Moderate alcohol intake produces benefits

To stay "heart healthy," adults should eat a low-fat diet, exercise regularly, and... have a beer? While researchers have been touting the potential health benefits of red wine over the past decade, two recent studies in the Journal of the American Medical Association suggest that a light to moderate intake of any kind of alcoholic beverage may be beneficial to the heart.

In one analysis, more than 2200 Connecticut-based men and women over age 65 provided information as how much alcohol they had consumed within the previous month. About half were non-drinkers. Alcohol drinkers were divided into light drinkers who usually consumed up to 1 to 1.5 drinks per day, and moderate drinkers, who consumed up to an average 1.5 to 4 drinks per day. (Heavier drinkers were excluded.) Researchers followed the participants for 14 years and tallied the number who developed heart failure during that time.

After controlling for potential confounders-age, gender, smoking, weight, history of MI, diabetes, and hypertension-the relative risk of heart failure in light drinkers as compared to non-drinkers was 0.79 (95% CI, 0.60-1.02). The relative risk of heart failure in moderate drinkers as compared to non-drinkers was 0.53 (95% CI, 0.32-0.88).

More evidence of health benefits

In the second study, Boston researchers assessed the usual alcohol intake of more than 1900 people who had just survived a heart attack. They divided participants into three groups: non-drinkers, alcohol drinkers who routinely consumed less than 7 drinks per week, and those who consumed more than 7 drinks per week. Participants were followed for 4 years; the end point was all cause mortality.

After controlling for age, gender, smoking, medications, diabetes, hypertension, and several indicators of cardiac health, the researchers reported that drinkers were less likely than non-drinkers to die within the follow-up period. The hazard ratio of those who consumed less than 7 drinks per week, when compared to non-drinkers, was 0.79 (95% CI, 0.60-1.03). In those who routinely consumed more than 7 drinks per week, the hazard ratio was 0.68 (95% CI, 0.45-1.05).

The kind of drinks consumed by the people in these studies did not appear to make a difference-the alcohol in beer, wine, or spirits seemed to have an equal effect.

Possible Pathways

Although these two studies differ in design, both highlight a point that scientists have been commenting on for some time-that light-to-moderate intake of alcohol appears to reduce the risk of heart disease. There are several possible pathways. Alcohol raises HDL cholesterol levels, decreases platelet aggregation, and increases fibrinolytic activity. Alcohol may also inhibit ischemic-induced arrhythmias and lower pulmonary artery pressure in people with congestive heart failure.

Advice to Patients

Should clinicians take the results of these studies as a sign to encourage their non-drinking patients to begin drinking alcohol? No. The authors of both studies are quick to point out that while alcohol appears to play a role in heart health, it complicates other medical conditions and may increase the risk of some kinds of cancer. In addition, a steady intake of alcohol can trigger an unhealthy rise in triglyceride levels, in itself a potential risk factor for heart disease in some people.

The author of the accompanying editorial notes that people who choose not to drink usually have a good reason for that decision. While it is reasonable for someone with heart disease to consume moderate amounts of alcohol if they choose to do so, there are few instances when a non-drinker should be encouraged to begin drinking for health reasons.

For people who do enjoy alcohol, a reasonable limit is about 2 drinks per day for men and 1 drink per day for women. In the US, a serving is equal to 12 oz beer, 5 oz wine, and 1.5 oz liquor. As always, clinicians should discuss with their patients whether or not alcohol should be part of their daily routine.