Is alcohol good for the heart?

• Evidence: Context is important
• Alcohol and the heart: the potential problems
• Advice

One of the media’s favourite stories, advice about whether alcohol can protect against coronary heart disease can be confusing.

To debunk the myths and find out the facts, we talked to two medical experts: Professor Paul Wallace, Drinkaware’s Chief Medical Adviser and Dr Jonathan Chick, Consultant Psychiatrist at Royal Edinburgh Hospital and Editor-in-chief of the journal Alcohol and Alcoholism.

Both agree that, where alcohol and the heart are concerned, drinking within the government daily unit guidelines is key. The guidelines advise that women should not regularly drink more than 2-3 units (equivalent to a 175ml glass of 13% wine) and that men should not regularly drink more than 3-4 units (equivalent to a pint and a half of 4% beer). ‘Regularly’ means drinking every day or most days of the week.

Simply put, alcohol can be good and bad for the heart – and it isn’t necessarily just red wine that can help you, as the media often suggests. There’s confusion because, say our experts, alcohol’s protective effects depend on a number of crucial factors:

• Overall, alcohol only gives you benefits if you drink within the government's daily unit guidelines
• Any protective benefits on the heart generally only work over the age of 45
• Beyond the recommended limits, alcohol’s potential benefits on the heart are outweighed by its risks of getting other illnesses, such as liver disease or cancer
• Any benefits on the heart depend on your overall consumption and general pattern of drinking (how much and how often)

We have the evidence but it’s all about context

So what do we know about alcohol’s beneficial effects on the heart? Scientists believe that there are two main mechanisms by which small amounts of alcohol can help protect over 45 year olds. The first, explains Professor Wallace, is that alcohol appears to increase the level of "good" cholesterol (HDL) in the blood. This reduces the amount of fatty deposit (atheroma) which narrows our arteries and makes them more likely to clog. Secondly, alcohol can help prevent the formation of blood clots which can close off the arteries, causing a heart attack. It can stop platelets from clumping together to form clots and, a small amount of alcohol with a meal can reduce the sudden rise of a protein (fibrinogen) produced by the liver which increases the likelihood of harmful blood clots forming - thrombosis.

Alcohol and the heart: the potential problems

Wine drinkers would like to believe that the old adage that red wine is good for the heart is true. But, is it? “Antioxidants in general help to prevent thrombosis and red wine has a high concentration of antioxidant substances called flavonoids. White alcoholic drinks, like vodka and cider, contain the least concentration of flavonoids. But this is an subject where more research is needed before we can give specific advice,” says Dr Chick.

Professor Wallace agrees that this commonly held belief about red wine is debatable.”You can find this effect from other alcohol, such as beer,” he says. “I do worry that people have actually got the wrong end of the stick and think: ‘I am drinking red wine and it’s okay because it is good for the heart.’”

Another FAQ is whether women are less likely to experience the heart disease protection benefits of alcohol. In fact, Dr Chick says that while some studies show the benefits only in men, others reveal them in women too. Again, though, there’s a benefits trade-off. He says women tend to be less susceptible to dying from coronary heart disease but that picture is changing now. “Illnesses such as breast cancer begin to show at surprisingly low levels of drinking in women,” says Dr Chick.

Importantly, people who don’t usually drink alcohol are not advised to start doing so to protect themselves against heart disease – the evidence for the benefits does not justify this. “There are other ways to reduce the risk of heart disease, like stopping smoking, taking more exercise and eating a healthier diet, which don’t carry risk,” says Professor Wallace.

Advice

Indeed, this is the overall alcohol and the heart conclusion from Professor Wallace and Dr Chick: there is evidence to suggest that low and moderate drinking (i.e., within the government's daily unit guidelines) can protect against coronary heart disease, but it is a relatively small effect and you should try other safer things first.

“A healthy diet, taking regular exercise, stopping smoking - you should try these things before thinking about using alcohol as a protector against coronary heart disease because alcohol can make other problems for you,” says Professor Wallace. “For the facts, read information on the Drinkaware or British Heart Foundation websites.”

The message is "be sensible". When new studies come out, don’t simply believe the headlines; think it through. “We do have a lot of evidence about alcohol and the heart now,” concludes Professor Wallace. “It’s about interpretation of that evidence.”