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Is a Little Wine Good for the Heart?
Author: Dr. Rick Westermeyer, M.D.
Many of you have heard or read that moderate alcohol may be beneficial to your health. Here is an example of a CNN report from December 1997: "A Drink A Day Keeps The Grim Reaper Away." It stated that "researchers report that modest drinking is, on balance, healthful and alcohol's ill effects are offset by alcohol's benefit to the heart."
As a physician, it was important to me to go to the scientific literature myself to examine the evidence before I would start advising patients, as some doctors have, that alcohol be used for medicinal purposes.
First, I obtained the original research paper printed in the New England Journal of Medicine, December, 1997. Then, I did a literature search of all the articles that have been published on alcohol in the last three years. What I found was quite surprising, considering all the popular press coverage of the beneficial and medicinal properties of alcohol. The largest and longest study to date was published in the New England Journal of Medicine in December 1997, and was entitled "Alcohol Consumption and Mortality among Middle-aged and Elderly U.S. Adults."i
It followed nearly 500,000 individuals for nine years and reported a 20% decrease in mortality for those aged 35 to 70 during the study period for those who consumed at least one alcoholic beverage per day as compared to non-drinkers.They attributed nearly all of the lower death rates to medicinal effects of alcohol in protections against cardiovascular disease.
From a purely medical point of view, should physicians start recommending alcohol consumption to protect against heart disease and to promote good health? Many people have interpreted these findings to suggest moderate drinking of alcoholic beverages should be part of a healthy lifestyle.
After carefully studying the original research paper from the New England Journal of Medicine (NEJM) plus reviewing over 50 other alcohol related articles published in the medical literature in the last three years, I established the following six points that should be considered before using alcohol for medicinal purposes:
1. Alcohol is a well-established risk factor for numerous cancers. The NEJM study showed a 30% increase in breast cancer in women consuming as little as one drink per day. This added to the already known increased incidence of mouth, throat, esophagal, stomach, pancreatic, and liver cancer associated with alcohol consumption.ii The only reason that an overall decreased mortality rate was shown in the alcohol drinking population was because many more people die from heart disease than cancer. How could any physician face a patient dying a slow, painful death from a cancer clearly linked to the alcohol that had previously been recommended as a way to decrease the chance of a heart attack by only 30%, when other less risky preventative measures are available without causing cancer as a side effect?
2. By analyzing only those aged 35 to 70, the study did not accurately reflect the lifetime risk of alcohol consumption. Alcohol-related injury is the number one cause of death in the 15 to 30 years old age group.iii
3. The mechanism by which alcohol gives cardiac protection may be harmful to other body systems. Alcohol appears to protect against heart attack in two ways. First, it reduces the build up of plaque in the blood vessels. Second, alcohol acts as a blood thinner that prevents clots from forming in the already narrowedcoronary arteries, which is the initial event in most heart attacks.iv Interfering with the delicate balance in the blood clotting mechanism may be a dangerous thing. A few years ago, it was noted that aspirin had blood thinning properties that prevented heart attacks. The initial reports were so impressive that thousands of physicians voluntarily started taking aspirin daily as a part of a study of the long term benefits.
The research project was stopped prematurely when it was noted that the aspirin group was experiencing an unexpectedly high incidence of hemorrhagic stroke. While trying to prevent a heart attack by thinning the blood, some of these doctors died, or were permanently disabled by bleeding into their brains. Now most doctors only recommend aspirin to patients who have already had one heart attack, because the risk of a second heart attack is greater than the aspirin-induced stroke.
