Skip to main content

Alcohol and Cardiovascular Risk

  • Living reference work entry
  • First Online:
Handbook of Psychocardiology
  • 326 Accesses

Abstract

Alcohol is a psychoactive substance that has a considerable impact on the physical and mental health of individuals. While there is clear evidence for a wide range of harms associated with alcohol consumption, research has also been conducted into the potential positive effects, including cardiovascular effects. The results of many of these studies are suggestive of a J-shaped association between low levels of regular alcohol intake and a reduction in cardiovascular risk – particularly coronary heart disease risk. This is an association that appears to be affected both by the level and the pattern of alcohol consumption. However, most of this research has consisted of observational and population-based studies, with inherent methodological limitations and difficulties controlling for confounding factors. Consequently, there is still insufficient evidence to suggest a causal relationship between alcohol consumption and a reduction in cardiovascular risk. On a population level, the putative benefits of alcohol intake are more salient for some individuals compared to others – such as older adults with other cardiovascular risk factors. On the other hand, negative health effects can arise from even low levels of alcohol intake. Thus, the provision of advice regarding alcohol consumption needs to be individualized and is best undertaken within a clinical context.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Similar content being viewed by others

References

  • Albert, M. A., Glynn, R. J., & Ridker, P. M. (2003). Alcohol consumption and plasma concentration of C-reactive protein. Circulation, 107(3), 443–447.

    Article  PubMed  Google Scholar 

  • Bagnardi, V., Zatonski, W., Scotti, L., La Vecchia, C., & Corrao, G. (2008). Does drinking pattern modify the effect of alcohol on the risk of coronary heart disease? Evidence from a meta-analysis. Journal of Epidemiology and Community Health, 62(7), 615–619.

    Article  PubMed  Google Scholar 

  • Brien, S. E., Ronksley, P. E., Turner, B. J., Mukamal, K. J., & Ghali, W. A. (2011). Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: Systematic review and meta-analysis of interventional studies. BMJ [British Medical Journal], 342, d636.

    Article  Google Scholar 

  • Butt, P., Beirness, D., Cesa, F., Gliksman, L., Paradis, C., & Stockwell, T. (2011). Alcohol and health in Canada: A summary of evidence and guidelines for low-risk drinking. Ottawa, ON: Canadian Centre on Substance Abuse.

    Google Scholar 

  • Collins, D. J., & Lapsley, H. M. (2008). The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. Canberra: Department of Health and Ageing.

    Book  Google Scholar 

  • Corrao, G., Rubbiati, L., Bagnardi, V., Zambon, A., & Poikolainen, K. (2000). Alcohol and coronary heart disease: A meta-analysis. Addiction, 95(10), 1505–1523.

    Article  PubMed  Google Scholar 

  • Costanzo, S., Di Castelnuovo, A., Donati, M. B., Iacoviello, L., & de Gaetano, G. (2010a). Alcohol consumption and mortality in patients with cardiovascular disease: A meta-analysis. Journal of the American College of Cardiology, 55(13), 1339–1347. doi:10.1016/j.jacc.2010.01.006.

    Article  PubMed  Google Scholar 

  • Costanzo, S., Di Castelnuovo, A., Donati, M. B., Iacoviello, L., & de Gaetano, G. (2010b). Cardiovascular and overall mortality risk in relation to alcohol consumption in patients with cardiovascular disease. Circulation, 121(17), 1951–1959. doi:10.1161/CIRCULATIONAHA.109.865840.

    Article  PubMed  Google Scholar 

  • Criqui, M. H., & Ringel, B. L. (1994). Does diet or alcohol explain the French paradox? The Lancet, 344(8939), 1719–1723.

    Article  Google Scholar 

  • Del Boca, F. K., & Darkes, J. (2003). The validity of self‐reports of alcohol consumption: state of the science and challenges for research. Addiction, 98(s2), 1–12.

    Google Scholar 

  • Di Castelnuovo, A., Costanzo, S., Bagnardi, V., Donati, M. B., Iacoviello, L., & de Gaetano, G. (2006). Alcohol dosing and total mortality in men and women: An updated meta-analysis of 34 prospective studies. Archives of Internal Medicine, 166(22), 2437–2445.

