Alcohol and Cardiovascular Disease: How Much is Too Much?
Purpose of Review
Previous research suggests that low-moderate alcohol consumption may have cardioprotective effects, while heavy or binge-pattern drinking is harmful. New evidence and research methodology may inform safe thresholds of alcohol use. This review examines recent evidence regarding alcohol’s effect on cardiovascular disease, with a special consideration of pattern, drink type, and total quantity.
New epidemiologic research confirms the potential harmful cardiovascular effects of heavy episodic alcohol use and does not support the previous observation that low-moderate alcohol use protects against stroke. Alcohol consumption also appears to have a continuous positive relationship with the risk of atrial fibrillation. In addition, Mendelian randomization analyses suggest that alcohol may have a direct causal role in adverse cardiovascular effects. Recent studies have confirmed that heavy alcohol use (>14 drinks per week in women and >21 drinks per week in men) and heavy episodic drinking are associated with an increased risk of mortality.
New research raises concerns that even low-moderate alcohol use may not offer cardio- or cerebrovascular protection. Drinking ≥3 drinks per day on a regular basis or ≥5 drinks in any one episode should be discouraged.
KeywordsAlcohol Cardiovascular disease CVD Alcohol consumption Drinking
Compliance with Ethical Standards
Conflict of Interest
A.T., G.P., and D.P.L. declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 9.Chiva-Blanch G, Magraner E, Condines X, Valderas-Martinez P, Roth I, Arranz S, et al. Effects of alcohol and polyphenols from beer on atherosclerotic biomarkers in high cardiovascular risk men: a randomized feeding trial. Nutr Metab Cardiovasc Dis. 2015;25(1):36–45. doi: 10.1016/j.numecd.2014.07.008.CrossRefPubMedGoogle Scholar
- 10.Bell S, Mehta G, Moore K, Britton A. Ten-year alcohol consumption typologies and trajectories of C-reactive protein, interleukin-6 and interleukin-1 receptor antagonist over the following 12 years: a prospective cohort study. J Intern Med. 2016. doi: 10.1111/joim.12544.PubMedPubMedCentralGoogle Scholar
- 13.Sabater-Lleal M, Huang J, Chasman D, Naitza S, Dehghan A, Johnson AD, et al. Multiethnic meta-analysis of genome-wide association studies in >100 000 subjects identifies 23 fibrinogen-associated loci but no strong evidence of a causal association between circulating fibrinogen and cardiovascular disease. Circulation. 2013;128(12):1310–24. doi: 10.1161/CIRCULATIONAHA.113.002251.CrossRefPubMedGoogle Scholar
- 19.Smyth A, Teo KK, Rangarajan S, O’Donnell M, Zhang X, Rana P, et al. Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study. Lancet (London, England). 2015;386(10007):1945–54. doi: 10.1016/s0140-6736(15)00235-4.CrossRefGoogle Scholar
- 20.Gemes K, Janszky I, Laugsand LE, Laszlo KD, Ahnve S, Vatten LJ, et al. Alcohol consumption is associated with a lower incidence of acute myocardial infarction: results from a large prospective population-based study in Norway. J Intern Med. 2016;279(4):365–75. doi: 10.1111/joim.12428.CrossRefPubMedGoogle Scholar
- 21.Pai JK, Mukamal KJ, Rimm EB. Long-term alcohol consumption in relation to all-cause and cardiovascular mortality among survivors of myocardial infarction: the Health Professionals Follow-up Study. Eur Heart J. 2012;33(13):1598–605. doi: 10.1093/eurheartj/ehs047.CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Huang C, Zhan J, Liu YJ, Li DJ, Wang SQ, He QQ. Association between alcohol consumption and risk of cardiovascular disease and all-cause mortality in patients with hypertension: a meta-analysis of prospective cohort studies. Mayo Clin Proc. 2014;89(9):1201–10. doi: 10.1016/j.mayocp.2014.05.014.CrossRefPubMedGoogle Scholar
- 28.Zheng YL, Lian F, Shi Q, Zhang C, Chen YW, Zhou YH, et al. Alcohol intake and associated risk of major cardiovascular outcomes in women compared with men: a systematic review and meta-analysis of prospective observational studies. BMC Public Health. 2015;15:773. doi: 10.1186/s12889-015-2081-y.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Goddard E. Estimating alcohol consumption from survey data: updated method of converting volumes to units, vol. 37. Cardiff: Office for National Statistics; 2007.Google Scholar
- 31.O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet (London, England). 2016;388(10046):761–75. doi: 10.1016/S0140-6736(16)30506-2.CrossRefGoogle Scholar
- 32.McManus DD, Yin X, Gladstone R, Vittinghoff E, Vasan RS, Larson MG, et al. Alcohol consumption, left atrial diameter, and atrial fibrillation. J Am Heart Assoc. 2016;5(9). doi: 10.1161/JAHA.116.004060.
- 34.• Mostofsky E, Chahal HS, Mukamal KJ, Rimm EB, Mittleman MA. Alcohol and immediate risk of cardiovascular events: a systematic review and dose-response meta-analysis. Circulation. 2016;133(10):979–87. doi: 10.1161/CIRCULATIONAHA.115.019743. A recent meta-analysis highlighting the importance of the pattern of consumption of alcohol as a precipitant of myocardial infarction.CrossRefPubMedGoogle Scholar
- 35.Matyas C, Varga ZV, Mukhopadhyay P, Paloczi J, Lajtos T, Erdelyi K, et al. Chronic plus binge ethanol feeding induces myocardial oxidative stress, mitochondrial and cardiovascular dysfunction, and steatosis. Am J Physiol Heart Circ Physiol. 2016;310(11):H1658–70. doi: 10.1152/ajpheart.00214.2016.CrossRefPubMedGoogle Scholar
- 43.Hange D, Sigurdsson JA, Bjorkelund C, Sundh V, Bengtsson C. A 32-year longitudinal study of alcohol consumption in Swedish women: reduced risk of myocardial infarction but increased risk of cancer. Scand J Prim Health Care. 2015;33(3):153–62. doi: 10.3109/02813432.2015.1067515.CrossRefPubMedPubMedCentralGoogle Scholar
- 45.• Knott CS, Coombs N, Stamatakis E, Biddulph JP. All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population based cohorts. BMJ : Br Med J. 2015;350:h384. A recent meta-analysis of 10 epidemiological studies which suggests that previously described protective associations between alcohol and all-cause mortality may be explained by residual confounding and inappropriate referent groups.Google Scholar
- 46.Dai J, Mukamal KJ, Krasnow RE, Swan GE, Reed T. Higher usual alcohol consumption was associated with a lower 41-y mortality risk from coronary artery disease in men independent of genetic and common environmental factors: the prospective NHLBI Twin Study. Am J Clin Nutr. 2015;102(1):31–9. doi: 10.3945/ajcn.114.106435.CrossRefPubMedPubMedCentralGoogle Scholar
- 50.•• Holmes MV, Dale CE, Zuccolo L, Silverwood RJ, Guo Y, Ye Z, et al. Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. BMJ. 2014;349:g4164. doi: 10.1136/bmj.g4164. A Mendelian analysis of 56 epidemiological studies which suggested that even low-moderate drinkers would benefit from reduced alcohol consumption.CrossRefPubMedPubMedCentralGoogle Scholar