This example clearly points out the danger of interfering, as alcohol does, with the delicate balance of the body in such areas of blood clotting. In addition, while preventing certain types of heart disease, alcohol has been clearly linked to heart rhythm problems and cardiomyopathy leading to congestive heart failure.v
4. The 30% decrease in the death rate from heart disease attributed to alcohol may be achieved and surpassed by other, much less risky, methods. Numerous studies have shown that simple lifestyle measures can reduce cardiac risk by 50 to 70% without any of the harmful side effects documented with alcohol usage.vi
5. The study's methodology and analysis bring into question the validity of the conclusions. It must be understood that all studies relating health risk and alcohol consumption rely on voluntary questionnaires being accurately completed. No one actually follows the patients around to document their consumption or verify their claims. One of the editors of the NEJM who wrote an editorial response pointed out that the study group reported their yearly alcohol consumption to be only half of US government per capita estimates based on industry production and sales.vii
He pointed out that either this study group did not reflect average American drinking habits, or they did not accurately complete their questionnaires. Anyone who has ever worked with alcoholics knows they are often in denial regarding their drinking patterns and some may have inaccurately placed themselves in the non-drinking groups statistics, which would have affected the validity of the conclusions.
Additionally, the NEJM study excluded from their statistics without explanation 32,000 individuals who had cancer or cirrhosis at the start of the study. These diseases are known to be closely linked to alcohol consumption and their exclusion could markedly effect mortality rates.
6. Beyond heart issues, alcohol has physiologic implications on virtually every major body system. When reading in the lay press one could easily conclude that most medical research in recent years has focused on the positive medicinal value of alcohol on the heart. In reality, a totally different picture emerges. A search of all English language research papers in the scientific literature in the last three years revealed 355 published articles of which 48 were review articles. Review articles summarize and condense research findings on a related topic. Of the 48 review articles, 44 were clearly dealing with the toxic affects of alcohol, and of the remaining four which dealt with the cardiac benefits, each article clearly included in the negative side effect. Here is only a sampling of statements taken from the abstracts of these articles.
Alcohol is a neurotoxin associated with significant morbidity and mortality...it may raise blood pressure, damage the myocardium, precipitate arrhythmias and damage the developing fetal heart(Sceepers, B.C. "Alcohol and the Brain." British Journal of Hospital Medicine, 1997; 57: 543-51).
It is well recognized that alcohol increases the risk of injury" (Guohua, L. "Alcohol and injury severity. Journal of Trauma 1997; 42:562-69).
Alcohol can lead to potentially hazardous hypoglycemia." (Meeking, D.R. "Alcohol ingestions and glycemic control. Diabetic Medicine 1997; 14:279-83).
...alcohol related problems include liver disease, dementia, confusion, peripheral neuropathy, insomnia, seizure disorders, poor nutrition, incontinence, diarrhea, myopathy, inadequate self care, macroaocytosis, depression, fractures, and adverse reactions to medications (Fink, A. "Alcohol related problems in older persons" Archives of Internal Medicine 1997; 157:242-3).
Alcohol has consistently been related to risks of sqaumous cell cancer..." (Thomas, D.B. "Alcohol as a cause of cancer. Environmental Health Perspectives 1995; 103:153-60).
The influence of alcohol on sexual behavior is part of popular knowledge (Donovan, C. "A review of the literature examining the relationship between alcohol use and HIV related sexual risk-taking in young people." Addiction 1997; 90:319-28).
Other studies showed the relationship between alcohol and osteoporosis, chronic gastritis, peptic ulcers, decreased immune response, aggressive behavior, fetal malformation and spontaneous abortion, and this is only a sampling! It is difficult to see how anyone could review the data and conclude that the beneficial properties of alcohol outweighs the toxic effects even when taken in moderate amounts.
One must consider the addictive potential of alcohol with its resultant social and economic implications. Approximately 10% of people who begin drinking will become sufficiently addicted to be considered problem drinkers or alcoholics. In a Gallup poll, one out of four Americans report their families being negatively impacted by alcohol abuse. The economic loss of worker productivity is measured in the billions of dollars. A medical pharmacology textbook states, "Alcohol is discussed here separately because its wide and abuse leads to more behavioral and organic toxicity than any other agent. The social and therapeutic problems thus generated are an unavoidable concern of every practitioner...Ethyl alcohol is an addictive drug and it would no doubt immediately be placed under the jurisdiction of the Food and Drug Administration, if it were first discovered today."viii
In conclusion, let's suppose you went to your physician and were offered a medication with the following informed consent:
"This is a drug which can reduce your chance of heart attack by 30%, but I must warn you that this drug is a direct brain and liver toxin. It will increase your chance of contracting cancer, and contribute to osteoporosis and ulcers. There's also a 5-10% chance that you will become hopelessly addicted to this drug, which could easily lead to losing your job or destroying your marriage. I must also inform you that there are some essential risk-free alternatives that are even more effective in preventing heart disease, but I think you'll really like the euphoric feeling you get when you take this drug."
