Drinking moderate amounts of alcohol is linked to reduced risk of heart failure
Evidence already exists for the beneficial effects of drinking moderate amounts of alcohol on the risk of developing a number of heart conditions; however, the role it plays in the risk of developing heart failure has been under-researched with conflicting results.
Now, a large study of nearly 15,000 men and women, published online January 20, 2015 in the European Heart Journal, shows that drinking up to seven drinks a week in early to middle age is associated with a 20% lower risk of men developing heart failure in the future when compared to people who did not drink at all, and a more modest 16% reduced risk for women.
Heart failure is a condition in which the heart can no longer pump blood around the body as well as it used to. The most common reason is that the heart muscle has been damaged, for instance by a heart attack. High blood pressure, heart muscle disease (cardiomyopathy), heart valve problems, an irregular heart beat (arrhythmia), viral infections, drinking excessive amounts of alcohol, consuming recreational drugs and the side-effects of radiotherapy treatment for cancer can all contribute to heart failure developing. Heart failure is a major public health problem with over 23 million people living with it worldwide.
Dr Scott Solomon, Professor of Medicine at Harvard Medical School and Senior Physician at Brigham and Women's Hospital, Boston, USA, Dr Alexandra Gonçalves, a research fellow at Brigham and Women's Hospital, and colleagues analysed data from 14,629 people aged between 45-64 years who had been recruited to the Atherosclerosis Risk in Communities Study between 1987 and 1989 in four communities in the USA. They followed the participants for 24-25 years to the end of 2011, and they questioned them about their alcohol consumption at the start and at each of the three subsequent visits made at three-yearly intervals.
They defined a drink as one that contains 14g of alcohol, equivalent to approximately one small (125ml) glass of wine, just over half a pint or a third of a litre of beer, and less than one shot of liquor such as whisky or vodka. The study participants were divided into six categories: abstainers (people who recorded having drunk no alcohol at every visit by the researchers), former drinkers, people who drank up to seven drinks a week, or between 7-14 drinks, 14-21 drinks, or 21 or more drinks a week.
During the follow-up period 1271 men and 1237 women developed heart failure. The lowest rate of heart failures occurred in those drinking up to 7 drinks per week and the highest rate was seen among former drinkers.
After taking account of various factors that could affect the results such as age, diabetes, high blood pressure, heart disease or heart attacks, body mass index, cholesterol levels, physical activity, education and smoking, men who consumed up to seven drinks a week had a 20% reduced risk of developing heart failure compared to abstainers, while the risk was reduced by 16% in women consuming the same amount. Former drinkers had the highest risk of developing heart failure -- a 19% and 17% increased risk among men and women respectively compared to abstainers. Interestingly, among both men and women consuming the most amount of alcohol (14 or more drinks a week), the risk of heart failure was not significantly different compared to the risk for abstainers. Drinking excessive amounts of alcohol over a long period of time is known to increase the risk of cardiomyopathy. However, the number of very heavy drinkers in the study was small, which could have limited its power to detect such an association.
However, when the researchers looked at death from any cause, there was an increased risk of death of 47% for men and 89% of women who reported consuming 21 or more drinks a week at the start of the study.
Professor Solomon said: "These findings suggest that drinking alcohol in moderation does not contribute to an increased risk of heart failure and may even be protective. No level of alcohol intake was associated with a higher risk of heart failure. However, heavy alcohol use is certainly a risk factor for deaths from any cause.
"The people who were classified as former drinkers at the start of the study had a higher risk of developing heart failure and of death from any cause when compared with abstainers. This could be related to the reasons why they had stopped drinking in the first place, for instance because they had already developed health problems that might have made them more likely to go on to develop heart failure."
The protective effect of moderate drinking were more marginal in women than in men and the authors think this may be due to the fact that women metabolise alcohol in a different way to men and it can affect them differently.
Overall, most participants were abstainers (42%) or former drinkers (19%), with 25% reporting up to seven drinks a week, eight percent reporting seven to 14 drinks a week, and three percent reporting drinking 14-21 and 21 or more drinks a week respectively. Most drinkers also drank more than one type of drink. This meant that the researchers were unable to assess the role of binge drinking or any differences between types of drink.
"It is important to bear in mind that our study shows there is an association between drinking moderate amounts of alcohol and a lower risk of heart failure but this does not necessarily mean that moderate alcohol consumption causes the lowered risk, although we did adjust our results to take account, as far as possible, for a variety of other lifestyle factors that could affect a person's risk," concluded Professor Solomon.
