Cardiovascular and Overall Mortality Risk in Relation to Alcohol Consumption in Patients With Cardiovascular Disease

Abstract

Alcohol, in striking contrast to tobacco and illicit drugs, is linked to an extensively documented J-shaped dose-effect curve, with regular moderate consumption reducing cardiovascular and overall mortality,1 whereas excessive or binge drinking has the opposite effect.1,2 Data indicative of a lower risk of cardiovascular events among moderate drinkers in apparently healthy people are extensive and consistent, whereas the role of alcohol intake among patients with cardiovascular disease (CVD) is less clear.3 Among the factors that contribute to prevention in survivors of primary cardiovascular events, lifestyle and dietary habits play a major role. However, guidelines in this area are based either on studies of apparently healthy subjects or on a few studies of cardiovascular patients.4,5 In particular, recommendations about alcohol consumption in patients with previous CVD reflect experts’ consensus rather than circumstantial evidence.3,6 The US Food and Drug Administration warns that heart disease patients should stop drinking, and people who take aspirin regularly should not drink alcohol.7 However, in the American Heart Association/American College of Cardiology guidelines for secondary prevention,5 CVD patients are encouraged to maintain a lifestyle that includes drinking alcohol in moderation. The “Diet and Lifestyle Recommendations” scientific statement from the American Heart Association Nutrition Committee8 advises, “If you consume alcohol, do so in moderation (equivalent of no more than 1 drink in women or 2 drinks in men per day).” The latter statement is largely accepted within the scientific community, definitely when referring to healthy people, although some would advise people to abstain completely rather than encouraging them to drink small amounts regularly. It has in fact been suggested that the consumption of alcohol for certain health benefits should not be encouraged, because the harm would far outweigh the gain, especially among poor populations and in low-income countries, where the …