Page last updated: Monday, May 12, 2008
Alcohol and Coronary Heart Disease Risk Reviewed
By Elisabeth Holmgren
As evidence regarding the association between moderate alcohol consumption and coronary heart disease (CHD) continues to accumulate, two recently published reviews from Harvard University and an international panel of scientists examined the findings to date. These reviews, or meta-analyses, allowed scientists to make comparisons among populations and to draw conclusions utilizing more than ten years of alcohol research published on CHD which remains a major health concern around the world. The scientists hoped to uncover patterns and discrepancies in research methods in order to assess the validity of study results and identify underlying mechanisms responsible for favorable findings associated with moderate drinking. Both reviews confirmed the significance of the association between moderate alcohol consumption and reduced risk for CHD and contributed some interesting new insights to the ongoing discussion regarding alcohol and health. How these insights translate to medical advice for the consumer remains cautionary though major groups like the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have increasingly recognized and discussed this growing body of evidence.

"These data support a causal interpretation of the association between moderate alcohol intake and lower risk for coronary heart disease and suggest that the benefit is mediated in part through several known biological markers of coronary heart disease." ~ Rimm et al., British Medical Journal.

The Harvard team reviewed "the inverse association between moderate alcohol intake and coronary heart disease" documented in over 40 prospective studies in their investigation of the role of biological markers potentially involved in the alcohol-CHD link. Biomarkers such as high density lipoprotein (HDL) cholesterol, apolipoprotein AI and triglycerides associated with light to moderate alcohol consumption were noted to "cause an estimated reduction of 24.7% in risk of coronary heart disease," based on alcohol intake of 30 grams per day.

They further explain that this 24.7% risk reduction "probably underestimates the true risk reduction associated with 30g of alcohol a day" because other biological factors, which were not included due to inconsistencies, may increase the potential benefit. Summarizing their findings, they write, "These data support a causal interpretation of the association between moderate alcohol intake and lower risk of coronary heart disease and suggest that the benefit is mediated in part through several known biological markers of coronary heart disease."

"There is now also substantial evidence that the intake of light to moderate amounts of alcohol is associated with reduced morbidity and mortality from several cardiovascular conditions." ~ Fagrell et al., Journal of Internal Medicine

In the second article, which included a review of almost 70 studies, Dr. Bengt Fagrell of Karolinska Hospital in Stockholm, Sweden, and colleagues state, "There is now also substantial evidence that the intake of light to moderate amounts of alcohol is associated with reduced morbidity and mortality from several cardiovascular conditions." However, they temper their statement by explaining that due to unresolved issues concerning experimental parameters, there remains an "uncertainty about the magnitude of the association between light-to-moderate drinking and the overall benefits."

Despite this uncertainty, the researchers express the opinion that those at greatest risk for cardiovascular diseases stand to gain the most from the potential cardioprotective effects of alcohol. They emphasize that for certain groups of individuals this favorable effect may outweigh the risks of negative effects associated with alcohol use such as abuse, injuries and other types of health problems. Cautionary statements against drinking for non-drinkers were also included in both discussions"Moderate alcohol consumption (1-2 drinks a day) can be beneficial in reducing the risk of coronary artery disease." ~ Gordis and Zakhari, Proceedings of the Association of American Physicians.

When the discussion turns to issues of public policy, leading agencies like the U.S. government's NIAAA have increasingly acknowledged the evidence linking moderate alcohol consumption and lower CHD risk in their publications over the last several years. Representing NIAAA, Drs. Gordis and Zakhari wrote in an early 1999 article for the Proceedings of the Association of American Physicians, "Moderate alcohol consumption (1-2 drinks a day) can be beneficial in reducing the risk of coronary artery disease." Following this initial analysis, NIAAA released two more publications addressing moderate alcohol consumption.

The October 1999 issue of Alcohol Alert, the agency's monthly newsletter, reported on data from more than 20 countries that "demonstrated a 20- to 40-percent lower incidence of CHD-related mortality among drinkers compared with nondrinkers." The Alert highlighted further favorable comparisons between moderate and heavy drinkers emphasizing the differences between responsible use and abuse. Cautionary messages were also given in attached commentary by Dr. Gordis which advised against recommendations drinking for solely for health reasons and drinking for non-drinkers.

Most recently, the entire November issue of NIAAA's journal Alcohol Research & Health was dedicated to moderation issues, including an article on moderate consumption and CHD by senior cardiology consultant at Kaiser Permanente Dr. Arthur Klatsky. While acknowledging the potential health benefits of light to moderate consumption, Klatsky called for further research to clarify the mechanisms involved in these effects. Given the current data, he ended his discussion with the statement, "Finally, the majority of the population consume only moderate amounts of alcohol and are therefore, as a group, at lowest total mortality risk."

As the research continues to accumulate, the information available to physicians and ultimately patients indicates a more balanced approach to the issues when it comes to moderate alcohol consumption and CHD. The opinions from the international team led by Dr. Fagrell summarize the general consensus regarding moderate alcohol use and coronary heart disease as the research stands to date. The researchers state that those most likely to benefit from the potential cardioprotective effects of moderate drinking are individuals with higher risk for CHD, such as middle-aged men and women. For this population, it is believed that the benefits of moderate drinking may outweigh the risks. In light of this evidence, they do not find it necessary to advise light to moderate drinkers to abstain. On the other hand, further research is warranted regarding moderate use and other health risks and injuries. As alcohol and health research continues to expand our understanding of CHD causes and prevention, perhaps the role of moderate alcohol consumption in society will also evolve.

This article is for educational purposes only, and it should not be used for marketing or advertising. The reader is urged to obtain the full scientific articles to review all the points made by each research team.

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