Can moderate alcohol consumption benefit people who have heart disease? What are the benefits?
Alcohol can be good for the heart but like many other things in life, too much of a good thing can be bad as well.
Research suggests that regular small amounts of alcohol can have a protective effect on one’s heart by preventing heart attacks from coronary artery disease. When used in moderation, alcohol appears to help increase the level of “good” cholesterol (HDL or high-density lipoprotein) which helps reduce the amount of plaque that can narrow arteries and lead to heart attacks. In addition, small amounts of alcohol might thin the blood reducing the risk of blood clots forming in the arteries of the heart which reduces the risk of heart attack. It might also be that when used in moderation as part of an overall healthy lifestyle (including regular exercise and a well-balanced heart healthy Mediterranean style diet), it might help people be more relaxed, cope with normal daily stress and contribute to an overall healthy way of living.
Are there risks to moderate alcohol consumption if you have heart disease? If so, what are the chief risks?
There are risks although usually they are minimal and do not prevent most people with stable heart disease from drinking small to moderate amounts of alcohol.
Some people’s hearts are more sensitive to the effects of alcohol than others. We know that people who binge drink are clearly at increased risk of abnormal heart rhythms (arrhythmias). Some people are more prone to certain arrhythmias (specifically atrial fibrillation) even when drinking only moderate amounts. Excessive alcohol intake can be directly toxic to the heart muscle, leading to cardiomyopathy and heart failure. And while small to moderate amounts of alcohol can lower blood pressure, drinking in greater amounts can clearly raise blood pressure and contribute to hypertension as well as the risk of stroke.
However, most people with heart disease that is stable and followed regularly by their doctor can still partake in small to moderate amounts of alcohol regularly without ill effects. If one has heart disease, it is always best to check with your doctor about whether it is safe to drink alcohol and if so how much and how often.
Does drinking alcohol affect your cholesterol levels (LDL, HDL, triglycerides)? Is this due to alcohol sugars?
While alcohol in small to moderate amounts can often have beneficial effects on cholesterol by raising the “good” or HDL cholesterol, one can have too much of a good thing and one’s cholesterol levels can go in the wrong direction with larger amounts of alcohol. Specifically one’s triglyceride levels (a type of fat in the blood) can significantly increase with excessive drinking as alcohol is ultimately a carbohydrate with sugars. Alcoholic beverages are usually high in calories which can lead to weight gain which subsequently can increase the risk of diabetes or stroke.
Is it safe to drink moderately if you are also taking a daily, low-dose aspirin or taking aspirin regularly?
Drinking excessively can definitely increase the risk of stomach irritation, gastrointestinal bleeding and stomach ulcers which is compounded if also on aspirin. However, most people who tolerate low-dose aspirin can drink small to moderate amounts of alcohol without problem. If one has a history of ulcers, reflux or other stomach irritation, they should check with their doctor about the pros and cons of aspirin use and regular alcohol use. Using stronger anti-inflammatory drugs (NSAIDs) when drinking definitely should be avoided.
Does moderate alcohol consumption interfere with any common heart medications?
Alcohol can increase the blood thinning effect of a blood thinner, Coumadin (warfarin), commonly used in cardiac patients. Alcohol can also cause dizziness or fainting in people who are on certain blood pressure medications so it is important to inform your doctor about your alcohol intake if you are on these medications.
Does the type of alcohol consumed matter when it comes to potential health benefits? We hear about red wine, but is that possibly healthful due to the resveratrol or other nutrients, or the alcohol itself?
While red wine has a reputation of having more heart-healthy benefits compared to other types of alcohol, it’s possible that red wine isn’t any better than beer, white wine or liquor for heart health. There is no definite medical consensus about whether moderate consumption of beer, wine, or distilled spirits has a stronger association with heart disease. Most of the evidence available suggests that each is effective, with none having a clear advantage. Whether red wine has further benefits due to antioxidants such as flavonoids or resveratrol is still not clear. Most researchers now believe that the most important ingredient is the alcohol itself.
Is moderate alcohol consumption`s “stress-reducing” effect a potential benefit?
Alcohol can relieve stress when consumed in limited amounts for some people in some specific situations. If regular alcohol use in moderation is part of an overall well-balanced healthy lifestyle, it can be part of coping with everyday stresses in a reasonably healthy way. HOWEVER–if one ends up getting drunk to help cope with stress or ends up having to drink excessively to cope with stress–then the opposite is true. Excessive alcohol use with almost certainly increase stress by interfering with healthy interpersonal relationships and increase the risk causing health problems such as liver disease, dementia, cancer and accidents.
What is “moderate alcohol consumption” for the average person? What should a serving be?
Moderate drinking is defined as no more than two alcoholic drinks a day for men and no more than one a day for women (or lighter-weight persons). One drink is equal to either 4 – 5 ounces of wine, 12 ounces of beer or 1 to 1.5 ounces of hard liquor. As we age, we cannot metabolize alcohol as well and generally it means that the amount of alcohol that we can safely consume is less.
If someone with heart disease isn’t drinking now, should they start? Why or why not?
If you don’t drink alcohol now, there is no reason to start. Before thinking about using alcohol as a protector against coronary heart disease, you should make sure that you are following a healthy diet, exercising regularly and absolutely not smoking. Alcohol can cause other problems and it’s potential benefits on the heart can be outweighed by its risks of liver disease, alcoholism, automobile accidents, accidental death or cancer (including breast cancer in women).
In addition, it may be that the cardioprotective effects of alcohol consumption could be explained by confounding variables. For example moderate drinkers might have more healthful lifestyles, higher economic status, better dietary habits, better healthcare, or higher educational levels. It might be that drinking alcohol in small to moderate amounts is beneficial, not medicinally as a drug per se but, if one actually enjoys drinking, as part of a well-balance, relaxed and healthy lifestyle. One day in the future, we might be able to predict more accurately who can use alcohol in moderation and who should avoid it completely, possibly with the help of advances in genetics. In the meantime, it is best to balance the potential benefits and risks for each individual person with the help of a trusted health care provider.
Cardiologists in Los Angeles
To find out more about alcohol and the risk for heart disease, contact our office today at (310) 659)-0714 to schedule an appointment. You can also fill out our online contact form, or visit us on Facebook, Twitter, or Google+. We look forward to serving you.
Written by and/or reviewed by Mark K. Urman, MD and Jeffrey F. Caren, MD
Last updated: 07/05/2019