Is alcohol good for the heart?

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 guidelines is key. The guidelines recommend that women should not regularly exceed 2-3 units daily and that men should not regularly exceed 3-4 units daily.

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 recommended limits
• 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

Heart and circulatory diseases are the UK’s biggest killers. We have an annual death rate in excess of 180,000 men and women. New ways to fight the disease are always going to attract interest – especially when they seem as simple as drinking a couple of glasses of red wine every night. But it definitely isn’t that simple.

Professor Paul Wallace thinks confusion about alcohol’s effects on the heart stem from the fact that scientific studies are often not put in their correct overall context. “Journalists and doctors have to look at the full range of trials and see where the balance is,” he says. “There are different types of heart disease: for example, alcohol has a  protective effect for coronary heart disease, but increases  the risk of developing the much rarer condition of cardiomyopathy [when the heart muscle becomes flabby], which is associated with high alcohol intake and can cause premature death.”

Professor Wallace says the recent Spanish study (1) which found that alcohol can cut the risk of heart problems in men by almost a third, did not report on other illnesses, such as liver disease or stroke, in the people surveyed. Any study that measures whether alcohol can be protective against coronary heart disease must look at the effect it has on other illnesses as well. “We don’t live in a coronary heart disease bubble,” says Professor Wallace.

It’s also difficult to apply this and other country-based study findings to Britain, because different nations' patterns of drinking vary. In Britain, the overall health benefits on the heart are outweighed by other alcohol-related illnesses largely because of our pattern of session drinking – drinking a lot over a short period of time. Our pattern of drinking is very different from the French, for example. In France people generally have alcohol with a meal.

“In Glasgow, Monday morning is the most common time to die of a heart attack and that’s widely believed to be because of weekend session drinking,” explains Dr Jonathan Chick. “The heavy session drinking puts a strain on the heart, causing abnormalities.”

Alcohol and the heart: the potential benefits

So what do we know about alcohol’s beneficial effects on the heart? Scientists believe that there are two main mechanisms by which 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

With the acknowledgement of these potential benefits comes the need for extreme caution. Both Professor Wallace and Dr Chick agree that they are associated with low to moderate drinkers: drink more than the recommended limits and you increase your risk of developing other illnesses, such as heart disease. So, for example, alcohol’s anti-clotting ability, potentially protective against heart attacks, may increase the risk of haemorrhagic stroke (when a blood vessel bursts inside the brain), or bleeding within the brain.

“Any possible benefits related to heart disease from  excessive alcohol use are likely to be far outweighed by the increased chances of developing different types of cancer, mental health problems and liver damage,” says Professor Wallace.

Is red wine good for the heart? (And other frequently asked questions)

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 is thought to be the alcoholic drink that contains the highest 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 recommended 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.”

References

1)    Larraitz Arriola1 and others, “Alcohol intake and the Risk of coronary heart disease in the Spanish EPIC cohort study”, British Medical Journal, Heart, 19 November 2009.

Page last updated by

Matthew Bateman, 05 Feb 2010.

Page checked on

04 Feb 2010