Page last updated: Tuesday, August 24, 2010
Cardiovascular and overall  mortality risk in relation to alcohol consumption in patients with cardiovascular disease

Brief Overview of Paper:
The authors state that alcohol is linked to an extensively documented J-shaped dose effect curve, with regular moderate consumption reducing cardiovascular and overall mortality, whereas excessive or binge drinking has the opposite effect.  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.
Recommendations about alcohol consumption in patients with previous CVD reflect experts’ consensus rather than circumstantial evidence.  For example, the US Food and Drug Administration warns that heart disease patients should stop drinking, and people who take aspirin regularly should not drink alcohol.   However, in the American Heart Association/American College of Cardiology guidelines for secondary prevention, 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 Committee 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 disease burden per unit of alcohol consumption is greater.” 
In this paper, the authors review the evidence on the beneficial or harmful effects of alcohol in patients who have experienced a first cardiovascular event and briefly discuss the major mechanisms underlying the relationship.  They point out that abuse of alcohol, binge drinking, and drinking outside meals have all been associated with detrimental effects.  The authors also discuss limitations inherent in observational studies of alcohol and health and disease. 
As for implications for practice and policy, they state that their review “provides reasonable evidence that regular and moderate alcohol intake is significantly associated with a reduction in the incidence of secondary cardiovascular and all-cause mortality in patients with a history of CVD.”  However, when it comes to formulating alcohol policy based on these results, they point out that there are marked differences in the patterns of drinking among countries, especially when comparing drinking patterns between Mediterranean countries and those of Northern Europe and Russia.  Hence, they state that “in some low-income populations and poor countries, even if the net effect on CVD might be beneficial, the effect of alcohol on the overall burden of disease might be detrimental because of more frequent uncontrolled alcohol-use disorders, cancer, liver cirrhosis, and injury.”  In their conclusions, they warn against heavy or excessive drinking but state that regular moderate drinkers “need not be told to modify their drinking habits.”     

AIM Council Member and co-author of this study Giovanni de Gaetano, MD, PhD  comments:
“When I obtained my MD degree, many years ago, there were three pieces of advice given to a patient who had suffered an acute myocardial infarction (AMI): don’t smoke, don’t drink and take complete bed rest for one month. Today the first advice only is still valid. Our review paper in Circulation offers a balanced but strong support to the benefit of moderate alcohol drinking after an AMI. In our conclusions we suggest not to advice abstainers to start drinking after an AMI, but to encourage those who were already drinkers before the event not to stop moderate drinking. It is too a prudent approach? We do believe that drinking should not be considered as a drug to be prescribed to prevent reoccurrence, but a lifestyle that may protect against cardiovascular risk. Obviously, a cardiologist should inform his AMI patient that moderate drinking might offer him a better health perpective than being an abstainer. He must certainly give him a strong advice, if it is the case, to stop heavy and/or irregular (binge) drinking”.

Article:  Costanzo S, Di Castelnuovo A, Donati MB, Iacoviello L, de Gaetano G.  Contemporary Reviews in Cardiovascular Medicine.   Cardiovascular and overall mortality risk in relation to alcohol consumption in patients with cardiovascular disease.  Circulation 2010;121;1951-1959.


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