Bottom’s Up? How Alcohol Affects the Heart

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.

Binge Drinkers

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.

Heavy Drinkers

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.

Chronic Drinkers

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.


© Stephen Sinatra, MD. All rights reserved.

Leave a Reply


  1. S. Margulies

    on July 6, 2016 at 9:42 pm

    Just want to mention that I suffered from afib for quite a few years until I had the great good fortune of having 3 ablations – the last was 7 years ago – and I’ve been absolutely FINE since then. But I still don’t touch a DROP of alcohol. The smallest sip of wine always triggered an afib attack in me. It was terrible to be so sensitive to wine (and I guess beer would fall into the same category), but so it is. I very much encourage anyone with afib to watch their reaction to alcohol and not take it as just coincidence if they get an attack. Stay off the alcohol! I suspect that I might be able to have a tiny taste of wine now but why take a chance? I think the pleasures of a glass of wine with dinner and/or just with friends are not worth the chance of starting that cycle all over again. Remember, afib begets afib. Once that pathway gets started it gets stronger with each attack. We can toast À Votre Santé with a glass of tea or water too!

  2. Dean Pfennig

    on May 3, 2018 at 12:46 pm

    Thanks, very good info.

  3. Lou Ellen Parrish

    on May 3, 2018 at 2:08 pm

    have a defibrillator, my second one, after a glass of wine i have PVC’S. STOPPED DRINKING,

  4. Natalia

    on May 3, 2018 at 4:27 pm

    100 g of alcohol – I guess this should be read 100 ml?

  5. Dockie Blauvelt

    on May 3, 2018 at 5:16 pm

    Dr Sinatra .. I am sorry to read you give wrong information.
    “Alcohol is high in sugar, …”
    I assume you mean ethanol, which the alcohol we consume.
    Please note that whatever sugar there was has been converted already to ethanol. Alcohol contains NO SUGAR .. unless you chose to add it in drinks.
    Wine & beer are complex, and have *some* carbohydrates … the amount is depending. BUT PLEASE .. do not continue this “Alcohol is high in sugar, ..” nonsense.
    This confuses readers, plus it is totally wrong.

  6. HeartMD Editor

    on May 4, 2018 at 11:43 am

    Hi Natalia, You’re right -is 100 ml, but we specified the amount in grams because that’s what was in the study. According to online conversion calculations, 100g is 100ml, so we’re all correct!

  7. HeartMD Editor

    on May 4, 2018 at 11:59 am

    Hi Dockie, we appreciate your comment which speaks to over-generalization (but not per se wrong info)! You’re absolutely right – alcohol on its own doesn’t contain sugar, but mixed drinks certainly can contain lots of sugar, and wine and beer also contain carbs (as you pointed out above). The level of danger due to sugar is contingent upon not only what type of drink someone drinks, but the amount that person imbibes on a regular basis. Since this article is focused on amount, we didn’t get into sugar content of types in relation to amount. But you make a great point, so we changed “alcohol is high in sugar” to “alcoholic drinks are often high in sugar” to clarify.

  8. Sandra

    on January 22, 2020 at 7:10 pm

    I am sixty year old lady diagnosed with AFIB in 2017. This came about from SVT I had off and on all my life, but worse at the end. Mine attacks are all caused by alcohol. I guess I am a binge drinker and have drank all my life. I can easily drink a bottle of wine in an evening once or twice a week. I also smoke 10 cigs a day and don’t exercise very much. I want to quit drinking and smoking badly as I want to look after my heart and I don’t want attacks to get worse over time. I do not have any other illness ie high blood pressure etc. and in very good health otherwise. Cardiologist says I may have to go on blood thinners at 65, but I am scared of that. I do respect alternative health practices that are natural. Any tips: thank you.

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