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Cardiovascular risks and benefits of moderate and heavy alcohol consumption

Key Points

  • Alcohol, in binge doses or high cumulative lifetime consumption, is clearly deleterious to most cardiovascular events, and produces progressive cardiovascular dysfunction and structural damage, increasing related morbidity and mortality

  • High-dose alcohol consumption raises total and cardiovascular mortality, and increases development of coronary and peripheral artery disease, arrhythmias, dilated cardiomyopathy, heart failure, stroke, arterial hypertension, dyslipidaemia, and diabetes mellitus

  • Alcoholic dilated cardiomyopathy progressively develops in a dose-dependent manner, starting with diastolic dysfunction and leading to systolic dysfunction and congestive heart failure

  • Genetic, racial, and behavioural susceptibility factors influence the degree of alcohol-induced heart damage, and include gender, as women are more sensitive than men to the harmful cardiac effects

  • The deleterious, toxic effect of high-dose alcohol in relation to cardiovascular disease is recognized, and furthermore, alcohol consumption for the benefit of cardiovascular health is not recommended in nonconsumers

  • Although low-dose alcohol decreases mortality, reducing alcohol consumption has global health benefits, and the beneficial versus detrimental effects of low-dose alcohol should be carefully considered

Abstract

The heart and vascular system are susceptible to the harmful effects of alcohol. Alcohol is an active toxin that undergoes widespread diffusion throughout the body, causing multiple synchronous and synergistic effects. Alcohol consumption decreases myocardial contractility and induces arrhythmias and dilated cardiomyopathy, resulting in progressive cardiovascular dysfunction and structural damage. Alcohol, whether at binge doses or a high cumulative lifetime consumption—both of which should be discouraged—is clearly deleterious for the cardiovascular system, increasing the incidence of total and cardiovascular mortality, coronary and peripheral artery disease, heart failure, stroke, hypertension, dyslipidaemia, and diabetes mellitus. However, epidemiological, case–control studies and meta-analyses have shown a U-type bimodal relationship so that low-to-moderate alcohol consumption (particularly of wine or beer) is associated with a decrease in cardiovascular events and mortality, compared with abstention. Potential confounding influences—alcohol-dose quantification, tobacco use, diet, exercise, lifestyle, cancer risk, accidents, and dependence—can affect the results of studies of both low-dose and high-dose alcohol consumption. Mendelian methodological approaches have led to doubts regarding the beneficial cardiovascular effects of alcohol, and the overall balance of beneficial and detrimental effects should be considered when making individual and population-wide recommendations, as reductions in alcohol consumption should provide overall health benefits.

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Figure 1: Effects of ethanol on cardiomyocyte structure and organelles.
Figure 2: Preclinical alcohol-induced structural myocardial damage.
Figure 3: End-stage alcoholic cardiomyopathy.
Figure 4: Comparison of J-shaped and U-shaped response curves.
Figure 5: Pooled curves of relative risk of fatal and nonfatal vascular events and wine intake, extracted from 17 independent relationships using random models.

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Acknowledgements

The author was supported by SGR-2013-1158 Generalitat de Catalunya, and also by the research network CIBEROBN Fisiopatologia de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain.

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Fernández-Solà, J. Cardiovascular risks and benefits of moderate and heavy alcohol consumption. Nat Rev Cardiol 12, 576–587 (2015). https://doi.org/10.1038/nrcardio.2015.91

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