Is that evening glass of wine really good for your heart?

Is that evening glass of wine really good for your heart?

Do you think a daily drink is good for your heart? This major review challenges long-held beliefs and challenges proven lifestyle choices for alcohol to protect cardiovascular health.

In a recent review in the journalTrafficResearchers are collecting and discussing the results of numerous publications representing decades of alcohol research to elucidate the substance's effects on cardiovascular health. The results of the review confirm the deleterious effects of heavier alcohol consumption (≥3 drinks daily) on all measures of cardiovascular disease.

More cautiously, this review challenges long-held beliefs associated with low to moderate alcohol consumption (1-2 daily), highlighting that previously hypothesized cardiovascular benefits may be due to methodological inconsistencies and sampling/analysis bias (lifestyle and socioeconomic). As a result, this review cautions against alcohol consumption for cardiovascular health and urges consumers to limit their alcohol consumption and clarify that the cardiovascular risk of light drinking remains uncertain.

background

Women face higher risks with higher alcohol levels due to differences in metabolism and body composition, meaning “moderate” effects are not the same for everyone. This makes blanket recommendations problematic.

Alcohol remains one of the most popular psychoactive substances in the world, with an estimated 2.3 billion consumers consuming an average of 5.5 liters per capita. Despite decades of research examining the effects of alcohol consumption on cardiovascular diseases (CVDs), observed associations remain complex and controversial, leading to numerous inconsistencies in public health recommendations and myths regarding the perceived dose-dependent benefits of the substance.

While some older observational studies suggested that low to moderate alcohol consumption (1-2 drinks daily) increased consumers' risk of certain CVDs, such as: [MR] and meta-analyses at individual scales question these hypotheses and find weak or no evidence of the substance's benefits on CVD outcomes regardless of consumption dose.

In contrast, the negative effects of heavier alcohol consumption (≥3 drinks daily) are well established in all aspects of cardiovascular health. Alcohol consumption and alcohol dependence were significantly associated with increased risk of myocardial infarction (MI), hypertension, heart failure (HF), stroke, and cardiac arrhythmia.

In today's world of increasing alcohol consumption (particularly after the recent COVID-19 pandemic) and worsening CVD-associated morbidity and mortality, a review of the facts, myths, and recommendations related to alcohol consumption is essential. This information enables policymakers, clinicians and consumers to make informed decisions and implement interventions to prevent adverse cardiovascular disease (CVD) and improve global public health.

About the study

Young adults are not immune: Research shows that binge drinking in the 20s has links to early signs of artery damage and higher blood pressure later, calling into question the idea that teens protect themselves from alcohol harm.

This review aims to address knowledge gaps regarding the associations between alcohol consumption and cardiovascular disease (CVD) by synthesizing findings from numerous previous publications, including large cohort studies, meta-analyses, and mechanistic research, on the topic. It also discusses an expert panel's proceedings on cardiovascular outcomes linked to alcohol consumption, focusing on hypertension, myocardial disease, arrhythmias, atherosclerosis and stroke.

The review evaluated previous research and emphasized the importance of study design, hypothesis testing, and appropriate confounding variables (age, gender, socioeconomic status, physical activity, and diet). Observational studies have been critically evaluated for possible selection bias and “sick quitter” effects. Pathophysiology studies were assessed for mechanistic plausibility, that is, the effects of dose-dependent alcohol consumption on participants' blood pressure, lipid profiles, myocardial structure, electrical conduction, and vascular function.

Particular attention was paid to the study results, particularly key endpoints such as CVD events, subclinical markers and mortality. All assessments were conducted in the context of World Health Organization (WHO) guidelines and other public health association guidelines. Notably, the study highlights that factual patient education is challenging given the current uncertainty in research at the Alcohol CVD Association.

As a result, it highlights the current knowledge gap and suggests future directions. While the evidence for harm from heavy drinking is clear, significant uncertainties remain about low-level consumption.

Study results

Mixing alcohol with common heart medications like aspirin or blood thinners can be dangerous, risking bleeding or altering how drugs work in the body - a critical interaction that is often overlooked.

This review explains several critical takeaways:

1. Low to moderate alcohol consumption has uncertain benefits for cardiovascular health. While traditional observational studies have suggested that 1-2 glasses of alcohol daily can confer cardiovascular protection and a popular narrative, these studies have often been vulnerable to extensive selection bias and other methodological problems. Controlling for lifestyle and socioeconomic variables significantly attenuates or appears to negate these previously observed benefits, suggesting that a protective association, if present, is likely weak and may not be causal.

2. In contrast, the paper finds a clear link between alcohol and higher blood pressure, with research suggesting that even low levels of alcohol consumption can significantly worsen the risk of high blood pressure. The association between low to moderate alcohol consumption and arrhythmia, particularly in atrial fibrillation, remains contradictory, although heavier consumption significantly increases the risk.

3. An overwhelming body of robust literature underscores the significant CVD-associated burdens of heavy/alcohol consumption and emphasizes that higher alcohol consumption exacerbates CVD-associated risks across all diseases tested. The review confirms that both binge drinking and long-term heavy drinking are associated with higher rates of myocardial infarction and stroke. Crucially, the paper also notes that for moderate drinkers, engaging in episodes of heavy or alcohol consumption negates any potential cardiovascular protection.

Conclusions

The present review concludes that while the harms of heavy drinking are certain, the true cardiovascular impact of low to moderate consumption remains unclear. As a result, the AHA advises against initiating alcohol consumption for the express purpose of cardiovascular protection. The statement reinforces that individuals should focus on proven heart-healthy behaviors (healthy diet, exercise and smoking cessation) to optimize cardiovascular health and overall well-being, as the potential benefits of alcohol are not firmly established and may not outweigh the risk.

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