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Encyclopedia > Alcohol and cardiovascular disease
Alcohol consumption and health
Alcohol and cancer
Alcohol and cardiovascular disease
Alcohol and weight
Alcoholic liver disease
Alcoholism
Effects of alcohol on the body
Fetal alcohol syndrome

The subject of alcohol and heart attacks is important because the major cause of death in many countries is heart disease. The relationship between alcohol consumption and health has been the subject of formal scientific research since at least 1926, when Dr. Raymond Pearl published his book, Alcohol and Longevity, in which he reported his finding that drinking alcohol in moderation was associated with greater longevity than either abstaining or drinking... The U.S. National Cancer Institutes (NCI) Cancer Trends Progress Report Alcohol Consumption states that drinking alcohol increases the risk of the following cancers in both men and women: mouth esophagus pharynx larynx liver cancer — The chances of getting liver cancer increase markedly with five or more drinks per... Alcohol and weight is a subject relevant to millions of people who like to drink alcoholic beverages and who also either want to maintain or to lose body weight. ... Alcoholism is the consumption of, or preoccupation with, alcoholic beverages to the extent that this behavior interferes with the drinkers normal personal, family, social, or work life, and may lead to physical or mental harm. ... The effects of alcohol on the human body can take several forms. ... Fetal alcohol syndrome or FAS is a disorder of permanent birth defects that occurs in the offspring of women who drink alcohol during pregnancy. ...


Research indicates that moderate drinkers are less likely to suffer heart attacks than are abstainers or heavy drinkers[1] (Anani et al.; Gaziano et al.; Manson et al.; Mulcamel et al.; National Institute on Alcohol Abuse and Alcoholism; Rimm et al.; Sesso et al.; Simons et al.; Walsh et al.). The first scientific study of the relationship between alcohol consumption and atherosclerosis was published in the Journal of the American Medical Association in 1904[2]. Public awareness of the French Paradox in the early 1990s stimulated increased interest in the subject of alcohol and heart disease. The French paradox refers to the fact that people in France suffer relatively low incidence of coronary heart disease, despite their diet being rich in saturated fats. ...


An exhaustive review of all major heart disease studies has found that "alcohol consumption is related to total mortality in a U-shaped manner, where moderate consumers have a reduced total mortality compared with total non-consumers and heavy consumers" (La Porte et al.). Research also reports that the risk of a heart attack among moderate drinkers with diabetes is 52 percent lower than among nondrinkers and that the risk of dying in the four years after a heart attack is 32 percent lower among those who were moderate drinkers in the year before the attack (Beulens et al.).

Contents

Debate over research methods

Ex-drinkers versus never-drinkers

A logical possibility is that many 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.[3] More recently, however, Fillmore et al failed to find significant support: analyzing 54 prospective studies, the authors found that those studies which were free of the error (including former drinkers in the abstaining group) did not demonstrate significant cardiac protection from alcohol, although they continued to exhibit a J-shaped relationship in which moderate drinkers were less likely (but not at a statistically significantly level of confidence) to suffer cardiac disease than lifelong abstainers (Addiction Research & Theory, 14(2) 2006. 101-132). The sociologist says research is needed that looks at the reasons people abstain, which hers did not do. Cardiologist Dr. Arthur Klatsky notes that Fillmore’s study, which she freely acknowledges proves nothing but only raises questions, is itself seriously flawed. To overcome the inherent weaknesses of all epidemiological studies, even when properly conducted, he calls for a randomized trial in which some subjects are assigned to abstain while others are assigned to drink alcohol in moderation and the health of all is monitored for a period of years [1]


Other Factors

Another possibility is that moderate drinkers have more healthful lifestyles (making them healthier), higher economic status (giving them greater access to better foods or better healthcare), higher educational levels (causing them to be more aware of disease symptoms), etc. However, when these and other factors are considered, the conclusion again remains the same: moderate drinkers are less likely to suffer heart disease.[4]


Possible mechanisms of any benefit

Given the epidemiological evidence that moderate drinking reduces heart disease, it becomes important to examine how alcohol might confer its cardiovascular benefits. Can alcohol’s protective affects be explained physiologically? Research suggests that moderate consumption of alcohol improves cardiovascular health in a number of ways[5][6][7][8][9][10][11][12][13][14] (Facchini et al), including the following.


