Current Cardiovascular Risk Reports

, Volume 5, Issue 3, pp 273–279 | Cite as

Alcohol and Cardiovascular Risk in Women

Article
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Abstract

Understanding the many health effects of even moderate alcohol use in women is not an easy task for clinicians. Moderate intake has been consistently linked with a lower risk of coronary heart disease in women, perhaps because it consistently increases levels of high-density lipoprotein cholesterol. Trials of alcohol use in women have shown that moderate drinking also increases levels of adiponectin, an insulin-sensitizing hormone, and lowers levels of fibrinogen. Recent literature has helped to clarify several aspects of the relationship of alcohol use with coronary heart disease in women, including its consistency across women of various ages and risk levels and the importance of drinking pattern. Counterbalancing the potential cardiovascular benefits are several non-cardiovascular effects of alcohol, particularly its association with higher risk of breast cancer. Navigating these opposing effects requires careful and individualized risk assessment for all women.

Keywords

Alcohol Cardiovascular disease Coronary heart disease HDL-cholesterol Insulin resistance 

Notes

Disclosure

Kenneth J. Mukamal reports no potential conflict of interest relevant to this article.

References

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  1. 1.
    Percent reporting alcohol use in the past month by age group and demographic characteristics: NSDUH (NHSDA), 1994–2002 [http://www.niaaa.nih.gov/Resources/DatabaseResources/QuickFacts/AlcoholConsumption/Pages/dkpat4.aspx]
  2. 2.
    National Institute on Alcohol Abuse and Alcoholism: alcohol and the cardiovascular system, research monograph—31. In: Zakhari S, Wassef M, editors. Bethesda, MD: National Institutes of Health; 1996.Google Scholar
  3. 3.
    Thun MJ, Peto R, Lopez AD, Monaco JH, Henley SJ, Heath Jr CW, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997;337(24):1705–14.PubMedCrossRefGoogle Scholar
  4. 4.
    Davies MJ, Baer DJ, Judd JT, Brown ED, Campbell WS, Taylor PR. Effects of moderate alcohol intake on fasting insulin and glucose concentrations and insulin sensitivity in postmenopausal women: a randomized controlled trial. JAMA. 2002;287(19):2559–62.PubMedCrossRefGoogle Scholar
  5. 5.
    Marfella R, Cacciapuoti F, Siniscalchi M, Sasso FC, Marchese F, Cinone F, et al. Effect of moderate red wine intake on cardiac prognosis after recent acute myocardial infarction of subjects with Type 2 diabetes mellitus. Diabet Med. 2006;23(9):974–81.PubMedCrossRefGoogle Scholar
  6. 6.
    Shai I, Wainstein J, Harman-Boehm I, Raz I, Fraser D, Rudich A, et al. Glycemic effects of moderate alcohol intake among patients with type 2 diabetes: a Multi-center, randomized clinical intervention trial. Diabetes Care. 2007.Google Scholar
  7. 7.
    Rimm EB, Williams P, Fosher K, Criqui M, Stampfer MJ. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. BMJ. 1999;319(7224):1523–8.PubMedGoogle Scholar
  8. 8.
    Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G. Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med. 2006;166(22):2437–45.PubMedCrossRefGoogle Scholar
  9. 9.
    Baraona E, Abittan CS, Dohmen K, Moretti M, Pozzato G, Chayes ZW, et al. Gender differences in pharmacokinetics of alcohol. Alcohol Clin Exp Res. 2001;25(4):502–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Johansen D, Andersen PK, Jensen MK, Schnohr P, Gronbaek M. Nonlinear relation between alcohol intake and high-density lipoprotein cholesterol level: results from the Copenhagen City Heart Study. Alcohol Clin Exp Res. 2003;27(8):1305–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Beulens JW, Sierksma A, van Tol A, Fournier N, van Gent T, Paul JL, et al. Moderate alcohol consumption increases cholesterol efflux mediated by ABCA1. J Lipid Res. 2004;45(9):1716–23.PubMedCrossRefGoogle Scholar