First, the Federal Drug Administration would never allow a drug with this degree of risk-to-benefit profile to ever be marketed. Second, if they did, what patient in their right mind would accept such a prescription and ever trust the judgment of that physician again? It is probably fair to say that many people who claim to be using alcohol for medicinal purposes were already recreational drinkers who were happy to find some science supporting their lifestyle.
From a purely medical perspective, it is hard to justify alcohol use. The medical journal Cardiology Clinicssummarizes this as follows: "Given the complex nature of alcohol disease relationships, alcohol consumption should not be considered a primary preventive strategy."ix
i Thun et al., New England Journal of Medicine 337 (1997): 1705-1714.
ii L. Rosener, "Alcohol consumption and the risk of breast cancer," Epidemiology Review 15 (1993):133-44.
iii J.M. McGinnis, "Actual causes of death in the United States," Journal of the American Medical Association, 279 (1993): 2207-2212.
iv W.B. Kannel, "Serum cholesterol, lipoproteins, and the risk of coronary heart disease," The Framingham Study, Ann Int Medicine 38 (1971): 1224-1232.
v M.R. Cowie, "Alcohol and the heart," British Journal of Hospital Medicine 57 (1997): 548-551.
vi G.J. Miller, "Alcohol consumption: protection against coronary disease and risk to health." Int. Journal Epidemiology, 19 (1990): 923-930.
vii J.D. Potter, "Hazards and benefits of alcohol," New England Journal of Medicine 337 (1997): 1763-1764.
viii F.H. Meyers, Review of Medical Pharmacology, Lange (1980): 242-46.
ix J. Gaziano, "Diet and Heart Disease: the role of fat, alcohol, and antioxidance." Cardiology Clinics 14 (1996):69-83.
Author: Dr. Rick Westermeyer, M.D.
Many of you have heard or read that moderate alcohol may be beneficial to your health. Here is an example of a CNN report from December 1997: "A Drink A Day Keeps The Grim Reaper Away." It stated that "researchers report that modest drinking is, on balance, healthful and alcohol's ill effects are offset by alcohol's benefit to the heart."
As a physician, it was important to me to go to the scientific literature myself to examine the evidence before I would start advising patients, as some doctors have, that alcohol be used for medicinal purposes.
First, I obtained the original research paper printed in the New England Journal of Medicine, December, 1997. Then, I did a literature search of all the articles that have been published on alcohol in the last three years. What I found was quite surprising, considering all the popular press coverage of the beneficial and medicinal properties of alcohol. The largest and longest study to date was published in the New England Journal of Medicine in December 1997, and was entitled "Alcohol Consumption and Mortality among Middle-aged and Elderly U.S. Adults."i
It followed nearly 500,000 individuals for nine years and reported a 20% decrease in mortality for those aged 35 to 70 during the study period for those who consumed at least one alcoholic beverage per day as compared to non-drinkers.They attributed nearly all of the lower death rates to medicinal effects of alcohol in protections against cardiovascular disease.
From a purely medical point of view, should physicians start recommending alcohol consumption to protect against heart disease and to promote good health? Many people have interpreted these findings to suggest moderate drinking of alcoholic beverages should be part of a healthy lifestyle.
After carefully studying the original research paper from the New England Journal of Medicine (NEJM) plus reviewing over 50 other alcohol related articles published in the medical literature in the last three years, I established the following six points that should be considered before using alcohol for medicinal purposes:
1. Alcohol is a well-established risk factor for numerous cancers. The NEJM study showed a 30% increase in breast cancer in women consuming as little as one drink per day. This added to the already known increased incidence of mouth, throat, esophagal, stomach, pancreatic, and liver cancer associated with alcohol consumption.ii The only reason that an overall decreased mortality rate was shown in the alcohol drinking population was because many more people die from heart disease than cancer. How could any physician face a patient dying a slow, painful death from a cancer clearly linked to the alcohol that had previously been recommended as a way to decrease the chance of a heart attack by only 30%, when other less risky preventative measures are available without causing cancer as a side effect?
