Alcohol and the Heart Tis the Season for Another New Year’s Resolution?

Alcohol is one of the oldest and most widely used recreational drugs and is certainly popular in our Western culture—especially around the holidays.

There is a perception that a glass of wine or beer protects the heart, but this may not apply to everyone, as recent reports question this widely based assumption.1 Studies have found that moderate alcohol consumption reduces death by 18% in men who drink 1-2 drinks daily or in women who drink 1 drink daily when compared to non-drinkers. However, drinking more than 3 drinks a day in men and 2 drinks a day in women increases mortality. Heavy alcohol consumption or binge drinking (men > 5 drinks, women > 4 drinks) increases the risk of sudden death and stroke. The modest beneficial effects of alcohol may be related to the frequency of drinking. Daily use appears beneficial, whereas binge drinking is associated with a greater number of heart attacks.

Beneficial biologic effects of alcohol include a reduction in HDL cholesterol levels, lower blood clotting factors and less inflammation in our blood vessels—making our arteries more resistant to forming plaques.1

Although there may be benefit to moderate consumption, these benefits may be diminished in those with Atrial Fibrillation.

Holiday Heart Syndrome

Atrial Fibrillation or AFib associated with excessive Holiday drinking is known as the “Holiday Heart Syndrome.” This usually self-limited heart rhythm disturbance may occur in healthy (even young) drinkers with no underlying cardiac problems. In fact, AFib has been demonstrated in 60% of binge drinkers.2 AFib is a fast, irregular heart beat that can lead to stroke, congestive heart failure and other cardiovascular complications. Symptoms of AFib include palpitations or a rapid disorderly heartbeat, shortness of breath, and fatigue. Quite commonly, AFib may go totally unnoticed.

Unfortunately, even modest levels of alcohol intake on a regular basis may also modestly increase the risk of AFib. In contrast, heavy alcohol consumption can cause AFib and very rarely, alcohol can cause sudden cardiac death after only one day of heavy drinking.

Chronic, heavy alcohol consumption can weaken the heart muscle leading to cardiomyopathy with congestive heart failure.

Is your drinking a problem?

First, it is very important to remember that in women the liver metabolizes alcohol more slowly and thus the maximum recommend dose per day is as follows:

Women           1 drink / day or <  7 drinks/week
Men                 2 drinks/day or <14 drinks/week

Second, when we talk about a drink, we are not talking about the whole bottle of wine, ladies!
According to the NIH National Institute on Alcohol Abuse and Alcoholism (NIAAA), a “standard drink” is defined as 12 grams of ethanol, 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80 proof spirits.3

The NIAAA estimated that 28% of US adults consumed amounts of alcohol that increased health risks while 23% of US residents over 12 years of age reported binge drinking within the past 30 days in the 2011 US National Survey on Drug Use and Health.

Alcohol and your Existing Risk Factors

Finally, if you have one or more of these risk factors: hypertension, high cholesterol or diabetes, alcohol has a compounding effect.  Alcohol elevates the systolic blood pressure (the top number). Women who drink more than 2 drinks daily double their likelihood of hypertension. Because alcohol is metabolized in the mouth and stomach to PURE SUGAR (a carbohydrate), which is rapidly absorbed, alcohol also raises the glucose levels in the blood, increasing the risk of weight gain and diabetes.  Furthermore, and probably most importantly, obesity independently increases the risk of AFib.

Obesity is an independent factor for AFib, and is clearly impacted by drinking since alcohol can lead to increased Body Mass Index (BMI). Thus, alcohol consumption contributes to the American Obesity Epidemic and this increases the risk of AFib as we age and gain weight. Alcohol is a calorie-laden waste. Per gram, alcohol has more calories than sugar and only slightly fewer calories per gram than fat.

Alcohol: 1 gram = 7 calories
Fat: 1 gram = 9 calories
Carbohydrates: 1 gram = 4 calories
Protein: 1 gram = 4 calories

So before you order your second or third eggnog or glass of champagne this season, think about the consequences! Hypertension and diabetes both increase the risk of AFib and the risk of stroke when AFib is present. Think about your body, your sleep pattern, your blood pressure, your glucose and perhaps you will opt for a walk around the party instead!

Until next time!

Stephanie Coulter, MD

Additional Reading & References

1.  J Am Coll Cardiol. 2016;68(23):2567-2576 Alcohol and Atrial Fibrillation: A Sobering Review
2.  Arrhythmias and the “Holiday Heart”: alcohol-associated cardiac rhythm disorders. Ettinger PO, Wu CF, De La Cruz C Jr, Weisse AB, Ahmed SS, Regan TJ Am Heart J. 1978;95(5):555

3.  Center for Behavioral Health Statistics and Quality. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50); 2015
