Background
Most adults in the United States drink alcohol at least occasionally; in 2005, 61.4% of individuals 18 years or older had had at least one alcoholic drink in the past year (versus 14.3% who called themselves former drinkers and 24.4% who had never had a drink). People aged 65 and younger tend to drink more than those older than 65. However, most people who consume alcohol consider themselves light drinkers (3 or fewer drinks/week) although far more women (79.4%) than men (58.4%) place themselves in that category.
In general, moderate drinking is considered to be no more than one drink/day for women and no more than two drinks/day for men. Heavy drinking is anything more than moderate drinking. Binge drinking is a pattern of alcohol consumption leading to a blood alcohol concentration of 0.08% or higher. This corresponds to more than four drinks on a single occasion for men or more than three drinks for women within about 2 hours.
Heavy drinking over time also can cause certain cancers, liver cirrhosis, immune system disorders, and brain damage, and in people with diabetes alcohol consumption can affect blood sugar levels. Additionally, there is an association between alcohol consumption and aggressive behaviors; and people who abuse alcohol are more likely to have personality disorders.
Body size plays a role in how alcohol content concentrates in the body and determines whether a person is legally impaired or not. Although the same number of drinks will likely be needed by either a man or woman to be considered impaired, women with their smaller body size and different internal chemistries will be more impaired than men if they match them drink for drink.
Due to varying alcohol contents, there are common definitions of what constitutes a “standard” alcoholic drink in the United States:
- 12 oz. of beer or cooler (~5% alcohol content)
- 8-9 oz. of malt liquor (~7% alcohol content)
- 5 oz. of table wine (~12% alcohol content)
- 3-4 oz. of fortified wine (such as sherry or port) (~17% alcohol content)
- 2-3 oz. of cordial, liqueur, or aperitif (~24% alcohol content)
- 1.5 oz. or a “shot” of 80-proof distilled spirits or liquor such as gin, rum, vodka, whiskey, and brandy (~40% alcohol content)
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Alcohol and the Heart
Alcohol in some form or another has been imbibed for thousands of years; its health benefits or deficits have been debated for hundreds. While its harmful effects on the liver are well documented and widely known, alcohol’s impact on the heart is less well understood, and indeed there is evidence that moderate alcohol consumption is beneficial. Certainly, the amount of alcohol one consumes matters most: In an analysis of 34 different scientific studies involving more than 1 million men and women, researchers found that there is a “J curve” relationship between the amount of alcohol consumed and total mortality. In simpler terms, some consumption of alcohol confers more of a survival benefit than no consumption of alcohol, but as people drink more alcohol, they lose that benefit and face increased risk of dying. (The curve created when these points are plotted on a graph resemble a tilted “J,” hence the name.)
There is little doubt that heavy drinking (more than 3 drinks per day) increases the risk of sudden cardiac death (SCD) and irregular heart rhythms (arrhythmias) while more moderate consumption decreased the risk of SCD in men compared to those who never or rarely drank. Moderate alcohol consumption also seems to have a beneficial effect on incidence of coronary artery disease and heart attack (myocardial infarction), although there were differences in the definition of “moderate” in varying studies. The upshot is that reasonable consumption — one drink per day for a woman and two drinks per day for a man — does seem to benefit the heart.
There are other cardiovascular diseases that have been studied in regard to the negative or positive impact alcohol. Alcoholic cardiomyopathy — in which excessive alcohol consumption weakens the heart muscle and prevents it from pumping efficiently — has been shown to improve to some degree with the complete cessation of alcohol drinking. Conversely, moderate drinking may protect the heart against congestive heart failure and may reduce the number of heart attacks.
Importantly, because high blood pressure (hypertension) is so widespread and because it leads to a number of major heart problems, men and women who drink three or more drinks daily are much more likely to have elevated blood pressures compared to nondrinkers. Blood pressure rises in binge drinkers even more; these effects are seen no matter what the age or gender of the patient. Conversely, light-to-moderate alcohol consumption appears to reduce various risks in patients with high blood pressure, including a decreased risk of heart attack and death. Data are less conclusive in terms of an association between alcohol consumption and stroke; however, in general, moderate consumption appears to reduce the risk, but heavier consumption increases the risk of suffering various types of strokes.
Researchers debate whether or not the type of alcohol consumed makes a difference. The idea that red wine seems to be the most cardioprotective of the various spirits comes from what has been called the “French paradox”: The rate of coronary artery disease mortality in France has been lower than observed in other industrialized countries with similar coronary risk factor profiles, and this has been attributed to the consumption of red wine. Of all the variables studied, wine was one of the only foodstuffs that correlated significantly with mortality.