I. Alcohol improves blood lipid profile. A. It increases HDL ("good") cholesterol. B. It decreases LDL ("bad") cholesterol.


II. Alcohol decreases thrombosis (blood clotting). A. It reduces platelet aggregation. B. It reduces fibrinogen (a blood clotter). C. It increases fibrinolysis (the process by which clots dissolve).


III. Alcohol acts through additional ways. A. It reduces coronary artery spasm in response to stress. B. It increases coronary blood flow. C. It reduces blood pressure. D. It reduces blood insulin level. E. It increases estrogen levels


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[3] (Barefoot et al.).


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%"[4].


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.


See also

The relationship between alcohol consumption and health has been the subject of formal scientific research since at least 1926, when Dr. Raymond Pearl published his book, Alcohol and Longevity, in which he reported his finding that drinking alcohol in moderation was associated with greater longevity than either abstaining or drinking... Alcohol and weight is a subject relevant to millions of people who like to drink alcoholic beverages and who also either want to maintain or to lose body weight. ... The U.S. National Cancer Institutes (NCI) Cancer Trends Progress Report Alcohol Consumption states that drinking alcohol increases the risk of the following cancers in both men and women: mouth esophagus pharynx larynx liver cancer — The chances of getting liver cancer increase markedly with five or more drinks per... This article summarizes the recommended maximum intake (or safe limits) of alcohol as recommended by the health agencies of various governments. ...