Wine only protects against cardiovascular disease (CVD) in people who exercise, according to results from the In Vino Veritas (IVV) study presented at ESC Congress September 2, 2014 by Professor Milos Taborsky from the Czech Republic.
Professor Taborsky said: "This is the first randomised trial comparing the effects of red and white wine on markers of atherosclerosis (1) in people at mild to moderate risk of CVD. We found that moderate wine drinking was only protective in people who exercised. Red and white wine produced the same results."
Evidence suggesting that mild to moderate consumption of wine protects against cardiovascular disease has been accumulating since the early 1990s. In particular, retrospective studies have found that wine increases levels of HDL, the "good" cholesterol. But until now there has been no long-term, prospective, randomised study comparing the effects of red and white wine on HDL cholesterol and other markers of atherosclerosis.
The IVV study (2) is the first long-term, prospective randomised trial comparing the effect of red and white wine on markers of atherosclerosis. The study included 146 people with mild to moderate risk of cardiovascular disease according to the HeartScore (3). Participants were randomised to one year of moderate consumption of red wine (Pinot Noir) or white wine (Chardonnay-Pinot) from the same year and wine region of the Czech Republic.
Moderate consumption was the World Health Organization definition of 0.2 L for women and 0.3 L for men, a maximum of five times a week. The primary endpoint was the level of HDL cholesterol at one year. Secondary endpoints were levels of other markers of atherosclerosis including LDL cholesterol. Participants consumed their usual diet.
Participants kept a logbook on their consumption of wine and other alcoholic beverages, medication use, and amount and type of exercise. They were required to return the corks from the wine bottles to confirm that they had drank the wine rather than sold it.
The researchers found that there was no difference between HDL cholesterol levels at the beginning of the study compared to one year in either the red or white wine groups. LDL cholesterol was lower in both groups at one year while total cholesterol was lower only in the red wine group.
Professor Taborsky said: "A rise in HDL cholesterol is the main indication of a protective effect against CVD, therefore we can conclude that neither red or white wine had any impact on study participants as a whole."
He added: "The only positive and continuous result was in the subgroup of patients who took more exercise, which means regular exercise at least twice a week, plus the wine consumption. In this group HDL cholesterol increased and LDL and total cholesterol decreased in the red and white wine groups. There may be some synergy between the low dose of ethyl alcohol in wine and exercise which is protective against CVD."
He continued: "In a future study we will compare the effects of red and white wine on markers of atherosclerosis in patients at high risk for CVD who take statins and do regular exercise. We hope to find that moderate wine consumption is safe in these patients."
Professor Taborsky concluded: "Our current study shows that the combination of moderate wine drinking plus regular exercise improves markers of atherosclerosis, suggesting that this combination is protective against cardiovascular disease."
Wine and heart health
The National Institute of Health:
Studies have shown that adults who drink light to moderate amounts of alcohol may be less likely to develop heart disease than those who do not drink at all or are heavy drinkers. Persons who do not drink alcohol should not start just because they want to avoid developing heart disease.
There is a fine line between healthy drinking and risky drinking. It is not recommended that you begin drinking or drink more often just to lower your risk of heart disease.
Health care providers recommend that if you drink alcohol, drink only light to moderate amounts:
· For men, limit alcohol to 1 to 2 drinks a day.
· For women, limit alcohol to 1 drink a day.
One drink is defined as:
· 4 ounces of wine
· 12 ounces of beer
· 1½ ounces of 80-proof spirits
· 1 ounce of 100-proof spirits
Heavier drinking can harm the heart and liver. Heart disease is the leading cause of death in people who abuse alcohol.
Alcohol may help the heart when used in light to moderate amounts:
· Increases the amount of HDL ("good") cholesterol
· Decreases the chance of forming clots in blood vessels
· Decreases inflammation
- Increases antioxidant activity (red wine contains antioxidants called flavonoids)
Alcohol In Moderation Lowers Risk Of Second Heart Attack
The online issue of the European Heart Journal reports that a study of almost 2,000 American men has demonstrated that men who survived a first heart attack and who consume alcohol in moderation have a lower risk of dying from heart disease or any other cause than non-drinkers.
The latest results from the US Health Professionals Follow-up Study, a prospective study of 51,529 US male health professionals, demonstrates that the any-cause mortality risk for men who survived a first heart attack and who consumed about two alcoholic drinks daily over an extended period of time was 14% lower, and the risk of dying from cardiovascular disease was 42% lower than in men who did not consume alcohol.