  12. 12.
    Rumpler WV, Clevidence BA, Muesing RA, Rhodes DG. Changes in women’s plasma lipid and lipoprotein concentrations due to moderate consumption of alcohol are affected by dietary fat level. J Nutr. 1999;129(9):1713–7.PubMedGoogle Scholar
  13. 13.
    Sillanaukee P, Koivula T, Jokela H, Pitkajarvi T, Seppa K. Alcohol consumption and its relation to lipid-based cardiovascular risk factors among middle-aged women: the role of HDL(3) cholesterol. Atherosclerosis. 2000;152(2):503–10.PubMedCrossRefGoogle Scholar
  14. 14.
    van der Gaag MS, van Tol A, Vermunt SH, Scheek LM, Schaafsma G, Hendriks HF. Alcohol consumption stimulates early steps in reverse cholesterol transport. J Lipid Res. 2001;42(12):2077–83.PubMedGoogle Scholar
  15. 15.
    Ellison RC, Zhang Y, Qureshi MM, Knox S, Arnett DK, Province MA. Lifestyle determinants of high-density lipoprotein cholesterol: the National Heart, Lung, and Blood Institute Family Heart Study. Am Heart J. 2004;147(3):529–35.PubMedCrossRefGoogle Scholar
  16. 16.
    Nishiwaki M, Ishikawa T, Ito T, Shige H, Tomiyasu K, Nakajima K, et al. Effects of alcohol on lipoprotein lipase, hepatic lipase, cholesteryl ester transfer protein, and lecithin:cholesterol acyltransferase in high-density lipoprotein cholesterol elevation. Atherosclerosis. 1994;111(1):99–109.PubMedCrossRefGoogle Scholar
  17. 17.
    Hansen AS, Marckmann P, Dragsted LO, Finne Nielsen IL, Nielsen SE, Gronbaek M. Effect of red wine and red grape extract on blood lipids, haemostatic factors, and other risk factors for cardiovascular disease. Eur J Clin Nutr. 2005;59(3):449–55.PubMedCrossRefGoogle Scholar
  18. 18.
    Sierksma A, van der Gaag MS, Kluft C, Hendriks HF. Moderate alcohol consumption reduces plasma C-reactive protein and fibrinogen levels; a randomized, diet-controlled intervention study. Eur J Clin Nutr. 2002;56(11):1130–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Gorinstein S, Caspi A, Goshev I, Aksu S, Salnikow J, Scheler C, et al. Structural changes in plasma circulating fibrinogen after moderate beer consumption as determined by electrophoresis and spectroscopy. J Agric Food Chem. 2003;51(3):822–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Deykin D, Janson P, McMahon L. Ethanol potentiation of aspirin-induced prolongation of the bleeding time. N Engl J Med. 1982;306(14):852–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Rubin R. Effect of ethanol on platelet function. Alcohol Clin Exp Res. 1999;23(6):1114–8.PubMedCrossRefGoogle Scholar
  22. 22.
    El-Sayed MS. Effects of alcohol ingestion post-exercise on platelet aggregation. Thromb Res. 2002;105(2):147–51.PubMedCrossRefGoogle Scholar
  23. 23.
    Renaud S, de Lorgeril M. Wine, alcohol, platelets, and the French paradox for coronary heart disease. Lancet. 1992;339(8808):1523–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Sumi H, Kozaki Y, Yatagai C, Hamada H. Effects of wine on plasma fibrinolytic and coagulation systems. Nihon Arukōru Yakubutsu Igakkai Zasshi. 1998;33:263–72.PubMedGoogle Scholar
  25. 25.
    Beulens JW, de Zoete EC, Kok FJ, Schaafsma G, Hendriks HF. Effect of moderate alcohol consumption on adipokines and insulin sensitivity in lean and overweight men: a diet intervention study. Eur J Clin Nutr. 2007.Google Scholar
  26. 26.
    Sierksma A, Patel H, Ouchi N, Kihara S, Funahashi T, Heine RJ, et al. Effect of moderate alcohol consumption on adiponectin, tumor necrosis factor-alpha, and insulin sensitivity. Diab Care. 2004;27(1):184–9.CrossRefGoogle Scholar
  27. 27.
    Joosten MM, Beulens JW, Kersten S, Hendriks HF. Moderate alcohol consumption increases insulin sensitivity and ADIPOQ expression in postmenopausal women: a randomised, crossover trial. Diabetologia. 2008;51(8):1375–81.PubMedCrossRefGoogle Scholar
  28. 28.
    Beulens JW, Rimm EB, Hendriks HF, Hu FB, Manson JE, Hunter DJ, et al. Alcohol consumption and type 2 diabetes: influence of genetic variation in alcohol dehydrogenase. Diabetes. 2007.Google Scholar
