Excess alcohol intake may increase risk for heart disease, especially in younger women
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Key takeaways:
- The link between excess alcohol intake and coronary heart disease is not well understood.
- Researchers reported additional risk for women, especially those who self-reported binge drinking.
ATLANTA — In a new study, young and middle-aged adults who reported high alcohol intake — at least 15 drinks for men and eight drinks for women per week — were more likely to develop coronary heart disease compared with adults who consume less alcohol.
Risk for CHD was highest for both men and women who reported binge drinking, which was defined as at least five drinks per day for men and four drinks per day for women in the past 3 months, according to research presented at the American College of Cardiology Scientific Session.
In the study, which utilized a systematic alcohol screening program in a large, real-world, diverse population, “we showed there was increased risk for coronary heart disease especially among women,” Jamal S. Rana, MD, PhD, FACC, cardiologist with The Permanente Medical Group and adjunct investigator in the division of research at Kaiser Permanente Northern California, said during a web briefing.
Link between alcohol and heart disease
“Excessive alcohol use is a significant public health problem in the U.S., amounting to roughly 140,000 deaths annually,” Rana said during the briefing.
Recent reports have shown a rise in mortality among middle-aged and younger adults attributed to drug- and alcohol-related incidents and suicide, Rana said.
However, the link between alcohol intake, including binge drinking, and risk for CHD is not well understood, Rana said.
The current study included more than 432,000 men and women aged 18 to 65 years without prior heart disease or stroke. Forty-four percent were women (mean age, 43 years) and half were white. Rana said it is one of the largest and more diverse studies to date examining the link between alcohol and CHD.
Participants had a primary care visit within the Kaiser Permanente Northern California health care system from 2014 to 2015 during which they reported weekly alcohol consumption levels, using the organization’s “Alcohol as a Vital Sign” screening initiative, which includes posters to help patients estimate alcohol intake.
Alcohol intake was defined as:
- low (1 to 2 drinks per week for men and women)
- moderate (3 to 14 drinks per week for men and 3 to 7 drinks per week for women)
- high ( 15 drinks per week for men and 8 drinks per week for women)
The researchers then analyzed new diagnoses of CHD over 4 years of follow-up.
‘Women consistently have higher risk’
Overall, 3,108 men and women were diagnosed with CHD over 4 years.
The researchers reported that the incidence of CHD rose with higher levels of weekly alcohol intake.
Among participants who did not report heavy episodic or “binge” drinking (defined as at least one day in the past 3 months with five or more drinks for men or four or more drinks for women), there was a 45% increased risk for CHD among women and a 15% increased risk among men who reported high intake compared with moderate intake, according to data presented at the briefing.
Among participants who reported binge drinking, there was a 68% increased risk for CHD among women and a 33% increased risk among men who reported high intake compared with moderate intake.
“We could see ... even among non-binge drinkers, that women consistently have higher risk any time they are [consuming] more than one drink on average per day,” Rana said.
Among women, risk for CHD was 29% higher for those who reported high intake compared with those who consumed only one to two drinks per week, according to the results.
The greatest difference was among those who reported binge drinking, Rana said.
“Not many studies have looked into binge drinking, which is actually very prevalent among younger populations,” Rana said.
The results showed no significant difference in CHD risk between participants who reported moderate vs. low alcohol intake, regardless of whether they were also categorized as binge drinking.
Health risks of excess alcohol intake
Rana said this research calls attention to the health risks of alcohol consumption — especially binge drinking — and underscores the importance of considering alcohol use in heart disease risk assessment and prevention efforts.
“At a public health level, I think we should start considering alcohol use as a vital sign the way we approach smoking, for instance,” Rana said during the briefing.
Alcohol has been shown to raise BP and lead to metabolic changes that are associated with obesity and inflammation, Rana said. Regarding the differences in CHD risk between men and women seen in this study, he said it is important to note that there are pharmacokinetic and physiological differences in the way that men and women process alcohol.
The researchers noted that a limitation of this research is that patients tend to underreport their alcohol intake when asked by a physician. Rana said the systematic alcohol screening program utilized in this study was very comprehensive in capturing data on alcohol intake, but the classifications of weekly consumption were based on standard U.S. guidelines and are not very high levels of consumption. This study may provide conservative estimates of CHD risk associated with alcohol consumption, according to the researchers.
Reference:
- Alcohol raises heart disease risk, particularly among women. https://www.acc.org/About-ACC/Press-Releases/2024/03/28/11/58/alcohol-raises-heart-disease-risk-particularly-among-women. Published March 28, 2024. Accessed March 28, 2024.
Perspective
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We have known for a long time that alcohol can affect the heart in many different ways. Especially with higher intake, alcohol can have a direct impact on the heart muscle itself as well as cardiac conduction and arrhythmias. More broadly speaking, alcohol consumption also influences risk factors for heart disease. High levels of alcohol consumption are associated with increased risk for high BP, weight gain, cholesterol levels and so on. The impacts of alcohol on the heart are likely dose-dependent, meaning that low doses maybe have minimal impact, and in some situations there is some thought of potentially beneficial effects, but with increasing amounts the detrimental impact can be there.
The key takeaway is the size of this study. The findings are quite in line with studies that have been reported previously that have been in prospective cohorts that are in many ways superior to a study like this, which was an electronic medical record health system observational study. But the size is where they derive all the power, whereas previous data come from more well-controlled cohorts in which alcohol consumption amounts are probably more reliable but the size is a limitation. This study is a reproduction of previous findings in a large community-dwelling cohort.
It's hard to draw many conclusions from the abstract. Binge drinking previously has been associated with heart disease and "holiday heart." Too much of nearly anything is probably not good.
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Rana JS, et al. Abstract 1044-11. Presented at: American College of Cardiology Scientific Session; April 6-8, 2024; Atlanta.
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