First things first, what is the AHA and how do we know if drinking is safe for the heart?
The American Heart Association is one of the nation’s leading voluntary health organizations dedicated to saving people from heart disease and stroke – America’s No. 1 and No. 5 killers, respectively – by raising awareness of risk factors, promoting healthy living and conducting groundbreaking research to develop life-saving treatments and preventions.
They’re also very passionate about educating people on safe drinking practices when it comes to alcohol and heart health.
When it comes to alcohol and cardiovascular disease the American Heart Association (AHA) recommends 1-2 drinks per day for men and 0-1 drinks per day for women (https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/alcohol-and-heart-health). Zero to one is hard to interpret; however, does not drinking mean you are making your heart, less healthy?
According to Dr. Benjamin Horne, a Clinical Associate Professor (Affiliated) at Stanford University who is based at the Intermountain Medical Center Heart Institute,
"The AHA does recommend a modest number of drinks per day since excessive drinking is a hazard to cardiac health. Interestingly, though, they also say that if you don’t drink that you shouldn’t start because there aren’t any clinical trials of alcohol to show whether the benefit is real, but there are enough safety issues that it is likely the harm from starting to drink is greater than the benefits."
You can see a positive correlation between moderate drinking and better heart health. One thing we do know is that moderate drinkers have fewer heart attacks and strokes than non-drinkers or heavy drinkers.
It seems like a paradox until you look at how much exercise people who drink moderately get in comparison to non-drinkers and heavy drinkers. Like with all observational studies, there are confounding factors that could explain away any apparent benefit. Moderate drinkers exercise more (not surprising) and tend to eat better too (also not surprising). The same isn’t true for non-drinkers or heavy drinkers who are less active and eat worse than moderate drinkers. Further, people who drink moderately tend to be wealthier and more educated than non-drinkers or heavy drinkers.
This is relevant because education tends to correlate with higher incomes and wealth is associated with healthier eating patterns (more vegetables, less fast food) as well as exercise habits. So it’s not clear whether alcohol makes you healthier or if being healthy makes you drink.
That’s why we need clinical trials where one group of people randomly gets alcohol while another group doesn’t and then we compare their heart health over time.
We don’t have those trials and it is unlikely that we ever will because assigning someone to drink alcohol in a randomized trial is known to come with harmful side effects while the possible benefits are uncertain, so the known harms are greater than the unproven potential benefits.
A study from the Harvard School of Public Health analyzed the effects of binge drinking on heart health.
The results were published in the journal Addiction: Binge drinking is a known cardiovascular risk factor, but it’s also common among young adults. A 2014 report found that, over a 24-hour period, college students consume an average of 4 alcoholic drinks, with one drink being defined as 12 ounces of beer or wine cooler, or 8 ounces of malt liquor, or 1.5 ounces of 80-proof spirits.
The researchers found that those who engaged in regular binge drinking had twice the risk of having a cardiovascular event such as stroke, heart attack, or death than those who didn’t engage in binge drinking. In addition to increasing your risk of developing high blood pressure and diabetes, binge drinking can damage your heart by causing irregular heartbeat and making existing conditions worse. When you drink heavily, your body releases stress hormones to help you deal with alcohol poisoning. Over time, these hormones can cause lasting damage to your heart muscle and other parts of your body.
It seems that a glass of wine with dinner each night can indeed benefit your heart. Moderate alcohol consumption—up to one drink per day for women and up to two drinks per day for men—is safe, and can even protect your heart against some age-related damage.
If you’re among those who have been advised by their doctors to avoid alcohol because of concerns about negative health effects, you may be wondering whether small amounts can be beneficial.
As mentioned above, it may but it does come with caveats.
Dr. Horne follows by saying,
"So far our work has just been presented in abstract format at the American College of Cardiology conference. We are working on the full manuscript now that will need peer review. Our study essentially showed that people taking statin medications had as much prevention of major adverse cardiovascular events whether or not they consumed alcohol, so those who did drink and took statins did not receive any additional benefit from alcohol.
People not taking statins did have a protective benefit from alcohol consumption, though, in our observational study.
This suggests to us that at least people who don’t already drink alcohol can receive that same health benefit by taking a statin, which medications do have strong evidence of benefit from randomized trials (and low safety risk). So non-drinking patients do not need to worry about whether they should start consuming alcohol if they take their statin."
If you currently do not drink alcohol, there is no need to start drinking (or even reduce your alcohol consumption since you have none). However, if you are concerned about heart health and want to improve it there are a number of things that you can do. The best advice is to talk with your doctor to discuss how you can lower your risk with lifestyle changes and with medications that are proven to improve health without being reliant on alcohol.
For more, see https://www.newswise.com/articles/alcohol-consumption-has-no-additional-preventative-heart-benefits-in-patients-on-cholesterol-lowering-medication and https://www.jacc.org/doi/abs/10.1016/S0735-1097%2822%2902593-1.
In summary, moderate alcohol consumption may be good for the heart.
Moderate drinkers tend to have better health and live longer than non-drinkers or heavy drinkers. This may be due to other factors, though, that cluster among moderate drinkers. Non-drinkers may receive the same health benefits from medications that are safe and effective at lowering risks. This is important to note because the Department of Health and Human Services reports that 34 percent of American adults do not drink alcohol. Heavy drinkers should reduce their alcohol intake.
The research shows further that even if you are a moderate drinker, there are several other things you can do to protect your heart (see: https://www.heart.org/en/healthy-living/healthy-lifestyle/my-life-check--lifes-simple-7):
Most importantly, don’t smoke! Smoking increases your risk of developing coronary artery disease by two times as much as being a moderate drinker.
Also, avoid unhealthy diets (high in saturated fats) and limit your intake of red meat.
Lose weight using a sustainable weight loss approach. Losing even just 10% of your body weight will have a substantial benefit on your health.
Increase your physical activity. Engaging in aerobic exercise is great, but even modest amounts of activity such as walking more each day will have a positive health impact.
These four steps alone will greatly reduce your risk factors for coronary artery disease.
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