  29. 29.
    Imhof A, Plamper I, Maier S, Trischler G, Koenig W. Effect of drinking on adiponectin in healthy men and women: a randomized intervention study of water, ethanol, red wine, and beer with or without alcohol. Diab Care. 2009;32(6):1101–3.CrossRefGoogle Scholar
  30. 30.
    Sakkinen PA, Wahl P, Cushman M, Lewis MR, Tracy RP. Clustering of procoagulation, inflammation, and fibrinolysis variables with metabolic factors in insulin resistance syndrome. Am J Epidemiol. 2000;152(10):897–907.PubMedCrossRefGoogle Scholar
  31. 31.
    Sacanella E, Vazquez-Agell M, Mena MP, Antunez E, Fernandez-Sola J, Nicolas JM, et al. Down-regulation of adhesion molecules and other inflammatory biomarkers after moderate wine consumption in healthy women: a randomized trial. Am J Clin Nutr. 2007;86(5):1463–9.PubMedGoogle Scholar
  32. 32.
    Spaak J, Merlocco AC, Soleas GJ, Tomlinson G, Morris BL, Picton P, et al. Dose-related effects of red wine and alcohol on hemodynamics, sympathetic nerve activity, and arterial diameter. Am J Physiol Heart Circ Physiol. 2008;294(2):H605–12.PubMedCrossRefGoogle Scholar
  33. 33.
    Kawabe H, Saito I, Saruta T. Effects of nighttime alcohol intake on evening and next morning home blood pressure in Japanese normotensives. Clin Exp Hypertens. 2007;29(1):43–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Abe H, Kawano Y, Kojima S, Ashida T, Kuramochi M, Matsuoka H, et al. Biphasic effects of repeated alcohol intake on 24-hour blood pressure in hypertensive patients. Circulation. 1994;89(6):2626–33.PubMedGoogle Scholar
  35. 35.
    Sierksma A, Sarkola T, Eriksson CJ, van der Gaag MS, Grobbee DE, Hendriks HF. Effect of moderate alcohol consumption on plasma dehydroepiandrosterone sulfate, testosterone, and estradiol levels in middle-aged men and postmenopausal women: a diet-controlled intervention study. Alcohol Clin Exp Res. 2004;28(5):780–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Reichman ME, Judd JT, Longcope C, Schatzkin A, Clevidence BA, Nair PP, et al. Effects of alcohol consumption on plasma and urinary hormone concentrations in premenopausal women. J Natl Cancer Inst. 1993;85(9):722–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Dorgan JF, Baer DJ, Albert PS, Judd JT, Brown ED, Corle DK, et al. Serum hormones and the alcohol-breast cancer association in postmenopausal women. J Natl Cancer Inst. 2001;93(9):710–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Corrao G, Rubbiati L, Bagnardi V, Zambon A, Poikolainen K. Alcohol and coronary heart disease: a meta-analysis. Addiction. 2000;95(10):1505–23.PubMedCrossRefGoogle Scholar
  39. 39.
    Klatsky AL. Alcohol and cardiovascular diseases: a historical overview. Ann NY Acad Sci. 2002;957:7–15.PubMedCrossRefGoogle Scholar
  40. 40.
    •• Hvidtfeldt UA, Tolstrup JS, Jakobsen MU, Heitmann BL, Gronbaek M, O’Reilly E, et al. Alcohol intake and risk of coronary heart disease in younger, middle-aged, and older adults. Circulation. 2010;121(14):1589–1597. This large-scale pooling project combined data from eight long-term cohort studies, resulting in a sample of nearly 200,000 women and nearly 1500 cases of incident coronary heart disease, perhaps the largest study of its kind. The relative risk associated with 1 to 2 drinks per day was approximately 0.5 and was similar in younger and older women, but because the rate of coronary events was 10-fold higher in older women, the absolute benefit to young women from drinking was only 3 cases prevented per 100,000 person-years. Google Scholar
  41. 41.
    Bos S, Grobbee DE, Boer JM, Verschuren WM, Beulens JW. Alcohol consumption and risk of cardiovascular disease among hypertensive women. Eur J Cardiovasc Prev Rehabil. 2010;17(1):119–26.PubMedCrossRefGoogle Scholar
  42. 42.
