From the Guidelines
Alcohol consumption is consistently associated with higher cardiovascular risk, including acute myocardial infarction, and its potential benefits on coronary arteries are likely mediated by confounding lifestyle factors. The relationship between alcohol and coronary artery health is complex, with both potential benefits and harms depending on consumption patterns. However, the most recent and highest quality study 1 suggests that the benefits of moderate alcohol consumption on cardiovascular risk are likely due to confounding factors, and excessive alcohol consumption is linked to hypertension, increased mortality rate, and recurrent cardiovascular events.
Key Findings
- Excessive alcohol consumption damages coronary arteries by raising blood pressure, increasing triglycerides, promoting inflammation, and leading to oxidative stress that damages arterial walls 1.
- Heavy drinking contributes to obesity and can trigger arrhythmias, and chronic excessive alcohol use may lead to alcoholic cardiomyopathy and accelerate atherosclerosis (plaque buildup) in coronary arteries.
- Binge drinking (>50 g at least once a week) is associated with a higher risk of coronary events (hazard ratio, 2.03 [95% CI, 1.41-2.94]) compared with regular drinking 1.
Recommendations
- Limiting alcohol consumption is crucial for maintaining heart health, and non-drinkers should not start drinking for potential cardiovascular benefits 1.
- The American Heart Association recommends that individuals who drink alcohol should limit their intake to no more than two drinks per day for men and one drink a day for women 1.
- Certain groups, such as children, adolescents, pregnant women, and individuals taking prescriptions or over-the-counter medications that can interact with alcohol, should not drink alcoholic beverages at all 1.
From the Research
Effects of Alcohol on Coronary Arteries
- Alcohol consumption has been shown to have a complex relationship with coronary artery disease, with light to moderate drinking associated with a lower risk of coronary heart disease 2, 3, 4.
- The mechanisms of cardioprotective effects of alcohol are complex and involve multiple pathways, including favorable effects on lipoprotein levels and reduction in inflammation 3, 5.
- However, heavy alcohol consumption has been associated with deleterious cardiovascular outcomes, including increased risk of coronary artery disease, heart failure, and cardiovascular mortality 2, 6.
- Acute effects of alcohol on coronary circulation have been found to be adverse, particularly in patients with pre-existing heart disease, with clinical studies demonstrating an adverse effect of acute alcohol intake on coronary supply-demand relation in patients with angina pectoris 6.
- The evidence is based on observational and population-based studies, and there is a need for long-term randomized controlled trials to provide causal evidence on the effects of alcohol consumption on coronary artery disease 4.
Key Findings
- Light to moderate alcohol consumption (up to 1 drink per day in women and up to 2 drinks per day in men) has been associated with a lower risk of coronary heart disease 3.
- The relationship between alcohol consumption and coronary artery disease is J- or U-shaped, with heavy drinking associated with increased risk and light to moderate drinking associated with decreased risk 2.
- Alcohol consumption has been shown to impact the risk of other cardiovascular diseases, including congestive heart failure, alcoholic cardiomyopathy, atrial fibrillation, and peripheral artery disease 3, 5.