Paradoxically, light-to-moderate alcohol use actually reduced the development of heart failure and did not appear to exacerbate it in most patients who had underlying heart failure. Numerous mechanisms have been proposed to explain the benefit that light-to-moderate alcohol intake has on the heart, including an increase of high-density lipoprotein cholesterol, reduction in plasma viscosity and fibrinogen concentration, increase in fibrinolysis, decrease in platelet aggregation, improvement in endothelial function, reduction of inflammation, and promotion of antioxidant effects. Controversy exists on whether alcohol has a direct cardioprotective effect on ischemic myocardium. Studies from our laboratory do not support the concept that alcohol has a direct cardioprotective effect on ischemic/reperfused myocardium. Perhaps the time has come for a prospectively randomized trial to determine whether 1 drink per day (or perhaps 1 drink every other day) reduces mortality and major cardiovascular events. Key Words: alcohol Ⅲ arrhythmia Ⅲ cardiomyopathy Ⅲ heart failure Ⅲ myocardial infarction A lcohol is an old drug that has attracted human interest for thousands of years. Evidence of wine making was depicted on the walls of the temples of the pharaohs in Egypt and the Sumerians of Mesopotamia. Scientific debate about the risks and benefits of alcohol started in Europe several centuries ago and continues today. How much alcohol should people drink, what should they drink, and who should be doing the drinking are important questions that need definitive answers. This article provides an in-depth analysis of the effect of alcohol on the human heart and its clinical relevance to patient care.A recurring theme is that although high doses of alcohol are harmful to the heart (cardiomyopathy, arrhythmias, and hypertension), mild to moderate alcohol consumption has been associated with reductions in coronary artery disease and even total mortality.When we reviewed the literature, it became very evident that definitions describing how much alcohol is in a drink vary remarkably by article and country, and terms such as light, moderate, and heavy drinking are variably defined. Table 1 provides some of the definitions we could...

The association between alcohol consumption and mortality: the Swedish women’s lifestyle and health study

“…Moderate intake of ethanol could prevent CVD by numerous biological mechanisms, such as improving endothelial function, lowering blood pressure, reducing inflammation, increasing high density lipoprotein (HDL) cholesterol and decreasing low density lipoprotein (LDL) cholesterol, enhancing fibrinolysis, inhibiting platelet aggregation and coagulation, attenuating insulin resistance, and releasing stress (6,40,41). In addition to ethanol, other components of alcoholic beverages, thus as flavonoids and resveratrol, prevent CVD in ways similar to ethanol (6).…”

“…In addition to ethanol, other components of alcoholic beverages, thus as flavonoids and resveratrol, prevent CVD in ways similar to ethanol (6). An open issue is whether the apparent benefit of ethanol for vascular health depends on alcoholic beverage type.…”

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Canadian Cardiovascular Society Consensus Conference guidelines on heart failure – 2008 update: Best practices for the transition of care of heart failure patients, and the recognition, investigation and treatment of cardiomyopathies

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“…Even though the models for each social problem may appear mathematically similar at the onset, there are fundamental differences which must be catered for. For example, a small intake of alcohol may be beneficial to health as shown by the J-shaped curve 3 of alcohol intake against health problems [27,22]. For smoking however, the graph of amount smoked against health problems immediately has an increasing gradient, indicating the detrimental effect of smoking on health.…”