2. By analyzing only those aged 35 to 70, the study did not accurately reflect the lifetime risk of alcohol consumption. Alcohol-related injury is the number one cause of death in the 15 to 30 years old age group.iii
3. The mechanism by which alcohol gives cardiac protection may be harmful to other body systems. Alcohol appears to protect against heart attack in two ways. First, it reduces the build up of plaque in the blood vessels. Second, alcohol acts as a blood thinner that prevents clots from forming in the already narrowedcoronary arteries, which is the initial event in most heart attacks.iv Interfering with the delicate balance in the blood clotting mechanism may be a dangerous thing. A few years ago, it was noted that aspirin had blood thinning properties that prevented heart attacks. The initial reports were so impressive that thousands of physicians voluntarily started taking aspirin daily as a part of a study of the long term benefits.
The research project was stopped prematurely when it was noted that the aspirin group was experiencing an unexpectedly high incidence of hemorrhagic stroke. While trying to prevent a heart attack by thinning the blood, some of these doctors died, or were permanently disabled by bleeding into their brains. Now most doctors only recommend aspirin to patients who have already had one heart attack, because the risk of a second heart attack is greater than the aspirin-induced stroke.
This example clearly points out the danger of interfering, as alcohol does, with the delicate balance of the body in such areas of blood clotting. In addition, while preventing certain types of heart disease, alcohol has been clearly linked to heart rhythm problems and cardiomyopathy leading to congestive heart failure.v
4. The 30% decrease in the death rate from heart disease attributed to alcohol may be achieved and surpassed by other, much less risky, methods. Numerous studies have shown that simple lifestyle measures can reduce cardiac risk by 50 to 70% without any of the harmful side effects documented with alcohol usage.vi
5. The study's methodology and analysis bring into question the validity of the conclusions. It must be understood that all studies relating health risk and alcohol consumption rely on voluntary questionnaires being accurately completed. No one actually follows the patients around to document their consumption or verify their claims. One of the editors of the NEJM who wrote an editorial response pointed out that the study group reported their yearly alcohol consumption to be only half of US government per capita estimates based on industry production and sales.vii
He pointed out that either this study group did not reflect average American drinking habits, or they did not accurately complete their questionnaires. Anyone who has ever worked with alcoholics knows they are often in denial regarding their drinking patterns and some may have inaccurately placed themselves in the non-drinking groups statistics, which would have affected the validity of the conclusions.
Additionally, the NEJM study excluded from their statistics without explanation 32,000 individuals who had cancer or cirrhosis at the start of the study. These diseases are known to be closely linked to alcohol consumption and their exclusion could markedly effect mortality rates.
6. Beyond heart issues, alcohol has physiologic implications on virtually every major body system. When reading in the lay press one could easily conclude that most medical research in recent years has focused on the positive medicinal value of alcohol on the heart. In reality, a totally different picture emerges. A search of all English language research papers in the scientific literature in the last three years revealed 355 published articles of which 48 were review articles. Review articles summarize and condense research findings on a related topic. Of the 48 review articles, 44 were clearly dealing with the toxic affects of alcohol, and of the remaining four which dealt with the cardiac benefits, each article clearly included in the negative side effect. Here is only a sampling of statements taken from the abstracts of these articles.
Alcohol is a neurotoxin associated with significant morbidity and mortality...it may raise blood pressure, damage the myocardium, precipitate arrhythmias and damage the developing fetal heart(Sceepers, B.C. "Alcohol and the Brain." British Journal of Hospital Medicine, 1997; 57: 543-51).
It is well recognized that alcohol increases the risk of injury" (Guohua, L. "Alcohol and injury severity. Journal of Trauma 1997; 42:562-69).
Alcohol can lead to potentially hazardous hypoglycemia." (Meeking, D.R. "Alcohol ingestions and glycemic control. Diabetic Medicine 1997; 14:279-83).
