Page last updated: Wednesday, November 12, 2008
Discussions concerning alcohol as an independent protective lifestyle factor
Many studies have linked moderate drinking to a lower risk of heart disease. What’s been less clear is whether people who exercise, abstain from smoking, maintain an optimal weight and adhere to an appropriate diet would see any additional benefit from drinking.

A study by Harvard University researchers sought to discover if in healthy, physically fit, nonsmoking men, drinking one or two units of alcohol a day provided any additional protection against heart attack. The study found that participants consuming one-half to two drinks a day had the lowest heart attack risk 40-60% lower than healthy men who didn’t drink, irrespective or beverage choice.

“These results tend to refute the oft-quoted hypothesis that lower coronary heart disease seen among moderate drinkers is due to their associated healthy lifestyle habits, and not to their alcohol consumption,” wrote Dr. R. Curtis Ellison, director of the Institute on Lifestyle and Health at Boston University School of Medicine, and co-author of a critique of the study.

Using data from more than 50,000 health professionals, study author Dr. Kenneth J. Mukamal, assistant professor of medicine at Harvard Medical School, and his colleagues identified more than 8,800 men who were nonsmokers, ate a healthy diet, exercised at least 30 minutes a day and weren’t overweight. Over a 16-year period, 106 of the men had heart attacks, but those who had two drinks a day had the lowest risk for heart attack, while non-drinkers had the highest risk.

Several other recent studies have added to the evidence suggesting that moderate alcohol intake complements a healthy lifestyle.

A recent British study identified moderate alcohol consumption among four healthy behaviours (including not smoking, exercising and eating five servings of fruits and vegetables a day) that added 14 years to life, compared with men and women who did not adopt these behaviours, and Danish researchers reported that both physical activity and moderate drinking have a protective effect on the heart and an additional benefit when combined as part of a healthy lifestyle.

However, none of the studies were “randomised controlled trials” -- the gold standard of scientific research, whereby people are randomly assigned to an intervention, such as exercising or consuming alcohol.

There is lots of observational data to support moderate drinking, said Dr. Robert A. Vogel, professor of medicine and director of clinical vascular biology at the University of Maryland School of Medicine. “However, we do not consider alcohol a validly tested drug because to do that you would have to randomise people for years with alcohol or not - and that’s not a study that can be done,” he said.

Vogel said he enjoys a daily glass of wine as part of a healthy lifestyle and tells patients who do the same that it’s “a reasonable thing to do.” Many doctors, though, tend to shy away from recommending alcohol to their patients. Instead, they have emphasised other lifestyle modifications, including diet and exercise.

“Clinicians are very resistant to taking alcohol out of the ‘alcoholism’ box and asking what its effects might be at more typical levels of intake,” Mukamal said. “Even if clinicians don’t believe there are benefits to alcohol, and I think that’s a reasonable concern since we don’t have randomised trails, they should at least be discussing it, but I don’t think that’s happening.”

Ellison agrees: For middle-aged and older men and postmenopausal women who don’t have ethical, religious or health reasons for avoiding alcohol, “physicians should at least inform them that the scientific data currently available strongly suggest that a small amount of alcohol on a regular basis may lower their risk of heart disease, stroke, diabetes, dementia, and even total mortality,” he said.

Sources: Kenneth J. Mukamal, M.D., M.P.H.; R. Curtis Ellison, M.D.; Robert A. Vogel, M.D.; Oct. 23, 2006, Archives of Internal Medicine; Oct, 23, 2006, news release, Beth Israel Deaconess Medical Center, Boston; Oct. 22, 2007, news release, Archives of Internal Medicine; Jan. 7, 2008, news release, PLoS Medicine; American Heart Association

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