Drinking habits and cardiovascular disease: the Framingham Study

Ethanol causes epicardial coronary artery vasoconstriction in the intact dog

Ethanol produces in vitro vasoconstriction of coronary arteries and can precipitate angina in patients with coronary obstructive disease. To demonstrate the in vivo effect of ethanol on coronary dynamics, baseline measurements of left anterior descending (LAD) coronary artery dimension by quantitative angiography, hemodynamics, arterial and coronary sinus blood gases, and blood ethanol levels were obtained in 14 closed-chest mongrel dogs. Three ethanol levels were established by intravenous bolus followed by 1-hour maintenance infusions. All measurements made at baseline were recorded every 30 minutes. Phentolamine (5 mg i.v.) and nicardipine (0.15 mg/kg i.v.) were given to evaluate constrictor mechanisms. Blood ethanol levels achieved at 60, 120, and 180 minutes were 649 +/- 48, 1,285 +/- 81, and 2,546 +/- 130 micrograms/ml, respectively. LAD cross-sectional area was reduced significantly from control at the end of each of the three dosing periods (-24 +/- 5%, -40 +/- 3%, and -53 +/- 3%; p less than 0.004). alpha-Adrenergic blockade had no effect on LAD cross-sectional area, while nicardipine partially reversed the ethanol-induced vasoconstriction. No significant change in vessel cross-sectional area took place in control dogs. These data suggest that ethanol induces epicardial coronary artery vasoconstriction in dogs at clinically important blood levels. alpha-Adrenergic blockade does not alter or reverse ethanol-induced vasoconstriction, while calcium channel blockade appears to be an effective vasodilator of ethanol-constricted vessels.

Alcohol and ischaemic heart disease in middle aged British men

The relation between alcohol intake and ischaemic heart disease was examined in a large scale prospective study of middle aged men drawn from general practices in 24 British towns. After an average follow up of 6.2 years 335 of the 7729 men had experienced a myocardial infarction (fatal or non-fatal) or sudden cardiac death. No significant relation was found between reported alcohol intake and the incidence of such events. Though the group of light daily drinkers had the lowest incidence of ischaemic heart disease events, it also contained the lowest proportion of current smokers, had the lowest mean blood pressure, had the lowest mean body mass index, and contained the lowest proportion of manual workers. These characteristics are more likely to account for the apparent protective effect of alcohol against ischaemic heart disease than a direct effect of alcohol. Compared with the effects of established risk factors alcohol seems to be quite unimportant in the development of ischaemic heart disease.

Alcohol consumption and mortality in Alameda County

The association between level of alcohol consumption and 15-year mortality, focusing particularly on the possible protective effect of light drinking compared to abstention, was studied in a representative population sample of 6928 residents of Alameda County, California. Because abstainers differ from light, moderate and heavy drinkers on a number of demographic, physical, and psychosocial characteristics, the role of these as confounders of the alcohol/mortality association was examined. Using multiple logistic models, the mortality experience of abstainers, moderate drinkers, heavy drinkers and very heavy drinkers was compared with that of light drinkers. Among men only, very heavy drinkers were at significantly greater risk of death from all causes than were light drinkers (OR = 2.5, p less than 0.01). Neither abstainers nor other drinkers were at significantly higher risk of death from ischemic heart disease than were light drinkers. This pattern of results persisted with adjustment for 11 covariates of alcohol consumption in addition to age.

Social drinking as a health and psychosocial risk factor. Anstie's limit revisited

This chapter reviews empirical evidence dealing with the risk of using beverage alcohol in quantities generally considered to be within the range of moderate or social drinking. It begins with a discussion of terms and concepts typically employed to define the limits of moderate and social drinking. The historical debate over moderate drinking is considered next, using Francis Anstie's daily limit of 1.5 oz of absolute ethanol as an example of an influential and enduring approach to this issue. The scientific evidence relevant to the association between moderate drinking and damage is reviewed in sections dealing with the risks of acute ingestion of alcohol and the hazards of chronic drinking. In a final section, a multidimensional model of risk is developed to serve as a basis for early intervention and prevention planning. It is concluded that both social and moderate drinking entail risk of health hazards and psychosocial consequences. These risks are not always a direct function of the amount of ethanol consumed but rather reflect complex interactions among a host of antecedent and mediating variables. When these are taken into account, a better estimate of the relative risk of different consequences of drinking can be made.

Economic change, alcohol consumption and heart disease mortality in nine industrialized countries

This paper examines the question of whether economic changes--including economic growth, unemployment and business failures--and alcohol consumption by beverage type are independently related to heart disease mortality. Controls for cigarette and animal fat consumption are also employed in a multivariate time series analysis. Data for nine countries in the post World War II era are investigated: Australia, Canada, England and Wales, Denmark, Federal Republic of Germany, Finland, France, Sweden and the United States. In all nine countries unemployment and business failures are positively related to heart disease mortality, and in eight countries the trend of economic growth shows an inverse relationship. The relation of alcohol consumption to heart disease mortality depends on beverage type. When spirits or wine consumption shows a significant relation, occasionally requiring controls for other beverages, it is positive. On the other hand, beer consumption shows an inverse relation to heart disease mortality in all countries. The statistical significance of that relationship also occasionally must be based on controls for other beverages.

The health benefits of moderate alcohol consumption: a review of the literature

A review of the literature on the positive benefits of light and moderate alcohol consumption suggests the following: Alcoholic beverages are food, containing approx. 7 calories per gram of ethanol. Beer contains small percentages of the recommended daily allowance of vitamins and significant proportions of the recommended daily allowance of trace metals and minerals. Wine, while possessing significantly smaller amounts of vitamins and minerals than beer, has considerably more iron. Both beer and wine have a favorable potassium to sodium ratio. Coronary heart disease (CHD) seems to have a negative association with regular alcoholic beverage use. While some report a linear relationship, most studies agree that the relationship is U-shaped. Many studies have suggested that this inverse relationship is due to alcohol's effect of increasing levels of high density lipoprotein cholesterol (HDL), which acts in the removal of cholesterol from tissue. Other explanations for moderate alcohol's cardioprotective effect include: associated diet changes in moderate drinkers, the silicon content in wine and beer, decreased platelet aggregation and coagulation, and the ability to lessen stress and/or alter personality patterns associated with CHD risks. Dry non-sweet wines and diluted distilled spirits have been recommended in the treatment of diabetes. It has been suggested that alcohol may improve glucose tolerance and blood glucose response to ingested carbohydrates. Due to reported decreased HDL values in diabetics, alcohol has been suggested as useful for its HDL-increasing function.

Alcohol, coronary heart disease, and total mortality

The dose-response relationship between alcohol consumption, coronary heart disease, and total mortality was examined. The results indicated that moderate consumers (1 to 2 drinks/day) were at a lower risk of coronary heart disease than nonconsumers or heavy consumers. Evaluation of total mortality in relationship to alcohol consumption reveals that a similar U-shaped relationship to longevity exists.

Alcohol, lipids and heart disease

The attenuating effect of moderate amounts of alcohol on cardiovascular morbidity and mortality has been reported by several groups of investigators at various geographic locations. At this time, the generally accepted explantation for this cardioprotective effect favors an increase in plasma high-density lipoprotein cholesterol, a factor inversely associated with the development of coronary heart disease (CHD). Other variables potentially influencing the development of CHD such as a reduced tendency for blood coagulation and increased fibrinolytic activity has been enhanced by alcohol and may be considered as possible additional mechanisms for the cardioprotective effects of the agent. Because of its addictive potential, alcohol should not be considered for treatment of CHD.