If you like having a glass of wine with dinner or enjoying a cocktail at a rooftop bar in West Hollywood, you may have wondered if drinking is bad for your heart, or if a little alcohol may even be good for your heart. It’s a question I get asked all the time and I think it is a question that everyone deserves the right to get answered.
To cut it short, with the science concerning alcohol and heart health, there is a lot of kvetching and arguing that goes on in the headlines, but one thing is heavy drinking. Consistent heavy drinking will always be bad for your cardiovascular system. I, as a cardiac surgeon at the Ronald Regan UCLA Medical Center in Westwood, would like to help you with the decisions that you need to make regarding your heart.
What does alcohol do to your heart?
There is no single, straightforward way to describe how alcohol affects the heart. Studies show that alcohol’s effects on the heart is biphasic, meaning that light to moderate use can have a protective effect, while heavy or binge drinking is very detrimental. ScienceDirect
This nuance has been the cause of decades of confusing headlines. One year, drinking red wine is “heart protective.” The next year, any drinking, not just binge drinking, is considered unsafe. This is what the most recent studies show.
A drink a day keeps the doctor away
For a long time, studies showed that light to moderate drinkers had a lower incidence of heart disease compared to non-drinkers. This was the basis of the expression “a glass of red wine a day is good for the heart.”
The AHA does not recommend the consumption of wine, alcohol or any other cardiology related substances that might improve health.
What Are The Guidelines Right Now?
According to the American Heart Association, the recommended alcohol intake limit for men is two drinks a day, while the limit for women is one drink a day. The Association claims that any alcohol intake can contribute to negative health concerns, and the impact depends on a variety of factors, including age, health, and even genetics. American Heart Association
One drink, in the U. S., has about 0.6 ounces of pure alcohol, so one drink is about 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits.
When Alcohol Causes Damage to the Heart
Research regarding low levels of alcohol consumption is controversial. However, research regarding high levels of consumption, such as a binge drinking, is not. The American Heart Association states that \\”Heavy drinking is defined as more than two drinks a day. Even binge drinking is associated with an increase in negative cardiovascular outcomes. This includes high blood pressure, coronary heart disease, strokes, irregular heartbeats, weakening of the heart muscle, and heart failure, as well.” Here are the effects that alcohol can have on the heart that are far too common, and more importantly, far too serious.
1. Hypertension (high blood pressure)
No more than two drinks a day, high blood pressure, and drinking alcohol can cause an increase in blood pressure, particularly in those with preexisting hypertension. The American Heart Association states that this is not a small concern. Hypertension (high blood pressure) increases the chances of having a stroke or heart attack.
Regular consumption of alcohol could lead to AFib, an irregular heartbeat that increases a person’s risk of stroke. A study published in the Annals of Internal Medicine examined 100 AFib patients over a four-week period. Each participant was given a heart monitor and an alcohol consumption monitor. It was found that patients who drank more than 2 alcoholic beverages over a 4 hour period had over a 350% higher risk of having an AFib episode than patients who did not drink. American Heart Association.
Although many people are not familiar with the term, it describes a legitimate phenomenon. “Holiday heart syndrome,” which can be triggered by binge drinking, describes a condition in which irregular heart rhythms are caused by changes in the body nervous system, and fluid levels. PubMed. The condition is named for the spike in cardiology cases post-holidays, when people drink more, but it is not limited to the holiday season.
Alcoholic Cardiomyopathy
Alcoholic cardiomyopathy is caused by chronic, heavy drinking, which causes direct damage to the heart muscle and its ability to pump blood. This damage can lead to heart failure. Cardiomyopathy can develop from drinking due to oxidative stress and damage to the mitochondria, functions which can lead to impaired calcium handling and cardiovascular problems.
Coronary artery disease and stroke
Long-term, heavy drinking increases the likelihood and severity of coronary artery disease and type 2 diabetes. This is caused by the development of dyslipidemia and vascular inflammation, which lead to insulin resistance. These ultimately lead to increases in the likelihood of stroke, heart failure, and myocardial infraction.
Alcohol and patients with heart disease
For a person with a preexisting heart condition, alcohol can become dangerous. This is something I explain to my patients. To start, If you have arrhythmia, and in particular, Afib, you should avoid drinking entirely. While restraint is recommended for most patients with Afib, drinking is known to trigger episodes and is often a reason for patients to have their alcohol intake. If you have high blood pressure, alcohol can have serious effects. Alcohol can make high blood pressure, more difficult to control and can make people especially susceptible and less responsive to blood pressure treatments.
For patients recovering from heart surgery – Alcohol can speed up or slow down your heart rate and blood pressure, and can have risky complications when taken with blood thinners, and other pain medications you might have been prescribed after your surgery. Don’t drink after your surgery until you specifically talk to your surgery team about Alcohol.
If you take blood thinners: Alcohol can impact the anticoagulant drugs (like warfarin) you take. This impact can put you at a greater risk for bleeding or can make your blood clotting medications work less effectively. This combination needs to be monitored with the utmost care.
Your Heart and The Sober-Curious Movement
Recently, Los Angeles has been seeing a surge in the sober-curious movement and the quality of non-alcoholic drinks at all the bars and restaurants in Silver Lake and Venice. This is a trend we can get behind.
If you want a reason to not drink, protecting your heart from the risk of Alcohol is one of the best. The positive changes that come with less Alcohol consumption are, lower blood pressure, less risk for AFib, and a better quality of sleep. You are also likely to become more successful at managing your weight. All of this support long term Cardiovascular health.
How Much Is Too Much? A Simple Framework
Here is how I break down the available research:
Low risk (for the majority of people who do not have heart issues): Up to one drink a day for women, and up to two a day for men — although even this amount is not risk free, especially as it pertains to blood pressure and odds of cancer.
Increased risk: Consuming three or more drinks a day, or binge drinking (four drinks in about two hours for women; five or more in the same time period for men). This amount of drinking time and time again is documented to cause serious damage to your heart.
High risk for heart patients: Because of your specific diagnosis, the amount of alcohol in your case, and your medication and history, any amount of alcohol could be risky. The right answer in your situation is a discussion with your cardiologist — not a guideline to be drawn from a general recommendation.
The Bottom Line
The relationship between drinking alcohol and heart disease is not a simple one. The research is unequivocal, however — the less alcohol a person consumes, the less risk they have for heart disease, and especially for people who already have heart disease, high blood pressure, or a history of heart surgeries, it is even more critical to follow this guideline.
I advise my patients in the Los Angeles and Westwood area to speak candidly to their entire care team about their alcohol consumption. This is not merely invasive and is necessary for constructing an overall picture of your cardiovascular health.
