Alcohol and cardiovascular disease

Excessive alcohol intake is associated with an elevated risk of alcoholic liver disease (ALD), heart failure, some cancers, and accidental injury, and is a leading cause of preventable death in industrialized countries. However, extensive research has shown that moderate alcohol intake is associated with health benefits, including less cardiovascular disease, diabetes, and hypertension. Excessive alcohol intake is associated with an elevated risk of alcoholic liver disease (ALD), heart failure, some cancers, and accidental injury, and is a leading cause of preventable death in industrialized countries. However, extensive research has shown that moderate alcohol intake is associated with health benefits, including less cardiovascular disease, diabetes, and hypertension. Epidemiological and short term experimental studies have shown drinkers who consume one to two drinks per drinking day have a beneficial association with ischemic heart disease compared to never-drinkers. Furthermore, regular consumption of light to moderate dose of alcohol (1 drink/day for women or up to 2-drinks/day for men) has shown to reduce the incidence of cardiovascular events and all-cause mortality in cardiovascular patients. However, cardiovascular patients who do not regularly consume alcohol are not encouraged to start drinking due to lack of controlled intervention studies and evidence. An understanding of the inverse relationship between alcohol consumption and atherosclerosis was understood as early as 1904. The observation of a lower risk of cardiovascular disease (CVD) in France despite a diet rich in saturated fat was labeled the French Paradox. While much concerning this paradox remains unclear, some have suggested that the higher consumption of red wine in France results in lower CVD. Although the reduced incidence of CVD disease associated with moderate alcohol consumption is well established, many physicians have been wary of promoting the use of alcohol for this benefit considering the many negative effects of excessive alcohol consumption. Extensive epidemiological studies have demonstrated the cardioprotective effect of alcohol consumption. However the mechanism by which this occurs is not fully understood. Research has suggested several possible mechanisms, including the following. There is a lack of medical consensus about whether moderate consumption of beer, wine, or distilled spirits has a stronger association with heart disease. Studies suggest that each is effective, with none having a clear advantage. Most researchers now believe that the most important ingredient is the alcohol itself. The American Heart Association has reported that 'More than a dozen prospective studies have demonstrated a consistent, strong, dose-response relation between increasing alcohol consumption and decreasing incidence of CHD (coronary heart disease). The data are similar in men and women in a number of different geographic and ethnic groups. Consumption of one or two drinks per day is associated with a reduction in risk of approximately 30% to 50%'. Heart disease is the largest cause of mortality in the United States and many other countries. Therefore, some physicians have suggested that patients be informed of the potential health benefits of drinking alcohol in moderation, especially if they abstain and alcohol is not contraindicated. Others, however, argue against the practice in fear that it might lead to heavy or abusive alcohol consumption. Heavy drinking is associated with a number of health and safety problems. It is well known that alcohol consumption increases the risk of hypertension. Hence, many clinical trials examined the effect of reduction in alcohol consumption on blood pressure. Systematic review and meta-analysis have shown that effect of alcohol reduction on blood pressure is dose dependent. A logical possibility is that some of the alcohol abstainers in research studies previously drank excessively and had undermined their health, thus explaining their high levels of risk. To test this hypothesis, some studies have excluded all but those who had avoided alcohol for their entire lives. The conclusion remained the same in some studies: moderate drinkers are less likely to suffer heart disease. A paper concludes, 'In this population of light to moderate drinkers, alcohol consumption in general was associated with decreased MI risk in women; however, episodic intoxication was related to a substantial increase in risk.'