Alcohol and Heart Disease

There has been a great deal of research into the links between alcohol and cardiovascular diseases. These are diseases that affect the heart and blood vessels, and together account for more deaths among Australians than any other group of diseases.

• In this country, the leading cause of death is ischaemic heart disease (a condition where the blood supply to the heart muscle is reduced because the arteries supplying it have become narrowed or blocked by fatty deposits on their walls, causing angina and heart attack).
• Stroke is the third largest cause of death (after cancer), and a major cause of disability. Approximately 80% of strokes result from a blocked blood vessel in the brain (ischaemic stroke), and 20% from a ruptured blood vessel (haemorrhagic stroke).
• Hypertension (high blood pressure) is a major risk factor for both stroke and heart disease.
• Other cardiovascular diseases include peripheral vascular disease (due to the narrowing of the arteries of the leg), and diseases affecting the structure and function of the heart.

The research to date shows that the relationship between alcohol and cardiovascular disease group is complex, and not always clear. There are some risks, and some benefits, and the outcome may depend not only on the amount that people drink over time, but also on the pattern of drinking, and the age of the person.

Cardiovascular disease: known risks and benefits of alcohol

Harmful effects: Long-term and heavy alcohol consumption is linked with stroke (especially from ruptured blood vessels), high blood pressure, and cardiomyopathy (weakness of the heart muscle, so that the heart doesn't pump blood as efficiently). A weekend of heavy drinking or holiday binge can result in what has been called the "holiday heart" syndrome (a sudden, irregular rhythm of the heart which can cause symptoms such as shortness of breath, changes in blood pressure, and even sudden death.).

Benefits: There is strong evidence that a regular pattern of drinking relatively small amounts of alcohol reduces the risk of ischaemic heart disease in people from middle age onwards. The benefit appears to come mainly from the alcohol itself, with little or no additional value from any other components of the drink (and so, for example, there is little if any extra benefit from red wine). There is, also, no additional benefit from drinking larger amounts of alcohol; and more variable drinking patterns, especially involving large amounts of alcohol, may actually increase the risk of illness and death from heart disease.

Points to bear in mind about the links between alcohol and cardiovascular conditions:

Heart disease:

• While there are some health benefits for the heart from low risk drinking, this applies only to older people.
• Heart disease is uncommon in young people, and therefore there are no health benefits from alcohol use for them.
• Older people who are non-drinkers can protect themselves against heart disease through other healthy life style strategies such as diet, exercise and no smoking.

Stroke:

It seems clear that heavy drinking (at risky or high risk levels) is a risk factor for both types of stroke (ischaemic and haemorrhagic), as well as for high blood pressure (which is a risk factor for both types of stroke). Evidence concerning the effect of more moderate consumption is less clear. The weight of evidence suggests that low level alcohol consumption may offer some protection against ischaemic stroke, while increasing the risk of haemorrhagic stroke. The pattern of drinking may also be important in determining stroke risk.

Hypertension:

The risk of high blood pressure increases with heavier drinking, and reducing heavy alcohol consumption will reduce blood pressure. At lower levels of drinking, however, the picture has not been as clear, and further research is needed on whether there are some possible benefits from low levels of alcohol consumption on blood pressure.

Peripheral vascular disease:

There may be a beneficial relationship between alcohol consumption and peripheral vascular disease (a disease of the blood vessels causing narrowing of the arteries in the leg) but this requires further study.

Cardiomyopathy:

Long-term drinking at risky levels can result in a weakness of the heart muscle, affecting its ability to pump blood as efficiently as previously.

Other cardiovascular disorders:

With regard to lower levels of drinking, there is evidence that one to two drinks can affect heart rate, blood pressure, the effectiveness of heart muscle and the amount of blood pumped, and blood flow to regions of the body. Although these actions generally are not considered to be clinically important, their short-term effect on blood flow might pose a problem for people with cardiovascular disease.

Adapted from:
Australian Department of Health and Ageing, Australian Alcohol Guidelines Fact Sheets www.alcoholguidelines.gov.au

Principal source:
National Health and Medical Research Council (NHMRC) (2001). Australian Alcohol Guidelines: Health Risks and Benefits. NHMRC, Canberra.

Other sources:
Laslett A, Donath S, and Dietze P (2002). Long-term consequences of alcohol consumption. In: National Alcohol Research Agenda. Commonwealth Department of Health and Ageing Care, Canberra.

Ridolfo B and Stevenson C (2001). The Quantification of Drug-caused Mortality and Morbidity in Australia, 1998. Australian Institute of Health and Welfare, Canberra.

Single E, Ashley M, Bondy S, Rankin J and Rehm J (1999). Evidence Regarding t he Level of Alcohol Consumption Considered to by Low-Risk for Men and Women. NHMRC, Canberra.

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