Friday, September 7, 2007

Advantages and Disadvantages of Alcohol Intake on Cardiovascular Health Reviewed

Advantages and Disadvantages of Alcohol Intake on Cardiovascular Health Reviewed

Study Highlights

In general, alcohol consumption creates a J-shaped curve in terms of the risk for myocardial infarction and total mortality. Consumption of 1 drink daily in women and 1 to 2 drinks daily in men has been demonstrated to reduce rates of total mortality by 18% vs abstinence, although the risk for mortality rises with heavy use of alcohol. Light to moderate drinking also reduces the risk for CHD events by 30% to 35% vs abstinence.

Alcohol use seems effective in reducing cardiovascular outcomes regardless of sex or age. Even among men with a healthy lifestyle, alcohol can reduce the risk for myocardial infarction by up to 50%.

Light to moderate alcohol consumption seems to be beneficial among patients with hypertension, although alcohol can increase blood pressure in a dose-dependent fashion, and heavier drinking may be particularly harmful for these patients. Alcohol also seems to reduce the risk for CHD among patients with diabetes.

Alcohol use also creates a J-shaped curve with regard to the risk for stroke and dementia, and alcohol consumption has been associated with a reduced risk for peripheral arterial disease.

Alcohol may also improve other significant cardiovascular risk factors. Drinking 1 to 2 alcoholic beverages per day can reduce the incidence of diabetes by 30%, and regular light alcohol consumption also reduces the risk of developing the metabolic syndrome.

It seems that the ethanol itself, rather than the type of drink consumed, is the component most responsible for the health benefits of alcoholic beverages.

Despite the benefits of light to moderate alcohol consumption, binge drinking is associated with a 2-fold increase in the risk for myocardial infarction and mortality vs with abstinence from alcohol. Therefore, the most cardiovascular protection seems to be derived from 1 drink per day among women and 1 to 2 drinks per day among men.

Nonetheless, the study authors do not recommend regular use of alcohol to prevent cardiovascular disease. They note that alcohol abuse is the third leading cause of preventable death in the United States and that encouraging regular use of alcohol may contribute more cases to this already significant problem.

Alcohol may improve the risk for cardiovascular disease through increasing the concentration of HDL cholesterol. Alcohol seems to increase HDL cholesterol in a dose-dependent fashion, with an average increase of 5% in HDL cholesterol among adults who consume 1 alcoholic beverage per day vs adults who abstain. In addition, alcohol can improve insulin sensitivity, particularly when consumed immediately before or during eating. Finally, alcohol can reduce intravascular inflammation and abdominal obesity, both of which promote cardiovascular events.

Clinical Context

The current review by O'Keefe and colleagues describes the evidence for alcohol in improving cardiovascular health.

Pearls for Practice

Alcohol can improve cardiovascular outcomes primarily by increasing HDL cholesterol and improving insulin sensitivity and abdominal obesity.

The current review suggests that light to moderate use of alcohol can help improve rates of total mortality, myocardial infarction, stroke, peripheral arterial disease, diabetes, and the metabolic syndrome. However, because of the high rate of preventable deaths associated with alcohol use, the study authors recommend against the universal prescription of alcohol consumption.

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