    Rajpathak SN, Freiberg MS, Wang C, Wylie-Rosett J, Wildman RP, Rohan TE, et al. Alcohol consumption and the risk of coronary heart disease in postmenopausal women with diabetes: Women’s Health Initiative Observational Study. Eur J Nutr. 2010;49(4):211–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Freiberg MS, Chang YF, Kraemer KL, Robinson JG, Adams-Campbell LL, Kuller LL. Alcohol consumption, hypertension, and total mortality among women. Am J Hypertens. 2009;22(11):1212–8.PubMedCrossRefGoogle Scholar
  44. 44.
    • Costanzo S, Di Castelnuovo A, Donati MB, Iacoviello L, de Gaetano G. Alcohol consumption and mortality in patients with cardiovascular disease: a meta-analysis. J Am Coll Cardiol. 2010;55(13):1339–1347. This meta-analysis reviews a number of studies of alcohol consumption among men and women with known cardiovascular disease. Although only about half of the studies included women, those studies found strong associations of alcohol consumption with lower mortality among such patients. In combination with the following three references, these articles cumulatively support the suggestion that women not stop drinking simply because of atherosclerotic vascular disease. Google Scholar
  45. 45.
    Beulens JW, Algra A, Soedamah-Muthu SS, Visseren FL, Grobbee DE, van der Graaf Y, et al. Alcohol consumption and risk of recurrent cardiovascular events and mortality in patients with clinically manifest vascular disease and diabetes mellitus: the Second Manifestations of ARTerial (SMART) disease study. Atherosclerosis. 2010;212(1):281–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Brugger-Andersen T, Ponitz V, Snapinn S, Dickstein K, group Os. Moderate alcohol consumption is associated with reduced long-term cardiovascular risk in patients following a complicated acute myocardial infarction. Int J Cardiol. 2009;133(2):229–32.PubMedCrossRefGoogle Scholar
  47. 47.
    Carter MD, Lee JH, Buchanan DM, Peterson ED, Tang F, Reid KJ, et al. Comparison of outcomes among moderate alcohol drinkers before acute myocardial infarction to effect of continued versus discontinuing alcohol intake after the infarct. Am J Cardiol. 2010;105(12):1651–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Tolstrup J, Jensen MK, Tjonneland A, Overvad K, Mukamal KJ, Gronbaek M. Prospective study of alcohol drinking patterns and coronary heart disease in women and men. BMJ. 2006;332(7552):1244–8.PubMedCrossRefGoogle Scholar
  49. 49.
    • Russell M, Chu BC, Banerjee A, Fan AZ, Trevisan M, Dorn JM, et al. Drinking patterns and myocardial infarction: a linear dose-response model. Alcohol Clin Exp Res. 2009;33(2):324–331. This innovative article, while technically challenging, asks a simple question—how do the quantity and frequency with which individuals drink influence their risk of myocardial infarction? The results were similar in men and women and support a lower risk with more frequent drinking but a higher risk with greater quantity per drinking day. These findings, particularly in women, point to a low-risk, high-reward pattern of drinking, characterized by 1 drink or less consumed several times per week. Google Scholar
  50. 50.
    Mukamal KJ, Jensen MK, Gronbaek M, Stampfer MJ, Manson JE, Pischon T, et al. Drinking frequency, mediating biomarkers, and risk of myocardial infarction in women and men. Circulation. 2005;112(10):1406–13.PubMedCrossRefGoogle Scholar
  51. 51.
    Muth ND, Laughlin GA, von Muhlen D, Smith SC, Barrett-Connor E. High-density lipoprotein subclasses are a potential intermediary between alcohol intake and reduced risk of cardiovascular disease: the Rancho Bernardo Study. Br J Nutr. 2010;104(7):1034–42.PubMedCrossRefGoogle Scholar
  52. 52.
    • Djousse L, Lee IM, Buring JE, Gaziano JM. Alcohol consumption and risk of cardiovascular disease and death in women: potential mediating mechanisms. Circulation. 2009;120(3):237–244. This analysis evaluated the association of alcohol consumption with risk of cardiovascular disease, cardiovascular mortality, and total mortality in over 26,000 women. There were J-shaped relationships between alcohol consumption and the three outcomes. Consistent with effects seen in experimental trials of alcohol, the most important contributors to the benefit of light-to-moderate drinking were higher HDL cholesterol, lower triglycerides, less diabetes, and lower levels of inflammatory factors. Google Scholar