First author, Dr. Jennifer Pai, assistant professor of medicine at Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and a research associate at Harvard School of Public Health, declared:
"Our findings clearly demonstrate that long-term moderate alcohol consumption among men who survived a heart attack was associated with a reduced risk of total and cardiovascular mortality. We also found that among men who consumed moderate amounts of alcohol prior to a heart attack, those who continued to consume alcohol 'in moderation' afterwards also had better long term prognosis."
Scientists know that amongst the healthy population, moderate alcohol consumption is linked to a lower risk of heart disease and death; however, whether the same applies to people with established heart disease is not known. There have been no prospective studies until now that measured alcohol consumption both before and after a heart attack, with long-term follow-up.
Dr. Pai and her team assessed a subset of 1,818 men in the Health Professionals Follow-up Study who survived a first heart attack between 1986 and 2006 and followed up 20 years from the time of their heart attack. 468 men died during the study period.
Every two years, the participants completed a survey regarding their lifestyle and medical factors, including their body mass index, their smoking habits, etc. and every four years they were surveyed regarding their alcohol consumption of beer, red wine and spirits and their diet.
A standard portion was defined as a 4oz or 125 ml of wine, which contains 11g of ethanol, i.e. the alcohol in the drink, a bottle or can of beer that contains 12.8g of ethanol, or a shot of spirits, which contains 14g of ethanol.
The men were categorized into four groups based on their daily alcohol intake, for instance 0g, 0.1-9.9g, 10-29.9g, and 30g or more. Between 10 to 29.9g of alcohol per day, i.e. the equivalent of about two drinks was classed as "moderate" drinking.
After adjusting for various variables, including smoking, body mass index, age and medical history, the researchers discovered that men who consumed about two alcoholic drinks per day following their first heart attack had a lower any-cause mortality risk as compared with non-drinkers, regardless of the type of drink they consumed.
The researchers examined the participants' alcohol consumption before and after the heart attack and discovered that the majority of men had not changed their drinking habits, and those who drank alcohol before and after their heart attack were more likely to have a lower risk of death compared with those who drank no alcohol. The researchers note, however, that the results were statistically not important because of the smaller numbers in their analysis.
They also observed a "U" shape in the results that demonstrated that participants' who drank 30g or more alcohol daily had a similar any-cause mortality risk to that of non-drinkers.
Dr. Pai explains:
"The adverse health effects of heavy drinking are well known, and include high blood pressure, reduced heart function and reduced ability to break down blood clots. In addition, other studies have shown that any benefits from light drinking are entirely eliminated after episodes of binge drinking.
Our results, showing the greatest benefit among moderate drinkers and a suggestion of excess mortality among men who consumed more than two drinks a day after a heart attack, emphasize the importance of alcohol in moderation."
She continued, saying:
"The findings of our study support the European Society of Cardiology recommended guidelines for long-term management of acute coronary syndromes that moderate alcohol consumption of 10-30 grams per day in men should not be discouraged and may be beneficial for long-term prognosis after a heart attack.
If the men were already consuming moderate amounts, then it may be beneficial to continue consuming moderate amounts of alcohol after a myocardial infarction. However, because excessive alcohol intake is harmful, we recommend that patients discuss drinking alcohol in moderation with their physicians to individually assess their risks and potential benefits."
The researchers are aware of the study's limitations, for instance, the fact that surveys reporting alcohol intake may include measurement errors, as well as treatments of heart attacks having changed in the last two decades, and that the findings only relate to drinking in men, although they do not believe that these factors affect the result's validity.
Dr. Pai concluded:
"Our study was only among men, so we cannot extrapolate to women. However, in all other cases of alcohol and chronic disease, associations are similar except at lower quantities for women. Thus, an association is likely to be observed at 5-14.9g per day, or up to a drink a day for women."
Light-to-moderate alcohol consumption=lower stroke risk in women
According to new research from Brigham and Women's Hospital (BWH), light-to-moderate alcohol consumption was associated with a lower risk of stroke in women.
The study was published on March 8, 2012 in Stroke, a journal of the American Heart Association (AHA).
Monik Jimenez ScD, BWH Department of Medicine, examined data from 83,578 female participants in the Nurses' Health Study. They looked at data of women who had no evidence of cardiovascular disease or cancer at baseline and followed them for up to 26 years. Participants provided information on diet, including self-reported alcohol consumption, lifestyle factors and stroke events.
There were 2,171 incidents of stroke: 1,206 were ischemic strokes, 363 hemorrhagic strokes, and 602 were of an unknown or probable type. An ischemic stroke occurs when blood flow to the brain is blocked. A hemorrhagic stroke occurs when a blood vessel bursts in the brain.
Approximately 30 percent of women reported that they never drank alcohol, 35 percent reported very low levels of consumption, 37 percent drank moderately, and only 11 percent of women reported drinking more than the equivalent of one mixed drink per day on average.
