How Alcohol Is Linked to Heart Disease

Imbibing—in small amounts—may be good for your heart, but it's also not a reason to start consuming alcohol if you don't already drink. Here's what science says about alcohol and heart disease.

Drinking by the numbers: Americans and alcohol

Although Dry January, Sober October, and sober-curious conversations and trials are on the rise, most Americans still imbibe. Nearly seven in 10 Americans report that they drank alcohol in the last year. And about 55 percent had done so in the month prior, according to the 2019 National Survey on Drug Use and Health.

Alcohol impacts the body in a variety of ways. But what’s the connection between drinking and your heart? One in four deaths in the U.S. can be attributed to some form of cardiovascular disease and 655,381 Americans died from heart disease in 2018, making it the leading cause of death in the country.

So how does that cocktail, glass of wine, or bottle of beer affect your heart? Read on for information from doctors, as well as the latest scientific data.

What is heart disease?

Heart disease is any condition that limits the heart’s ability to function normally. Heart disease is a type of cardiovascular disease, which is a disease of the heart or blood vessels. All heart diseases are cardiovascular diseases, but not all cardiovascular diseases are heart diseases.

The most common type of heart disease is coronary artery disease, where the blood vessels that supply the heart muscle become clogged with fatty plaques. Here are other common conditions that can affect your heart:

  • Heart attack: A blood clot blocks blood flow to part of the heart, preventing some or all of the heart muscle from receiving  enough oxygen. The longer blood flow is affected, the more damage is done to the heart.

  • Arrhythmia: The heart beats too slow (bradycardia), too fast (tachycardia), or irregularly.

  • Heart valve issues: A valve that connects areas of the heart either leaks, bulges, or doesn’t open fully enough for a healthy blood flow.

  • Congestive heart failure: A chronic condition in which the heart still beats, but isn’t performing optimally. The heart becomes enlarged, fluid can accumulate in the limbs and lungs, and the body doesn’t receive enough oxygen via the blood.

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Potential heart health benefits of drinking alcohol

Drinking alcohol is a “double-edged sword,” according to a review of studies published in 2017 in the journal Alcohol Research. There are thought to be some heart health benefits of drinking in moderation.

In fact, people with low to moderate levels of drinking may have a lower risk for heart disease compared to those who don’t drink at all or consume higher amounts. A study of adults in Korea published in 2017 in Medical Science Monitor found that light drinking was linked to a lower risk of metabolic syndrome, a cluster of health conditions that increase the risk of heart disease, type 2 diabetes, and stroke. (A stroke can be caused by a blockage, usually a blood clot, in blood flow to the brain (ischemic stroke) or a broken blood vessel that causes bleeding in the brain (hemorrhagic stroke).)

“There is some evidence that moderate amounts of alcohol might help to slightly raise levels of ‘good’ HDL cholesterol,” says Satjit Bhusri, MD, founder of Upper East Side Cardiology in New York City. “Researchers have also suggested that red wine in particular might protect the heart, thanks to the antioxidants it contains.”

But that doesn’t mean you should drink just to try to gain some cardiac benefits. “Exercise can also boost HDL cholesterol levels,” says Dr. Bhusri. “And antioxidants can be found in other foods, such as fruits, vegetables and grape juice.” (Check out more drug-free ways to score healthier cholesterol levels.)

Potential heart health risks of drinking alcohol

Binge drinking, or drinking well beyond moderation, can lead to a whole host of health issues, including high blood pressure, arrhythmia, and increased probability of metabolic syndrome. All of these can increase your risk for heart disease, or lead to complications if you already have it.

Chronic, long-term excessive drinking—as occurs with alcohol use disorder—can increase the risk of alcoholic cardiomyopathy, a type of heart failure caused by alcohol-induced damage to the heart muscle.

About 15 million Americans, or 6 percent of the population, have alcohol use disorder, which is defined by a set of criteria like having cravings and an inability to stop drinking regardless of the negative consequences.

A 2017 study in the Journal of the American College of Cardiology looked at 14 million people 21 or older who sought medical care in California between 2005 and 2009. The researchers found that about 2 percent of the people abused alcohol and their risk of heart attack was 45 percent higher than those who did not abuse alcohol. The heavy drinkers also had more than double the risk of congestive heart failure and atrial fibrillation, an irregular heartbeat.

In general, too much alcohol can raise blood pressure and increase stroke risk too.

Although a small or moderate intake of alcohol may have some benefits, it’s not a replacement for other poor lifestyle habits.

“Even though beverages like red wine or aged whiskey may have other compounds that could be beneficial, levels are not high enough to make much difference when compared to the compounds you get from a regular healthy diet,” says Eric Rimm, ScD, a professor of epidemiology and nutrition, and director of the program in cardiovascular epidemiology at the Harvard T.H. Chan School of Public Health.

Not to mention that many spirits are mixed with high-sugar beverages and consumed alongside higher-fat items or higher quantities of food. (Find out why drinking alcohol makes you hungry.)

“Be careful of what else you consume with the drink, as well,” Rimm says.

How much alcohol is safe and what counts as “one drink”?

That Alcohol Research review’s conclusion of the healthiest amount to drink aligns with the current Dietary Guidelines for Americans. Both suggest sticking to “moderate” drinking, which is no more than one drink per day for women and up to two per day for men.

“A drink might be less than you think: 12 ounces of beer, four ounces of wine, or 1 1/2 ounces of 80-proof spirits,” Dr. Bhusri says.

In addition to how much, you should consider how you drink, too, Rimm says.

“I enjoy wine with most of my dinners and I usually drink five to six days a week,” he adds. “I always take a day or two off each week and try to drink slowly and with food when I do choose to drink.”

Any kind of alcohol can lower the quality of your sleep if you imbibe too close to bedtime, so aim to finish your glass about four hours before bedtime, suggests the National Sleep Foundation.

What people with heart disease need to know about alcohol

“Drinking alcohol is tricky when talking to a patient because it depends on their past history with drinking too much or not drinking at all,” says Rimm. “Rarely will doctors tell a non-drinker to start drinking for health reasons.”

If you have certain heart issues, it’s best to go sober. “Don’t drink at all if you have certain heart rhythm abnormalities or have heart failure,” Dr. Bhusri adds.

Although consuming one or two drinks per day may lower your risk of developing heart disease and type 2 diabetes, “drinking more is not good and drinking heavily on just a few days a week is definitely not healthy,” Rimm says, especially if you’ve already been diagnosed with heart disease.

If you have any form of heart disease and currently drink, talk to your doctor about your consumption levels and frequency. This is especially important if you’re on any medication, as alcohol can interact with some drugs.

What and how much alcohol you drink is worth evaluating as part of your overall health profile, Rimm explains. But don’t forget everything else that plays a role in your well-being and heart disease risk.

“There are so many other healthy lifestyle choices that should be considered before alcohol that can be impactful for total health—like exercise, a healthy diet, not smoking, and keeping your weight, blood pressure, and cholesterol down,” he adds. “Alcohol should not be a primary focus when it comes to making decisions about disease prevention.”

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Karla Walsh
Karla Walsh is a food editor and freelance writer based in Des Moines, Iowa. Passionate about all things wellness, Walsh is a NASM certified personal trainer and AFAA certified group fitness instructor. She aims to bring seemingly intimidating food and fitness concepts down to earth for readers.