Abstract
Alcohol use is an important preventable and modifiable cause of non‐communicable disease, and has complex effects on the cardiovascular system that vary with dose. Observational and prospective studies have consistently shown a lower risk of cardiovascular and all‐cause mortality in people with low levels of alcohol consumption when compared to abstainers (the ‘J’‐shaped curve). Maximum potential benefit occurs at 0.5 to one standard drinks (7–14 g pure ethanol) per day for women (18% lower all‐cause mortality, 95% confidence interval (CI) = 13–22%) and one to two standard drinks (14–28 g ethanol) per day for men (17% lower all‐cause mortality, 95% CI = 15–19%). However, this evidence is contested, and overall the detrimental effects of alcohol far outweigh the beneficial effects, with the risk of premature mortality increasing steadily after an average consumption of 10 g ethanol/day. Blood pressure (BP) is increased by regular alcohol consumption in a dose‐dependent manner, with a relative risk for hypertension (systolic BP > 140 mm Hg or diastolic > 90 mm Hg) of 1.7 for 50 g ethanol/day and 2.5 at 100 g/day. Important reductions in BP readings can be expected after as little as 1 month of abstinence from alcohol. Heavy alcohol consumption in a binge pattern is associated with the development of acute cardiac arrhythmia, even in people with normal heart function. Atrial fibrillation is the most common arrhythmia associated with chronic high‐volume alcohol intake, and above 14 g alcohol/day the relative risk increases 10% for every extra standard drink (14 g ethanol). Ethanol and its metabolites have toxic effects on cardiac myocytes, and alcoholic cardiomyopathy (ACM) accounts for a third of all cases of non‐ischaemic dilated cardiomyopathy. Screening people drinking alcohol above low‐volume levels and delivering a brief intervention may prevent the development of cardiovascular complications. Although people with established cardiovascular disease show improved outcomes with a reduction to low‐volume alcohol consumption, there is no safe amount of alcohol to drink and patients with ACM should aim for abstinence in order to optimize medical treatment.
Highlights
The harmful effects of alcohol on the heart began to appear in the medical literature in the 19th century
People with established cardiovascular disease show improved outcomes with a reduction to lowvolume alcohol consumption, there is no safe amount of alcohol to drink and patients with alcoholic cardiomyopathy (ACM) should aim for abstinence in order to optimize medical treatment
This review summarizes the epidemiological evidence for the impact of alcohol on the heart at low, medium and high levels, before focusing on clinical presentations of people who consume alcohol at higher levels or in a binge pattern
Summary
The harmful effects of alcohol on the heart began to appear in the medical literature in the 19th century. The risk of ventricular tachycardia and sudden cardiac death is lower in individuals with modest alcohol intake (two to six drinks/week) than those with high intake (21–35 drinks/week) and binge drinkers This may be attributable to the protective effects of low-to-moderate alcohol consumption against coronary artery disease as described above [13]. Prospective studies have shown that chronic alcohol consumption of more than 100 g/day in men and 80 g/day in women over a period of 10 years is associated with dose-dependent effects on left ventricular function [44]. Interventions aiming at reducing total alcohol consumption and/or modifying the drinking pattern are associated with positive effects in harmful, hazardous or alcohol-dependent drinkers [65]. Significantly more relapsed patients (73%) died prematurely at the mean age of 48 years (mainly from heart attack or heart failure) compared to those without relapses (30%) in the 16-year observation period
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