This is not universally accepted by the medical community, nor is the mechanism by which red wine could produce such benefits clearly defined. However, red wine seems to positively affect the vascular “endothelium”, which is the vital barrier between the blood flowing through arteries and the contents of the artery walls. The endothelium is made up of the cells that line blood vessels, and a healthy endothelium is key to superior cardiovascular health. When the endothelium is damaged or disrupted, a cascade of events occurs, culminating in spasm (narrowing) of the artery and the formation of a blood clot at the site of disruption. If the clot is large enough, it can completely block flow inside the artery – resulting in a heart attack or stroke. Substances in red wine have been found to help guard against blood clotting, and to relax blood vessels, helping increase blood flow.
In general, numerous mechanisms have been proposed to explain the benefit of light-to-moderate alcohol on the heart, including an increase of protective high-density lipoprotein (HDL) cholesterol, reduction in blood clotting propensity, improvement in endothelial function, reduction of inflammation, and promotion of antioxidant effects. Why higher intake of alcohol is not associated with higher benefit is not known.
To drink or not to drink: What is the answer? If you don’t already drink, few people would recommend you START drinking simply for the possibility of some health benefits. If you ALREADY drink, keep in mind that these positive, protective effects disappear with increased alcohol consumption. Just like most things in life, moderation is the key.
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Alcohol Use Considerations
For many if not most people, having a drink, even daily, is something to be enjoyed but will not be missed if skipped. Such light consumption has been shown to be protective and probably relaxing. However, heavier or binge drinking can be much more problematic and lead not just to external impairment, but increased risk of death and other cardiac-related problems.
1. The elderly are more sensitive to the effects of alcohol and thus need to reduce their intake. Even drinking a small amount can impair judgment, coordination, and reaction time of elderly people. Reducing consumption can lessen the impact of alcohol on high blood pressure, diabetes, and other conditions that are more prevalent and problematic in the elderly. Drinking also can make older people forgetful and confused. These symptoms could be mistaken for signs of dementia or Alzheimer's disease.
2. Alcohol can interact with a wide variety of medications, ranging from side effects that may make you drowsy, to increasing feelings of helplessness, to actual liver damage. The National Institute on Alcohol Abuse and Alcoholism has a list of drug-alcohol interactions to which you can refer for specific effects with particular medications.
3. Family history of alcoholism or alcohol abuse tends to increase an individual’s risk of becoming an alcoholic. Such individuals should make every attempt to drink no more than moderately.
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Contra-Indications to Alcohol Use
1. Women who are pregnant should not drink any alcohol at all. Each year, up to 40,000 babies are born with some degree of alcohol-related damage. Drinking alcohol during pregnancy can cause a number of birth defects, ranging from mild to severe. These include mental retardation; learning, emotional and behavioral problems; and defects involving the heart, face and other organs. The term "fetal alcohol spectrum disorder" describes the many problems associated with exposure to alcohol before birth. The most severe of these is fetal alcohol syndrome (FAS), a combination of physical and mental birth defects.
2. Don’t drink and drive or pursue any activity that has the potential to produce injury even when unimpaired.
3. If you find that you need a drink as opposed to just desire a drink, consider the possibility that you have an abuse or addiction problem. There are numerous treatment programs available, some of which provide inpatient or facility-based rehabilitation, some of which provide avoidance therapies, some of which rely on fellowship and support.
4. Underage drinking, especially when teenagers leave home to attend college, is very unhealthy and can promote risky behaviors. Alcohol poisoning from excessive, rapid drinking has become increasingly prominent among college students. Parents should talk to their children at all ages to avoid the risks associated with underage alcohol and drug consumption.
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Medications to Help Treat Alcoholism
There are a number of anti-alcohol medications designed to stem an individual’s craving for, and intake of, alcohol. They must be prescribed by a physician and generally are more effective when used as part of an overall therapy program to combat alcohol abuse or alcoholism. Some of the available agents include:
- Naltrexone and acamprosate are U.S. Food and Drug Administration (FDA)-approved options for treatment of alcohol dependence in conjunction with behavior therapy.
- Disulfiram, which was the first FDA-approved agent to combat alcohol abuse and dependence, has less evidence to support its continued use to treat alcohol dependence. It does not appear to increase abstinence rates or decrease relapse rates or cravings compared with placebo, and it is not recommended for routine use.
- Topiramate and ondansetron are recommended to reduce drinking frequency and increase abstinence, but have not yet been approved for such indications.
- Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) are being studied in individuals who are dependent on alcohol but the trials have had few patients and do not tend to measure the same outcomes. However, they are recommended for patients with co-existent depressive disorders.
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Other Considerations
Intake of omega-3 fatty acids appears to be reduced in binge drinkers, particularly men. This lower intake can have longer-term health consequences, including negative impact on brain function. It is highly recommended that people who are even moderate let alone heavy or binge drinkers increase consumption of fish to combat this problem.
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Source
Rezkalla SH. To drink or not to drink? That is the question. Circulation 2007;116:1306-17.
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