    Article  PubMed  Google Scholar 

  • Di Castelnuovo, A., Costanzo, S., Donati, M. B., Iacoviello, L., & de Gaetano, G. (2010). Prevention of cardiovascular risk by moderate alcohol consumption: Epidemiologic evidence and plausible mechanisms. Internal and Emergency Medicine, 5(4), 291–297.

    Article  PubMed  Google Scholar 

  • Djoussé, L., Ellison, R. C., Beiser, A., Scaramucci, A., D’Agostino, R. B., & Wolf, P. A. (2002). Alcohol consumption and risk of ischemic stroke the Framingham Study. Stroke, 33(4), 907–912.

    Article  PubMed  Google Scholar 

  • Ellison, R. C. (2005). Importance of pattern of alcohol consumption. Circulation, 112(25), 3818–3819.

    Article  PubMed  Google Scholar 

  • Fauchier, L. (2003). Alcoholic cardiomyopathy and ventricular arrhythmias. CHEST Journal, 123(4), 1320–1320.

    Article  Google Scholar 

  • Fekjaer, H. O. (2013). Alcohol-a universal preventive agent? A critical analysis. Addiction, 108(12), 2051–2057. doi:10.1111/add.12104.

    Article  PubMed  Google Scholar 

  • Fillmore, K. M., Kerr, W. C., Stockwell, T., Chikritzhs, T., & Bostrom, A. (2006). Moderate alcohol use and reduced mortality risk: Systematic error in prospective studies. Addiction Research & Theory, 14(2), 101–132.

    Article  Google Scholar 

  • Fillmore, K. M., Stockwell, T., Chikritzhs, T., Bostrom, A., & Kerr, W. (2007). Moderate alcohol use and reduced mortality risk: Systematic error in prospective studies and new hypotheses. Annals of Epidemiology, 17(5 Suppl), S16–S23. doi:10.1016/j.annepidem.2007.01.005.

    Article  PubMed  Google Scholar 

  • Freiberg, M. S., & Samet, J. H. (2005). Alcohol and coronary heart disease the answer awaits a randomized controlled trial. Circulation, 112(10), 1379–1381.

    Article  PubMed  Google Scholar 

  • Gaziano, J. M., Buring, J. E., Breslow, J. L., Goldhaber, S. Z., Rosner, B., VanDenburgh, M.,... Hennekens, C. H. (1993). Moderate alcohol intake, increased levels of high-density lipoprotein and its subfractions, and decreased risk of myocardial infarction. New England Journal of Medicine, 329(25), 1829–1834.

    Google Scholar 

  • Goncalves, A., Jhund, P., Claggett, B., Shah, A., Konety, S., Butler, K.,... Solomon, S. (2014). Increasing alcohol consumption is related to detrimental changes in cardiac structure and function. Journal of the American College of Cardiology, 63(12_S).

    Google Scholar 

  • Grønbæk, M., Becker, U., Johansen, D., Gottschau, A., Schnohr, P., Hein, H. O.,... Sørensen, T. I. (2000). Type of alcohol consumed and mortality from all causes, coronary heart disease, and cancer. Annals of Internal Medicine, 133(6), 411–419.

    Google Scholar 

  • Hall, W. (2012). What place, if any, does information on putative cardioprotective effects of moderate alcohol use have in safer drinking guidelines? Drug and Alcohol Review, 31(2), 194–197.

    Article  PubMed  Google Scholar 

  • Hansel, B., Thomas, F., Pannier, B., Bean, K., Kontush, A., Chapman, M.,... Bruckert, E. (2010). Relationship between alcohol intake, health and social status and cardiovascular risk factors in the urban Paris-Ile-De-France Cohort: Is the cardioprotective action of alcohol a myth & quest. European Journal of Clinical Nutrition, 64(6), 561–568.

    Google Scholar 

  • Hansel, B., Kontush, A., & Bruckert, E. (2012). Is a cardioprotective action of alcohol a myth? Current Opinion in Cardiology, 27(5), 550–555. doi:10.1097/HCO.0b013e328356dc30.