...alcohol related problems include liver disease, dementia, confusion, peripheral neuropathy, insomnia, seizure disorders, poor nutrition, incontinence, diarrhea, myopathy, inadequate self care, macroaocytosis, depression, fractures, and adverse reactions to medications (Fink, A. "Alcohol related problems in older persons" Archives of Internal Medicine 1997; 157:242-3).
Alcohol has consistently been related to risks of sqaumous cell cancer..." (Thomas, D.B. "Alcohol as a cause of cancer. Environmental Health Perspectives 1995; 103:153-60).
The influence of alcohol on sexual behavior is part of popular knowledge (Donovan, C. "A review of the literature examining the relationship between alcohol use and HIV related sexual risk-taking in young people." Addiction 1997; 90:319-28).
Other studies showed the relationship between alcohol and osteoporosis, chronic gastritis, peptic ulcers, decreased immune response, aggressive behavior, fetal malformation and spontaneous abortion, and this is only a sampling! It is difficult to see how anyone could review the data and conclude that the beneficial properties of alcohol outweighs the toxic effects even when taken in moderate amounts.
One must consider the addictive potential of alcohol with its resultant social and economic implications. Approximately 10% of people who begin drinking will become sufficiently addicted to be considered problem drinkers or alcoholics. In a Gallup poll, one out of four Americans report their families being negatively impacted by alcohol abuse. The economic loss of worker productivity is measured in the billions of dollars. A medical pharmacology textbook states, "Alcohol is discussed here separately because its wide and abuse leads to more behavioral and organic toxicity than any other agent. The social and therapeutic problems thus generated are an unavoidable concern of every practitioner...Ethyl alcohol is an addictive drug and it would no doubt immediately be placed under the jurisdiction of the Food and Drug Administration, if it were first discovered today."viii
In conclusion, let's suppose you went to your physician and were offered a medication with the following informed consent:
"This is a drug which can reduce your chance of heart attack by 30%, but I must warn you that this drug is a direct brain and liver toxin. It will increase your chance of contracting cancer, and contribute to osteoporosis and ulcers. There's also a 5-10% chance that you will become hopelessly addicted to this drug, which could easily lead to losing your job or destroying your marriage. I must also inform you that there are some essential risk-free alternatives that are even more effective in preventing heart disease, but I think you'll really like the euphoric feeling you get when you take this drug."
First, the Federal Drug Administration would never allow a drug with this degree of risk-to-benefit profile to ever be marketed. Second, if they did, what patient in their right mind would accept such a prescription and ever trust the judgment of that physician again? It is probably fair to say that many people who claim to be using alcohol for medicinal purposes were already recreational drinkers who were happy to find some science supporting their lifestyle.
From a purely medical perspective, it is hard to justify alcohol use. The medical journal Cardiology Clinicssummarizes this as follows: "Given the complex nature of alcohol disease relationships, alcohol consumption should not be considered a primary preventive strategy."ix
i Thun et al., New England Journal of Medicine 337 (1997): 1705-1714.
ii L. Rosener, "Alcohol consumption and the risk of breast cancer," Epidemiology Review 15 (1993):133-44.
iii J.M. McGinnis, "Actual causes of death in the United States," Journal of the American Medical Association, 279 (1993): 2207-2212.
iv W.B. Kannel, "Serum cholesterol, lipoproteins, and the risk of coronary heart disease," The Framingham Study, Ann Int Medicine 38 (1971): 1224-1232.
v M.R. Cowie, "Alcohol and the heart," British Journal of Hospital Medicine 57 (1997): 548-551.
vi G.J. Miller, "Alcohol consumption: protection against coronary disease and risk to health." Int. Journal Epidemiology, 19 (1990): 923-930.
vii J.D. Potter, "Hazards and benefits of alcohol," New England Journal of Medicine 337 (1997): 1763-1764.
viii F.H. Meyers, Review of Medical Pharmacology, Lange (1980): 242-46.
ix J. Gaziano, "Diet and Heart Disease: the role of fat, alcohol, and antioxidance." Cardiology Clinics 14 (1996):69-83.
