Written by: Cameron Rosario
Medically reviewed by: Rob Philibert MD PhD
There have been a number of studies that suggest that light to moderate levels of alcohol use are correlated with a lower risk for heart disease. However, the rationale or “cause and effect” for this association is not clear with many researchers believing that the reasons for the association is that the individuals who drink lightly have more protective lifestyles than those who are abstinent or drink heavily. Therefore, clinicians do not recommend that abstinent patients begin drinking for the sake of better heart health. The reason for this lack of recommendation is clear. In 2016, 3 million deaths were attributed to alcohol consumption which contributes to 5.3 percent of global deaths. In this blog, we review some of the evidence, pros and cons, surrounding this controversy.
Some of the Problems with Drinking Alcohol
- Altered heart rate
Alcohol use can increase heart rate or variability. The human heart normally has 60 to 100 beats per minute (bpm). Alcohol can impair cardiac autonomic nervous activity causing episodes of rapid heart beats known as tachycardia. These rapid runs of the heart tax the cardiac muscle and are strongly associated with risk for CHD and sudden death. One particularly well characterized form of tachycardia is a rhythm disturbance associated with alcohol abuse known as “holiday heart.” This is a syndrome of rapid heart beat that often occurs after patients have “benders” or bouts of extended alcohol consumption after vacations or extended holidays.
- Weakened heart muscle
Good cardiac muscle tone is essential for good heart health. However, high levels of alcohol consumption can negatively impact the heart muscle, known as the myocardium. Eventually, this can lead to alcoholic cardiomyopathy in which the heart chambers become enlarged, leading to weaker, less efficient contractions. Left unchecked, this form of cardiomyopathy can then progress to frank congestive heart failure.
- Increased blood pressure
High levels of alcohol consumption are associated with elevated blood pressure or hypertension. Ideally, your resting blood pressure values should be 120/80 mm Hg or lower. But higher levels of alcohol consumption are associated with increasing blood pressure. In severe cases, patients can develop alcohol-induced hypertension. The increased cardiac workload from this direct consequence of alcoholism can then result in the hardening and thickening of blood vessels leading to a heart attack or stroke.
- Changes in exercise routine
An often overlooked consequence of drinking is opportunity cost. Simply put, because recent alcohol consumption doubles your risk for injury, healthcare providers strenuously recommend that you do not exercise when drinking or under the influence of alcohol. It is simply too easy to get hurt while riding a bike or running on a treadmill after a drink or two. Unfortunately, in today’s modern world, this loss of available time often leads to loss of the aerobic activities that increase cardiac fitness. For those who drink casually, this occasional loss of opportunity is inconsequential. However, as the frequency of drinking increases, the likelihood of having windows of complete sobriety narrow thus leading to the loss of protective activities and increased risk for CHD.
The Golden Rule in medicine is moderation. Like everything else, when used in moderation, alcohol use can be healthy. But at higher levels of consumption, alcohol has detrimental effects on the heart. Live wisely and be open with your clinicians about your use of alcohol. If you feel that you need to cut down on your drinking, annoy others by your drinking, feel guilty about your drinking, or drink in the morning, tell your clinician and get treatment. Quite literally, it is good for your heart.