    Article  PubMed  Google Scholar 

  • Karatzi, K., Papamichael, C., Aznaouridis, K., Karatzis, E., Lekakis, J., Matsouka, C.,... Feliou, G. (2004). Constituents of red wine other than alcohol improve endothelial function in patients with coronary artery disease. Coronary Artery Disease, 15(8), 485–490.

    Google Scholar 

  • Klatsky, A. L. (2010). Alcohol and cardiovascular mortality: Common sense and scientific truth. Journal of the American College of Cardiology, 55(13), 1336–1338. doi:10.1016/j.jacc.2009.10.057.

    Article  PubMed  Google Scholar 

  • Kloner, R. A., & Rezkalla, S. H. (2007). To drink or not to drink? That is the question. Circulation, 116(11), 1306–1317.

    Article  PubMed  Google Scholar 

  • Laslett, A.-M., Catalano, P., Chikritzhs, Y., Dale, C., Doran, C., Ferris, J., Jainullabudeen, T., Livingston, M., Matthews, S., Mugavin, J., Room, R., Schlotterlein, M., & Wilkinson, C. (2010). The range and magnitude of alcohol’s harm to others. Fitzroy: AER Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Eastern Health.

    Google Scholar 

  • Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H.,... Andrews, K. G. (2013). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), 2224–2260.

    Google Scholar 

  • Lucas, D. L., Brown, R. A., Wassef, M., & Giles, T. D. (2005). Alcohol and the cardiovascular system: Research challenges and opportunities. Journal of the American College of Cardiology, 45(12), 1916–1924. doi:10.1016/j.jacc.2005.02.075.

    Article  PubMed  Google Scholar 

  • Magnus, P., Bakke, E., Hoff, D. A., Høiseth, G., Graff-Iversen, S., Knudsen, G. P.,... Tambs, K. (2011). Controlling for high-density lipoprotein cholesterol does not affect the magnitude of the relationship between alcohol and coronary heart disease. Circulation, 124(21), 2296–2302.

    Google Scholar 

  • Malyutina, S., Bobak, M., Kurilovitch, S., Gafarov, V., Simonova, G., Nikitin, Y., & Marmot, M. (2002). Relation between heavy and binge drinking and all-cause and cardiovascular mortality in Novosibirsk, Russia: A prospective cohort study. The Lancet, 360(9344), 1448–1454.

    Article  Google Scholar 

  • Marmot, M., & Brunner, E. (1991). Alcohol and cardiovascular disease: The status of the U shaped curve. BMJ [British Medical Journal], 303(6802), 565.

    Article  Google Scholar 

  • Mukamal, K. J., Conigrave, K. M., Mittleman, M. A., Camargo, C. A., Jr., Stampfer, M. J., Willett, W. C., & Rimm, E. B. (2003). Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. New England Journal of Medicine, 348(2), 109–118.

    Article  PubMed  Google Scholar 

  • Mukamal, K. J., Ascherio, A., Mittleman, M. A., Conigrave, K. M., Camargo, C. A., Kawachi, I.,... Rimm, E. B. (2005). Alcohol and risk for ischemic stroke in men: The role of drinking patterns and usual beverage. Annals of Internal Medicine, 142(1), 11–19.

    Google Scholar 

  • Mukamal, K. J., Mackey, R. H., Kuller, L. H., Tracy, R. P., Kronmal, R. A., Mittleman, M. A., & Siscovick, D. S. (2007). Alcohol consumption and lipoprotein subclasses in older adults. Journal of Clinical Endocrinology & Metabolism, 92(7), 2559–2566.

    Article  Google Scholar 

  • Mukamal, K. J., Chen, C. M., Rao, S. R., & Breslow, R. A. (2010). Alcohol consumption and cardiovascular mortality among U.S. adults, 1987 to 2002. Journal of the American College of Cardiology, 55(13), 1328–1335. doi:10.1016/j.jacc.2009.10.056.

