In the 2018 Guidelines on Hypertension, commandment no. 6 states that we should make lifestyle interventions such as sodium restriction, healthy eating, regular exercise, weight control, and smoking cessation, and also alcohol moderation.

It is clear that heavy alcohol consumption induces hypertension and may probably be one of the main causes of secondary hypertension, but few sources detail what a moderate or “healthy” consumption is.

There are consistent observational data to indicate that there is an association between alcohol use and cardiovascular events, and that, as a whole, it is U-shaped. In other words, low or moderate alcohol consumption (up to one drink or 12.5 g alcohol per day in women and up to two drinks or 25 g per day in men) are associated with a reduced risk of overall cardiovascular events and mortality, compared with absolute abstinence or excessive consumption.

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The alcohol content of a beverage is expressed in degrees and it measures the content of absolute alcohol in 100 cm3, i.e. the alcohol percentage in a beverage. For example, if we have a 13-degree wine, that means that it contains 13 cm3 of absolute alcohol for every 100 cm3 of wine. In product labels, alcoholic content is expressed as (°) or vol%. The calculation would be as follows: consumed volume (in cm3) × alcohol content × 0.8, and then divide all by 100. We must ask the patient about the type of beverage (so as to get the alcohol content) and the amount consumed (so as to get the volume, in cm3) in order to calculate whether such consumption is good or bad for their health.

In any case, this generalization masks important aspects that merit closer examination.

Patterns of drinking, the type of alcohol consumed, and factors associated with alcohol consumption, such as socio-economic status and dietary patterns, may modify significantly such generalization. Well-established cardiac disease also implies differences, particularly for patients with left ventricular dysfunction.

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Furthermore, the effects of alcohol on coronary pathologies may differ from its effects on arrhythmias or heart failure risk, and they may also differ on ischaemic stroke and intracerebral haemorrhage.

It is important to consider that even if there is a modest cardiovascular benefit derived from moderate consumption, it may imply a risk of cancer and cirrhosis.

Finally, the data supporting this modest benefit have emerged from observational studies that are subject to many methodological limitations and potential confounding variables.

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Consequently, for the time being, it may be better to advise restraint as opposed to support consumption to reduce cardiovascular risk.

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Original title: Are the Cardiac Effects of Alcohol Good, Bad, or Neither?

Reference: Leong DP et al. Eur Heart J. 2019 Mar 1;40(9):712-714.

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