Consuming one or two alcoholic drinks a day is associated with a reduced heart attack risk. Alcohol may lower the chance of a heart attack through many mechanisms. Most important is its effects on HDL (or “good”) cholesterol. Moderate drinking increases HDL by about 12%.
Alcohol also may protect against heart attacks by inhibiting constriction of the coronary arteries, limiting clot formation, and decreasing levels of homocysteine—an amino acid linked to increased heart-attack risk. Some evidence has also linked moderate intake of alcohol to a lower rate of obesity.
Researchers are unlikely to ever conduct a clinical trial in which people would be randomly assigned either to drink alcohol or to abstain. In the absence of such trials, however, there is no way to be entirely certain whether the effects of alcohol are due to the drink itself or to other factors that may be common in moderate drinkers.
How Often to Drink Alcohol—and What to Drink
A number of recent studies have attempted to tease out some of the details of how moderate alcohol intake helps prevent heart attacks—including the pattern in which people drink and what they drink.
A recent report from the March 2004 issue of Addiction compared 427 men who had suffered a recent nonfatal heart attack with 905 similar men who had never had a heart attack. Men who drank alcohol daily in the previous two years were 59% less likely to have a heart attack than life-long abstainers.
People who drank alcohol somewhat less frequently—even those who drank less than once a week—also had a decreased risk of heart attacks. But men who consumed alcohol only on weekends (and who were often binge drinkers) elevated their risk of a heart attack compared with daily or less-than-once-weekly drinkers. Although this study also found that alcohol was only beneficial when consumed with meals, other studies have not demonstrated such a link.
Some experts have suggested that the reduced rate of heart attacks associated with alcohol consumption is offset by increases in death from other causes. But according to another article in the same issue of Addiction, middle-aged men who drank about two drinks a day were still 50% less likely to die of any cause over 10 years compared with those who drank once per week or less. Women who drank alcohol about one to six drinks per week (spread out across the week) were 28% less likely to die of any cause than those who drank alcohol less frequently.
Some, but not all, research has indicated that red wine is modestly better for the heart than other alcoholic beverages. This line of thinking began when investigators discovered that the French have a lower rate of heart attacks than Americans despite the fact that both countries consume similar amounts of animal fat—a phenomenon known as the “French paradox.” Some experts have suggested that red wine, which is favored by the French, is the factor that lowers their heart-attack risk, but many subsequent studies, including a 2003 report in The New England Journal of Medicine, have found that any type of alcoholic beverage—beer, wine, or spirits—has the same potential to reduce the risk of a heart attack.
Should You Drink Alcohol?
Although much evidence points toward the heart benefits of alcohol, experts do not recommend that people who abstain start drinking alcohol to improve their heart health. Instead, the American Heart Association recommends the traditional methods for preventing heart disease, including consuming a healthy diet, exercising, and controlling blood cholesterol, weight, and blood pressure.
But for people who do drink alcohol moderately, a drink or two per day for men and no more than a drink a day for women can be one of the many ways to maintain heart health. (More than one drink a day for women may increase the risk of breast cancer; because women tend to weigh less, heavier drinking is also more likely to lead to cirrhosis of the liver in women than in men.)
One drink is generally defined as 12 oz. of beer, 5 oz. of wine, or 1.5 oz. of spirits.
Who Should Not Drink Alcohol
Of course, alcohol abuse can be detrimental to your health. Excessive alcohol intake has been linked to a weakening of the heart muscle, hemorrhagic (bleeding) stroke, cirrhosis of the liver, pancreatitis (inflammation of the pancreas), certain cancers, trauma (such as in car accidents), suicide, and homicide. Heavy alcohol intake can also cause or exacerbate high blood pressure. The American Heart Association recommends that people with the following conditions not drink alcohol:
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A personal or strong family history of alcoholism
- Uncontrolled high blood pressure (however, moderate alcohol intake appears helpful in men with controlled hypertension)
- High blood triglyceride levels
- Pancreatitis
- Liver disease
- Porphyria (a genetic disorder of the metabolism)
- Heart failure
- Pregnancy
- Use of medications that can have adverse interactions with alcohol
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