Issue 12

12
Health
GPLUS SEP 14 - SEP 20, 2013
In High Spirits
Alcohol and Heart Disease
Dr. Bikash Rai Das
Consultant Heart Surgeon, GNRC Hospital,
The most common questions,
I’m asked whenever I go for
any TV interview or any
interactive programmes are “Doctor,
can I take alcohol? What are
its effects on heart?” People have
many queries about alcohol that’s
why we are bombarded with lots
of questions whenever there is an
opportunity. Any advice about the
consumption of alcohol must take
into account not only the complex
relation between alcohol and heart
disease but also the well-known
association of heavy consumption
of alcohol with a large number of
health risks such as liver disease or
cancer.
Mild to moderate alcohol
consumption has been associated
with lower rates of heart diseases
in multiple Western-based observational
studies. However, the
landmark Interheart Study has revealed
that alcohol consumption
in South Asians was not protective
against heart disease in sharp
contrast to other populations who
benefit from it. In fact Asian Indians
who consume alcohol had
a 60% higher risk of heart attack
which was greater with local spirits
(80%) than branded spirits (50%).
The harm was observed in alcohol
users classified as occasional as
well as regular light, moderate, and
heavy consumers. Another large
study of 4465 subjects in India
also confirmed the possible harm
of alcohol consumption on heart
disease risk in men. Compared to
lifetime abstainers, alcohol users
had higher blood sugar, blood pressure
levels, and the cholesterol levels
and significantly higher tobacco
use. Potential explanations for this
alcohol
How does alcohol affect the
heart?
Drinking too much alcohol can
raise the levels of some fats in the
blood (triglycerides). It can also
lead to high blood pressure, heart
failure and an increased calorie
intake. (Consuming too many
calories can lead to obesity and a
higher risk of developing diabetes.)
Excessive drinking and binge
drinking can lead to stroke. Binge
drinking is defined as consuming
four or more drinks for women and
five or more drinks for men on an
occasion. Although binge drinking
is more common among young
adults ages 18 to 34, according to a
report, those 65 and older who report
binge drinking do so more often
— an average of five to six times
a month. Binge drinking can make
your heart beat irregularly. Other
serious problems include fetal alcohol
syndrome, cardiomyopathy
and sudden cardiac death.
What about red wine and
heart disease?
Research suggests that small
amounts of alcohol can have a protective
effect on your heart. This
benefit appears to be restricted
to over 45-year old people drinking
well within the recommended
guidelines. Scientists aren’t sure
how alcohol has the protective effect
but think there are two main
mechanisms:
Preventing artery damage. Alcohol
appears to increase the level
of ‘good’ cholesterol (HDL) in the
blood. This reduces the amount
of fatty deposit (atheroma) which
narrows our arteries and makes
them more likely to clog.
Preventing blood clots. Alcohol
can help prevent the formation
of blood clots which
can close off the arteries, causing
a heart attack. It can stop
platelets from clumping together
to form clots and a small amount
of alcohol with a meal can reduce
the sudden rise of a protein (fibrinogen)
produced by the liver.
This increases the likelihood of
harmful blood clots forming,
called thrombosis. Over the past
several decades, many studies
have been published in science
journals about how drinking alcohol
may be associated with reduced
mortality due to heart disease
in some populations. Some
researchers have suggested that
the benefit may be due to wine,
especially red wine. Others are
examining the potential benefits
of components in red wine such as
flavonoids and other antioxidants
in reducing heart disease risk. Red
wine has a high concentration of
antioxidant substances called flavonoids.
White alcoholic drinks,
like vodka and cider, contain the
least concentration of flavonoids.
But other alcohols, such as beer,
have the same antioxidant effect
as wine. Much of the interest in
red wine comes from the observation
that the French (who have
a long tradition of drinking red
wine) often have healthy hearts
and arteries despite typically having
high-fat foods in their diet.
But studies show that people who
drink wine over other types of alcohol
tend to live healthier lives,
smoking less, drinking less and
having a healthier diet. So these
other factors, rather than the red
wine, may in fact be responsible
for their good health. Some of
these components may be found
in other foods such as grapes or
red grape juice. The linkage reported
in many of these studies
may be due to other lifestyle factors
rather than alcohol. Such factors
may include increased physical
activity, and a diet high in
fruits and vegetables and lower in
saturated fats
What is the advice to the
habitual drinker?
If you drink, do so in moderation.
The incidence of heart disease
in those who drink moderate
amounts of alcohol (no more than
two drinks per day for men or one
drink per day for women) is lower
than in nondrinkers. However,
with increased intake of alcohol,
there are increased health dangers
including high blood pressure,
obesity, stroke. If you’re a heavy
drinker, statistics show that cutting
back can help reduce your
stroke risk. Be informed about the
risks when you take a drink and
take steps to prevent stroke from
happening to you or someone you
love.
What is the advice to the
diabetics?
Drinking a glass of wine is
good for the heart in the sense that
the main mechanism by which alcohol
protects the heart is increasing
good cholesterol. The grape
skin provides flavonoids and other
antioxidant substances that protect
the heart and vessels from the
damaging effects of free oxygen
radicals produced by our body.
This is particularly true for diabetics
because they have been shown
to have a high production of free
oxygen radicals. But we don’t have
any evidence specifically related to
diabetes patients.
A glass of wine can also help
individuals relax. The strongest
evidence is in favor of wine, but
some evidence recently showed
beer and other types of alcohol
may provide the same benefits related
to increasing good cholesterol
(HDL).
In general, alcohol does not
seem to have an adverse effect,
unless an excessive amount is
used — and it increases calories,
among other things. For example,
excessive amounts of alcoholic
consumption could be harmful by
increasing the risk of high blood
pressure, for which diabetic patients
are already at high risk. For
all people, alcohol can lower blood
sugar. So for people with diabetes,
it is recommended that any alcohol
be consumed with a meal. In all
cases, alcohol still contains calories,
so remember to include it in
the meal plan (one alcoholic drink
is 1 fat exchange). If further help
is needed, seek the help of a registered
dietitian.
Then, is it a good idea to start
drinking alcohol to protect yourself
against heart disease?
Simply put, it’s just not worth
it. With alcohol and the heart, it’s a
benefit and risk trade off. So, for example,
alcohol’s anti-clotting ability,
potentially protective action
against heart attack, may increase
the risk of stroke (when a blood
vessel bursts inside the brain), or
bleeding within the brain. Beyond
the daily unit guidelines, alcohol’s
potential benefits on the heart are
outweighed by its increased risks
of developing other illnesses, such
as liver disease or cancer. There
are safer ways to reduce your risk
of developing heart disease. To
keep your heart healthy, the British
Heart Foundation (BHF) advisestaking
exercise, eating a healthy
diet, being aware of dangers such
as smoking, drinking, high blood
pressure and stress.
What are the recommendations?
The American Heart Association
says that if you drink alcohol,
do so in moderation. This means
an average of one to two drinks
per day for men and one drink
per day for women. (A drink is
one 12 oz. beer, 4 oz. of wine, 1.5
oz. of 80-proof spirits, or 1 oz. of
100-proof spirits.) Drinking more
alcohol increases dangers such as
high blood pressure, obesity etc.
Also, it’s not possible to predict in
which people alcoholism will become
a problem. Given these and
other risks, the American Heart
Association cautions people NOT
to start drinking, if they do not already
drink alcohol.