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Alcohol and cardiovascular diseases: a historical overview
1Kaiser Permanente Medical Center, Oakland, CA 94611, USA.
Insights
Alcohol consumption impacts cardiovascular health, increasing risks for cardiomyopathy, hypertension, and certain arrhythmias. However, moderate alcohol intake may lower the risk of stroke and coronary heart disease.
Area of Science:
- Cardiology
- Epidemiology
- Toxicology
Background:
- Historical understanding of alcohol's cardiovascular effects is fragmented.
- Early research was confounded by nutritional deficiencies (beriberi) and co-exposures (arsenic, cobalt).
- The link between heavy alcohol use and hypertension was noted historically but not widely accepted until recent decades.
Observation:
- Alcoholic cardiomyopathy has been recognized for over 150 years.
- Holiday heart syndrome (supraventricular tachyarrhythmias) is a known clinical observation.
- Distinguishing stroke types was crucial for understanding alcohol's differential effects.
Findings:
- Heavy alcohol consumption is linked to hypertension, though mechanisms are unclear.
- Alcohol intake may increase the risk of hemorrhagic stroke but decrease the risk of ischemic stroke.
- Evidence suggests alcohol may offer protection against coronary artery disease and atherosclerosis.
Implications:
- Separate consideration of alcohol-related cardiovascular disorders is necessary.
- Further research is needed to elucidate the mechanisms behind alcohol's cardiovascular effects.
- Understanding the role of beverage type (e.g., the French Paradox) requires further investigation.
Abstract:
Evident disparities in relationships make it desirable to consider several disorders separately. (1) Alcoholic cardiomyopathy was perceived 150 years ago, but understanding was clouded by recognition of beriberi and of synergistic toxicity from alcohol with arsenic or cobalt. (2) A report of a link between heavy drinking and hypertension in WWI French soldiers was apparently ignored for > 50 years. Epidemiological and intervention studies have now firmly established this association, but a mechanism remains elusive. (3) The 'holiday heart syndrome', an increased risk of supraventricular tachyarrhythmias in alcoholics, has been widely known to clinicians for 25 years; data remain sparse about the total role of heavier drinking in cardiac rhythm disturbances. (4) Failure of earlier studies to distinguish types of stroke impeded understanding; it now seems probable that alcohol drinking increases risk of haemorrhagic stroke but lowers risk of ischaemic stroke. (5) Heberden reported angina relief by alcohol in 1786, and an inverse alcohol-atherosclerosis association was observed by pathologists early in this century. Recent population studies and plausible mechanisms support a protective effect of alcohol against coronary disease. International comparisons dating back to 1819 suggest beverage choice as a factor, but this issue (the 'French Paradox') remains unresolved.