By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
“Would you like a drink?”
It’s a question asked millions of times a day in restaurants, bars, and homes everywhere. Having a drink with someone has long been an experience of connection and belonging, shared by friends and strangers alike. It’s good for the soul. But is it good for the heart?
Officially I’m on record calling out alcohol as one of my top toxins to be avoided and, as a general rule, I’m sticking to my guns on that. Alcoholic drinks are often high in sugar, inflammatory, and alcohol can disrupt heart rhythms. If your heart is compromised, it’s best to steer clear because you don’t need the additional risk, even if that risk may be small.
That said, I also don’t live under a rock. I enjoy an occasional glass of wine myself, and know that many of you do, as well.
Alcohol and Heart Disease: Your Risk Depends on What Type of Drinker You Are
Because alcohol affects the heart differently based on how much and how frequently you consume it, it’s important to understand your relative risk. Let’s take a closer look, first by identifying the type of drinker you are, and then assessing the risks associated with it.
Light to Moderate Drinkers
How much: Up to one drink per day for women, up to two drinks per day for men, 3 to 5 times per week.
Risk level (1 = low, 10 = high): 1
There’s good news if you like to unwind at the end of the day with a cocktail or glass of wine. Research shows an inverse relationship between drinking light to moderate amounts of alcohol and heart disease: that daily drink can actually protect your heart health by raising HDL cholesterol, decreasing clotting activity, and lowering blood pressure. One meta-analysis even found that the consumption of 30 grams of alcohol (about 2 drinks) per day was associated with a 0.70 mg/dL decrease in the levels of inflammatory Lp(a).
Despite this last bit o f data, my alcohol recommendations are more conservative. I believe that, if you are going to drink alcohol, you must be extremely disciplined and limit yourself to just one drink per day if you’re a woman, or two if you’re a man – and not drink every single day (you need to give your body a rest). When you drink more, the risks begin to outweigh the benefits.
A 2018 study, published in The Lancet, supports this “minimal is more” approach, and even suggests that drinking guidelines be lowered to 100 grams of alcohol (about 6 drinks) per week for both men and women. I have to say, I’m in agreement. Since it’s so easy to overindulge and build up a tolerance with alcohol, drinking 3 to 5 drinks per week in a social setting is ideal.
How much: Drinking until blood-alcohol levels reach 0.08 g/dL or more; typically when men consume five or more drinks, and when women consume four or more drinks, in about two hours (body weight plays a big role in how many drinks will take a person to the legal limit in a given period of time).
Risk level (1 = low, 10 = high): 6
Binge drinkers consume a lot of alcohol at a fairly rapid rate, but not on a regular basis. The behavior is typically associated with college students and young adults, but it’s actually much more widespread—so much so that the CDC calls binge drinking “the most common pattern of excessive alcohol use in the United States.”
Even though binge drinking alcohol may not be a regular occurrence, it’s risky from a heart health standpoint. Research shows that the behavior is associated with high blood pressure, increased triglyceride levels, increased blood clotting, higher cholesterol levels, and arrhythmias—particularly ventricular fibrillation, the most serious disturbance of the heart’s rhythm.
In the cardiac ward, we used to have another name for cardiac events associated with binge drinking: “holiday heart syndrome.”
The term was originally coined in 1978 to describe the increase in heart attacks, arrhythmias, and high blood pressure that go hand in hand with increased alcohol intake over the holidays. People tend to think of it as being limited to Thanksgiving, Hanukkah, and Christmas, but its definition should include every holiday—and all other occasions when people have a reason to get together and celebrate.
How much: Five or more drinks on the same occasion, on each of five or more days, in the past 30 days
Risk level (1 = low, 10 = high): 8
For heavy drinkers, the effects of drinking alcohol on heart health are largely the same as for binge drinkers, but I bump up the risk level for this group due to an increased risk for a-fib and stroke, as well as other co-occurring risk factors.
Heavy drinkers, for example, are more likely to smoke, eat poorly, carry extra weight, and forego exercise, so they are also more likely to have complicating issues such as high blood pressure or metabolic syndrome. Under the best circumstances, these conditions will hasten the progression of heart disease—but adding regular, heavy doses of alcohol to the mix is like throwing gasoline on a fire.
Heart medications, which individuals with additional heart disease risk factors are more apt to be taking, also up the ante. Alcohol can interfere with the body’s ability to absorb and/or metabolize them, leading to serious side effects.
How much: More than six drinks per day, for 5–20 years
Risk level (1 = low, 10 = high): 10+
Alcohol’s effects on the heart are the same for chronic drinkers as for heavy drinkers, with one significant addition—the risk of developing alcoholic cardiomyopathy.
In people who suffer from cardiomyopathy, the heart becomes enlarged and the tissue weakens and thins, compromising its ability to circulate blood. How alcohol brings about this effect on the heart isn’t fully understood, but leading theories point to chronic exposure to the inflammatory and toxic metabolites of alcohol, as well as alcohol’s influence on the electrical signals that govern heart rhythm.
Alcoholic cardiomyopathy may or may not be symptomatic. In patients who do have symptoms, they may experience shortness of breath, edema, fatigue, dizziness, weakness, and a rapid or irregular pulse. Such are the symptoms of heart failure.
Beyond its cardiovascular impact, chronic alcohol use also can be emotionally isolating and destructive for both the person who drinks and their loved ones. This can be an ongoing source of stress and shame, and the vital connections associated with happiness and longevity are often lost – further complicating the risk profile.
- Andrade J & Gin K. Alcohol and the Heart. BCMJ. 2009 May;51(5):200–205.
- Barwell J & Solan M (rev. D Sullivan). Alcoholic Cardiomyopathy and Your Health. HealthLine. Accessed June 30, 2016.
- Centers for Disease Control and Prevention. Fact Sheets: Binge Drinking. Accessed April 23, 2018.
- Costanzo S, et al. Cardiovascular and Overall Mortality Risk in Relation to Alcohol Consumption in Patients With Cardiovascular Disease. Circulation. 2010;121:1951–1959.
- Milić S, et al. Cardiac Manifestations in Alcoholic Liver Disease. Postgrad Med J. 2016 Apr;92(1086):235–239. E-pub 2016 Feb 5.
- National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Alcohol’s Effects on the Risk for Coronary Heart Disease. Accessed June 30, 2016.
- National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. Drinking Levels Defined. Accessed June 30, 2016.
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- EB Rimm, et al. Moderate Alcohol Intake and Lower Risk of Coronary Heart Disease: Meta-Analysis of Effects on Lipids and Haemostatic Factors. BMJ. 1999;319:1523–1528.
- Wood, Angela M, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. The Lancet , Volume 391 , Issue 10129 , 1513 – 1523.
© Stephen Sinatra, MD. All rights reserved.