    Article  PubMed  Google Scholar 

  • Naimi, T. S., Brown, D. W., Brewer, R. D., Giles, W. H., Mensah, G., Serdula, M. K.,... Naimi, S. (2005). Cardiovascular risk factors and confounders among nondrinking and moderate-drinking US adults. American Journal of Preventive Medicine, 28(4), 369–373.

    Google Scholar 

  • Naimi, T. S., Xuan, Z., Brown, D. W., & Saitz, R. (2013). Confounding and studies of ‘moderate’ alcohol consumption: The case of drinking frequency and implications for low-risk drinking guidelines. Addiction, 108(9), 1534–1543. doi:10.1111/j.1360-0443.2012.04074.x.

    Article  PubMed  Google Scholar 

  • NHMRC. (2009). Australian guidelines to reduce health risks from drinking alcohol. Canberra: Commonwealth Government of Australia.

    Google Scholar 

  • O’Keefe, J. H., Bybee, K. A., & Lavie, C. J. (2007). Alcohol and cardiovascular health: The razor-sharp double-edged sword. Journal of the American College of Cardiology, 50(11), 1009–1014. doi:10.1016/j.jacc.2007.04.089.

    Article  PubMed  Google Scholar 

  • Ohsawa, M., & Tanno, K. (2013). Conflicting effect of alcohol on cardiovascular risk: A clue to understand the different etiologies of coronary artery disease, stroke and peripheral artery disease. Hypertension Research, 36(1), 16–18. doi:10.1038/hr.2012.152.

    Article  PubMed  Google Scholar 

  • Parry, C. D., Patra, J., & Rehm, J. (2011). Alcohol consumption and non-communicable diseases: Epidemiology and policy implications. Addiction, 106(10), 1718–1724. doi:10.1111/j.1360-0443.2011.03605.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Patra, J., Taylor, B., Irving, H., Roerecke, M., Baliunas, D., Mohapatra, S., & Rehm, J. (2010). Alcohol consumption and the risk of morbidity and mortality for different stroke types-a systematic review and meta-analysis. BMC Public Health, 10(1), 258.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pearson, T. A. (1996). Alcohol and heart disease. Circulation, 94(11), 3023–3025.

    Article  PubMed  Google Scholar 

  • Piano, M. R. (2002). Alcoholic cardiomyopathy Incidence, clinical characteristics, and pathophysiology. CHEST Journal, 121(5), 1638–1650.

    Article  Google Scholar 

  • Piano, M. R., & Phillips, S. A. (2014). Alcoholic cardiomyopathy: Pathophysiologic insights. Cardiovascular Toxicology, 14(4), 291–308.

    Google Scholar 

  • Rehm, J., Room, R., Graham, K., Monteiro, M., Gmel, G., & Sempos, C. T. (2003). The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: An overview. Addiction, 98(9), 1209–1228. doi:10.1046/j.1360-0443.2003.00467.x.

    Article  PubMed  Google Scholar 

  • Rehm, J., Mathers, C., Popova, S., Thavorncharoensap, M., Teerawattananon, Y., & Patra, J. (2009). Alcohol and global health 1. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet, 373, 2223–2233. doi:10.1016/S0140-6736(12)61766-8.

    Article  PubMed  Google Scholar 

  • Renaud, S. d., & de Lorgeril, M. (1992). Wine, alcohol, platelets, and the French paradox for coronary heart disease. The Lancet, 339(8808), 1523–1526.

    Article  Google Scholar 

  • Rimm, E. B., Klatsky, A., Grobbee, D., & Stampfer, M. J. (1996). Review of moderate alcohol consumption and reduced risk of coronary heart disease: Is the effect due to beer, wine, or spirits? BMJ, 312(7033), 731–736.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rimm, E. B., Williams, P., Fosher, K., Criqui, M., & Stampfer, M. J. (1999). Moderate alcohol intake and lower risk of coronary heart disease: Meta-analysis of effects on lipids and haemostatic factors. BMJ, 319(7224), 1523–1528.

    Article  PubMed  PubMed Central  Google Scholar 

  • Roerecke, M., & Rehm, J. (2010). Irregular heavy drinking occasions and risk of ischemic heart disease: A systematic review and meta-analysis. American Journal of Epidemiology, 171(6), 633–644. doi:10.1093/aje/kwp451.

