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Alcohol and CV Health: Jekyll and Hyde J-Curves
Evan L O'Keefe1, James J DiNicolantonio2, James H O'Keefe2
1Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States.
Insights
Light to moderate alcohol consumption may lower risks for mortality and cardiovascular diseases. However, heavy drinking increases death and cardiovascular disease risks, with no recommendation for non-drinkers to start due to potential abuse.
Area of Science:
- Cardiovascular Health and Public Health
Background:
- Light to moderate alcohol intake is linked to reduced risks of all-cause mortality, coronary artery disease (CAD), type 2 diabetes mellitus (T2D), heart failure (HF), and stroke.
- Heavy alcohol consumption (>4 drinks/day) significantly increases the risk of death and cardiovascular disease (CVD).
- Excessive alcohol use is a major cause of premature death in the US, contributing to hypertension (HTN), cardiomyopathy, atrial fibrillation (AF), and stroke.
Purpose of the Study:
- To analyze the association between different levels of alcohol consumption and health outcomes, including mortality and cardiovascular diseases.
- To evaluate the risk-to-benefit ratio of alcohol consumption, particularly in younger populations.
- To inform healthcare professionals on advising patients regarding alcohol intake.
Main Methods:
- Analysis of observational studies examining the relationship between alcohol consumption patterns and various health endpoints.
- Review of data on the impact of heavy alcohol use on cardiovascular health and mortality.
- Consideration of the potential for alcohol abuse even in individuals with perceived low risk.
Main Results:
- Light to moderate drinking (≤1 drink/day for women, 1-2 drinks/day for men) is associated with lower risks for mortality, CAD, T2D, HF, and stroke.
- Heavy drinking is linked to increased mortality and cardiovascular disease risks.
- Red wine consumed with evening meals may be associated with better long-term cardiovascular outcomes.
Conclusions:
- While light to moderate alcohol consumption may offer some health benefits, heavy drinking poses significant risks.
- The risk-benefit balance of alcohol is unfavorable for younger individuals, and alcohol abuse remains a leading cause of premature death.
- Healthcare professionals should not encourage non-drinkers to start consuming alcohol due to the lack of definitive outcome data and the risk of abuse.
Abstract:
A routine of light or moderate alcohol consumption (≤1 drink/day for women and 1 to 2 drinks/day for men) is associated with a lower risk for all-cause mortality, coronary artery disease (CAD), type 2 diabetes mellitus (T2D), heart failure (HF), and stroke. Conversely, heavy drinking, (>4 drinks/day) is associated with an increased risk for death and cardiovascular (CV) disease (CVD). Excessive alcohol intake trails behind only smoking and obesity among the 3 leading causes of premature deaths in the United States (US). Heavy alcohol use is a common cause of reversible hypertension (HTN), nonischemic dilated cardiomyopathy, atrial fibrillation (AF), and stroke (both ischemic and hemorrhagic). Among males aged 15 to 59 years, alcohol abuse is perhaps the leading cause of premature death. As such, the risk-to-benefit ratio of drinking is less favorable in younger individuals. A daily habit of light to moderate drinking is ideal for those who choose to consume alcohol regularly. Red wine in particular before or during the evening meal is linked with the best long-term CV outcomes. Most of the studies on alcohol and health are observational, and correlation does not prove causation. Health care professionals should not advise nondrinkers to begin drinking because of the paucity of randomized outcome data coupled with the potential for alcohol abuse even among seemingly low risk individuals.
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