  53. 53.
    Conen D, Tedrow UB, Cook NR, Moorthy MV, Buring JE, Albert CM. Alcohol consumption and risk of incident atrial fibrillation in women. JAMA. 2008;300(21):2489–96.PubMedCrossRefGoogle Scholar
  54. 54.
    Sesso HD, Cook NR, Buring JE, Manson JE, Gaziano JM. Alcohol consumption and the risk of hypertension in women and men. Hypertension. 2008;51(4):1080–7.PubMedCrossRefGoogle Scholar
  55. 55.
    • Patra J, Taylor B, Irving H, Roerecke M, Baliunas D, Mohapatra S, et al. Alcohol consumption and the risk of morbidity and mortality for different stroke types—a systematic review and meta-analysis. BMC Public Health. 2010;10:258. This comprehensive meta-analysis reviews a number of case-control and cohort studies relating alcohol consumption to fatal and non-fatal stroke. It demonstrates a modestly lower risk among light drinkers for ischemic stroke, a markedly elevated risk for heavy drinkers for ischemic stroke, and a dose-dependent increase in risk for hemorrhagic stroke. These results fit well with two parallel mechanisms—increased blood pressure with heavier drinking and dose-dependent antithrombotic activity. Google Scholar
  56. 56.
    •• Mostofsky E, Burger MR, Schlaug G, Mukamal KJ, Rosamond WD, Mittleman MA. Alcohol and acute ischemic stroke onset: the stroke onset study. Stroke. 2010;41(9):1845–1849. This study is the first to explore the possibility that alcohol consumption triggers strokes. Using a case-crossover approach in which each patient reports their most recent and their usual alcohol use, the study demonstrated an immediate but very brief (< 1 hour) increase in risk immediately following drinking. Usual intake was light in these older adults, demonstrating that higher risk is not limited to episodes of binging. Google Scholar
  57. 57.
    Gerlich MG, Kramer A, Gmel G, Maggiorini M, Luscher TF, Rickli H, et al. Patterns of alcohol consumption and acute myocardial infarction: a case-crossover analysis. Eur Addict Res. 2009;15(3):143–9.PubMedCrossRefGoogle Scholar
  58. 58.
    World Cancer Research Fund/American Institute for Cancer Research: Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective. In: Washington DC: AICR; 2007.Google Scholar
  59. 59.
    Giovannucci E. Diet, body weight, and colorectal cancer: a summary of the epidemiologic evidence. J Womens Health (Larchmt). 2003;12(2):173–82.CrossRefGoogle Scholar
  60. 60.
    Suzuki R, Orsini N, Mignone L, Saji S, Wolk A. Alcohol intake and risk of breast cancer defined by estrogen and progesterone receptor status—A meta-analysis of epidemiological studies. Int J Cancer. 2007.Google Scholar
  61. 61.
    McDonald JA, Mandel MG, Marchbanks PA, Folger SG, Daling JR, Ursin G, et al. Alcohol exposure and breast cancer: results of the women’s contraceptive and reproductive experiences study. Cancer Epidemiol Biomark Prev. 2004;13(12):2106–16.Google Scholar
  62. 62.
    • Allen NE, Beral V, Casabonne D, Kan SW, Reeves GK, Brown A, et al. Moderate alcohol intake and cancer incidence in women. J Natl Cancer Inst. 2009;101(5):296–305. This very large cohort study recruited women from mammography clinics and followed them for new cases of cancer. Although it has incorrectly been interpreted to suggest that light drinking increases all forms of cancer, it clearly shows that even light drinking increases risk of breast cancer and that drinking more than 1 drink per day (the currently recommended limit) increases risk for a number of types of cancer. Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Beth Israel Deaconess Medical CenterDivision of General Medicine and Primary Care Research ProgramBrooklineUSA

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