    Article  PubMed  Google Scholar 

  • Roerecke, M., & Rehm, J. (2011). Ischemic heart disease mortality and morbidity rates in former drinkers: A meta-analysis. American Journal of Epidemiology, 173(3), 245–258.

    Article  PubMed  PubMed Central  Google Scholar 

  • Roerecke, M., & Rehm, J. (2012). The cardioprotective association of average alcohol consumption and ischaemic heart disease: A systematic review and meta-analysis. Addiction, 107(7), 1246–1260.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ronksley, P. E., Brien, S. E., Turner, B. J., Mukamal, K. J., & Ghali, W. A. (2011). Association of alcohol consumption with selected cardiovascular disease outcomes: A systematic review and meta-analysis. BMJ, 342, d671. doi:10.1136/bmj.d671.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ruidavets, J.-B., Ducimetière, P., Evans, A., Montaye, M., Haas, B., Bingham, A.,... Kee, F. (2010). Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: The Prospective Epidemiological Study of Myocardial Infarction (PRIME). BMJ: British Medical Journal, 341.

    Google Scholar 

  • Shaper, A. G., Wannamethee, G., & Walker, M. (1988). Alcohol and mortality in British men: Explaining the U-shaped curve. The Lancet, 332(8623), 1267–1273.

    Article  Google Scholar 

  • Sheikh, A. I., Khalif, M. O., & Houmsse, M. (2014). Alcohol consumption and atrial fibrillation: Leisure or suffering? Ibnosina Journal of Medicine and Biomedical Sciences, 6(2), 110–113.

    Google Scholar 

  • Skog, O.-J. (1996). Public health consequences of the J-curve hypothesis of alcohol problems. Addiction, 91(3), 325–337.

    Article  PubMed  Google Scholar 

  • Soedamah-Muthu, S. S., De Neve, M., Shelton, N. J., Tielemans, S. M., & Stamatakis, E. (2013). Joint associations of alcohol consumption and physical activity with all-cause and cardiovascular mortality. American Journal of Cardiology, 112(3), 380–386. doi:10.1016/j.amjcard.2013.03.040.

    Article  PubMed  Google Scholar 

  • Stockwell, T., Greer, A., Fillmore, K., Chikritzhs, T., & Zeisser, C. (2012). How good is the science. BMJ, 344, e2276.

    Article  PubMed  Google Scholar 

  • Taylor, B., Irving, H. M., Baliunas, D., Roerecke, M., Patra, J., Mohapatra, S., & Rehm, J. (2009). Alcohol and hypertension: Gender differences in dose–response relationships determined through systematic review and meta-analysis. Addiction, 104(12), 1981–1990.

    Article  PubMed  Google Scholar 

  • Thompson, P. L. (2013). J-curve revisited: Cardiovascular benefits of moderate alcohol use cannot be dismissed. Medical Journal of Australia, 198(8), 419–422.

    Article  PubMed  Google Scholar 

  • WHO. (2009). Global health risks: Mortality and burden of disease attributable to selected major risks. Geneva: WHO.

    Google Scholar 

  • WHO. (2011). Global status report on alcohol and health. Geneva: WHO.

    Google Scholar 

  • WHO. (2014). Global status report on alcohol and health 2014. Geneva: WHO.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dan Lubman .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media Singapore

About this entry

Cite this entry

Arunogiri, S., Lubman, D. (2015). Alcohol and Cardiovascular Risk. In: Alvarenga, M., Byrne, D. (eds) Handbook of Psychocardiology. Springer, Singapore. https://doi.org/10.1007/978-981-4560-53-5_8-1

Download citation

  • DOI: https://doi.org/10.1007/978-981-4560-53-5_8-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Singapore

  • Online ISBN: 978-981-4560-53-5

  • eBook Packages: Springer Reference Behavioral Science and PsychologyReference Module Humanities and Social SciencesReference Module Business, Economics and Social Sciences

Publish with us

Policies and ethics