Sources

References

  1. ^ Hennekens, C.H. Alcohol and risk of coronary events. In: Zakhari, S., and Wassef, M., eds. Alcohol and the Cardiovascular System NIAAA Research Monograph No. 31. NIH Pub. No. 96-4133. Washington, DC: U.S. Govt. Print. Off., 1996. pp. 15-24.
  2. ^ Cabot, R.C. "The relation of alcohol to arterioscleroisis" Journal of the American Medical Association, 1904, "43", 774-775.
  3. ^ a b Rimm, Eric B; Klatsky, Arthur; Grobbee, Diederick; Stampfer, Meir J Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits? BMJ 1996;312:731-736 (23 March)
  4. ^ a b Pearson, Thomas A. "Alcohol and Heart Disease." Circulation 1996;94:3023-3025. Retrieved on 2006-1-30.
  5. ^ Davidson, Dennis M Cardiovascular Effects of Alcohol Western Journal of Medicine 1989 October; 151(4): 430–439
  6. ^ Ely SW, Berne RM Protective effects of adenosine in myocardial ischemia Circulation, 1992 Mar;85(3):893-904 This paper appears to say nothing about alcohol
  7. ^ Facchini F, Chen YD, Reaven GM Light-to-moderate alcohol intake is associated with enhanced insulin sensitivity Diabetes Care 1994 Feb;17(2):115-9
  8. ^ Langer RD, Criqui MH, Reed DM Lipoproteins and blood pressure as biological pathways for effect of moderate alcohol consumption on coronary heart disease Circulation 1992 Mar;85(3):910-5
  9. ^ Mennen LI, Balkau B, Vol S, Caces E, Eschwege E. Fibrinogen may explain in part the protective effect of moderate drinking on the risk of cardiovascular disease. Arteriosclerotic and Thrombodic Vascular Biology 1999 Apr;19(4):887-92
  10. ^ Paassilta Marita; Kervinen, Kari; Rantala, Asko O; Savolainen, Markku J; Lilja, Mauno; Reunanen, Antti; Kesäniemi, Y Antero Social alcohol consumption and low Lp(a) lipoprotein concentrations in middle aged Finnish men: population based study British Medical Journal 1998 February 14; 316(7131): 594–595
  11. ^ Rimm, Eric B; Williams, Paige; Fosher, Kerry; Criqui, Michael; Stampfer, Meir J Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors British Medical Journal 1999;319:1523-1528 (11 December)
  12. ^ Thun MJ, Peto R, Lopez AD, Monaco JH, Henley SJ, Heath CW Jr, Doll R Alcohol consumption and mortality among middle-aged and elderly U.S. adults New England Journal of Medicine 1997 Dec 11;337(24):1705-14
  13. ^ Zhang QH, Das K, Siddiqui S, Myers AK Effects of acute, moderate ethanol consumption on human platelet aggregation in platelet-rich plasma and whole blood Alcohol: Clinical and Experimental Research, 2000 Apr;24(4):528-34
  14. ^ Wang, Zhiqing; Barker, Thomas H; Fuller, Gerald M Alcohol at Moderate Levels Decreases Fibrinogen Expression In Vivo and In VitroAlcohol: Clinical and Experimental Research Volume 23 Page 1927 - December 1999.doi:10.1111/j.1530-0277.1999.tb04093.x
  • British Medical Journal "Alcohol drinking patterns have different CHD outcomes in men and women"
  • British Medical Journal "Prospective study of alcohol drinking patterns and coronary heart disease in women and men"
  • Anani, U. A., et al. Alcohol consumption and risk of coronary heart disease by diabetes status. Circulation, 2000, 102, 500-505.
  • Barefoot, J. C., et al. Alcoholic beverage preference, diet, and health habits in the UNC Alumni Heart Study. American Journal of Clinical Nutrition, August 2002 v76 i2, 466-472.
  • Beulens, J., et al. Alcohol consumption and risk of type 2 diabetes among older women. Diabetes Care, 2005 (December), 28, 2933-2938.
  • Gaziano, J., et al. Potential mortality benefits for drinkers with previous heart attacks. The Lancet, 1998, 352, M 1882-1885.
  • La Porte, R., et al. Coronary heart disease and total mortality. Recent developments in Alcoholism, 1985, 3, 157-163.
  • Manson, J. E., et al. Prevention of Myocardial Infarction. New York: Oxford University Press, 1996.
  • Mulcamel, K.J., et al. Alcohol consumption after myocardial infarction. Journal of the American Medical Association, 2001, 285(15), 1965-1970.
  • Mulcamel, K.J., et al. Alcohol and AMI: Benefits from beer, wine, and liquor. American Journal of Nursing, 2001, 101(8), 18.
  • National Institute on Alcohol Abuse and Alcoholism. Alcohol Alert, No. 45. October, 1999.
  • Rimm, E., et al. Prospective study of alcohol consumption and risk of coronary disease in men. The Lancet. 1991, 338, 464-468.
  • Sesso, H.D., et al. Seven-year changes in alcohol consumption and subsequent risk of cardiovascular disease in men. Archives of Internal Medicine, 2001, 160, 2505-2612.
  • Simons, L. A., et al. Moderate alcohol intake is associated with survival in the elderly: the Dubbo Study. The Medical Journal of Australia, 2000, 172, 121.
  • Walsh, C. R., et al. Alcohol consumption and risk of congestive heart failure in the Framingham Heart Study. Annals of Internal Medicine, 2002, '136(3), 181-191.

  Results from FactBites:
 
Alcohol, Wine and Cardiovascular Disease (703 words)
Research is being done to find out what the apparent benefits of drinking wine or alcohol in some populations may be due to, including the role of antioxidants, an increase in HDL ("good") cholesterol or anti-clotting properties.
The best-known effect of alcohol is a small increase in HDL cholesterol.
Alcohol or some substances such as resveratrol (res-VAIR'ah-trol) found in alcoholic beverages may prevent platelets in the blood from sticking together.
Alcohol: Nutrition Source, Harvard School of Public Health (3048 words)
In the U.S., alcohol is implicated in about half of fatal traffic accidents.(1) Heavy drinking can damage the liver and heart, harm an unborn child, increase the chances of developing breast and some other cancers, contribute to depression and violence, and interfere with relationships.
The most definitive way to investigate the effect of alcohol on cardiovascular disease would be with a large trial in which some volunteers were randomly assigned to have one or more alcoholic drinks a day and others had drinks that looked, tasted, and smelled like alcohol but were actually alcohol-free.
Moderate drinkers who have two copies of the gene for the slow-acting enzyme are at much lower risk for cardiovascular disease than moderate drinkers who have two genes for the fast-acting enzyme.(16) Those with one gene for the slow-acting enzyme and one for the faster enzyme fell in between.
  More results at FactBites »

 
 

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