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<strong>12</strong> 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 <strong>12</strong> 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.
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