June 29, 2017
Fermented grains, fruits, and honey have been used to make alcohol, dating back to as early as 7000 B.C.1 Alcohol has been consumed by various populations across the world. It was not until approximately the 19th Century, however, that persons started to limit alcohol consumption, eventually pushing to prohibition status. Limitations were set because of concern for harms from alcohol.
Recently, alcohol consumption has shown promise, potentially providing cardiovascular benefit based on the amount consumed.
Underprescribing Leads to Thousands of Preventable Strokes Annually
Hospitals Performing TAVR Keep Readmissions, Costs Low
The risk-to-benefit curve remains controversial. Is it a J-shaped or U-shaped curve? Is there a cut point where there is a balance between risk and benefit? The answer may be yes.
To determine the answers to the above questions, a population-based cohort study of linked electronic primary care records, hospital admissions, and mortality from 1997-2010 was undertaken.2 In approximately 2 million persons aged ≥ 30 years old who were free of cardiovascular disease at entry into the study, non-drinking increased the risk of unstable angina, myocardial infarction, coronary death, heart failure, ischemic stroke, peripheral artery disease, and abdominal aortic aneurysm compared with moderate drinking (consumption within contemporaneous UK weekly/daily guidelines of 21/3 and 14/2 for men and women, respectively).
Story continues on page 2
Heavy drinking (exceeding guidelines) increased the risk of coronary death, heart failure, cardiac arrest, transient ischemic attack, ischemic stroke, intracerebral hemorrhage, and peripheral disease compared to moderate drinking. Heavy drinking had a lower risk of myocardial infarction and stable angina. There was no effect on the results by gender or by beverage specialty.
This data suggests there is a J-shaped curve with moderate drinking associated with the lowest risk of cardiovascular disease compared with non-drinkers or heavy drinkers. Although these results provide context about how to apply them in treatment algorithms, caution must be emphasized.
First, drinking alcohol carries other social risks such as driving under the influence or death. Second, there are certainly safer ways to reduce cardiovascular risk such as diet, exercise, smoking cessation, and medication therapy. Finally, not all cardiovascular disease events were reduced by moderate drinking suggesting that cardiovascular risk remains elevated despite moderate drinking.
1. Foundation for a Drug-Free World. Alcohol: a short story. http://www.drugfreeworld.org/drugfacts/alcohol/a-short-history.html. Accessed June 29, 2017.
2. Bell S, Daskalopoulou M, Rapsomaniki E, et al. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population-based cohort study using linked health records. BMJ. 2017;356:j909.