In the study, low consumption was considered less than 4.9 grams daily (less than 1/2 glass of wine per day). Moderate consumption was considered 5 to 14.9 grams daily (1/2 to 1 1/2 glasses of wine, one serving of a mixed drink, or one beer).
After analyzing the data, the researchers saw that women who consumed low to moderate amounts of alcohol had a lower risk of total stroke compared to women who never drank. Higher levels of alcohol intake were not associated with reduced risk of stroke.
The researchers speculate on several scenarios that may explain alcohol's ability to reduce stroke risk. Alcohol may have components to prevent blood clots and cholesterol from building up in the arteries, both of which can lead to stroke. Higher levels of alcohol intake may increase the risk of high blood pressure and atrial fibrillation which are risk factors for stroke.
The study's findings support the public health message issued by AHA regarding alcohol consumption. AHA recommends that women and men who consume alcohol should do so in moderation. This means one drink per day for women and one to two drinks per day for men. The AHA defines one drink as: one 12-ounce beer, 4 ounces of wine, 11/2 ounces of 80-proof spirits, or 1 ounce of 100-proof spirits. Also, in light of the study findings, AHA cautions that people who abstain from alcohol should not start drinking due to the dangers associated with it (e.g., alcoholism).
Ischaemic Stroke Risk Lowest for Moderate Alcohol Consumption
Consuming alcohol more frequently than twice a week increases the risk of stroke mortality in men, according to a study carried out at the University of Eastern Finland. The results show that the effects of alcohol are not limited to the amount consumed, but also the frequency of drinking matters. The results were published in Acta Neurologica Scandinavica.
Excessive consumption of alcohol is associated with a variety of different diseases. The relationship between alcohol consumption and ischaemic stroke shows a J curve pattern, which means that in people who are moderate consumers of alcohol, the risk of stroke is the lowest, while heavy consumption of alcohol increases the risk of stroke.
The risk of cerebral haemorrhage increases linearly as the consumption of alcohol increases: the higher the amount of alcohol consumed, the higher the risk of stroke. In addition to alcohol, other significant risk factors for stroke include elevated blood pressure, coronary artery disease, heart failure, atrial fibrillation, diabetes, smoking, overweight, asymptomatic carotid artery stenosis, and elevated cholesterol levels.
The study showed that people who consume alcohol more frequently than twice a week have over a threefold risk of stroke mortality than people who do not consume alcohol at all. The risk of stroke mortality is elevated irrespective of the amount of alcohol consumed.
The study is based on follow-up data from the Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD. At the onset of the study, the men participating in the study were middle-aged, and the follow-up time was 20 years. A total of 2,609 men participated in the study.
The consumption of alcohol was measured with the help of a Nordic alcohol survey charting the amount of alcohol consumed at one time and the average number of drinking occasions in the preceding 12 months. The data on cases of stroke was obtained from hospital discharge registers, the Finnish Stroke Register, and the National Cause of Death Register maintained by Statistics Finland.
Moderate drinking and cardiovascular health: beer
Beer could stand up alongside wine regarding positive effects on cardiovascular health. This is the conclusion of a study conducted by Research Laboratories at the Fondazione di Ricerca e Cura "Giovanni Paolo II", in Campobasso, Italy. Both for wine and beer the key is moderate and regular drinking.
The research, published online by the European Journal of Epidemiology, using the statistic approach of meta-analysis, pooled different scientific studies conducted worldwide in previous years to achieve a general result. This way it has been possible to examine data concerning over 200,000 people, for whom alcohol drinking habits were associated with cardiovascular disease.
Results confirm what was already known about wine: a moderate consumption (approximately two glasses per day for men and one for women) can lower the risk of cardiovascular disease, up to 31% less when comparing to non drinkers. What this research adds are new data on beer. For the first time, in fact, evidence about dose-dependent effect is shown for this beverage. Maximum protection is observed, for a beer containing 5% of alcohol, with a consumption of slightly more than an English pint a day.
"In our research – explains Simona Costanzo, first author of the paper - we considered wine and beer separately: you first observe a reduction in cardiovascular risk with low to moderate drinking. Then, with an increasing consumption, you can see that the advantage disappears, until the risk gets higher. The interesting part of our research is that, among the studies selected for this meta-analysis, there were 12 in which wine and beer consumption could be compared directly. Using these data we were able to observe that the risk curves for the two beverages are closely overlapping".
But beer as well as wine, drinkers, should be cautious before toasting too much at these results. "What we are talking about – says Augusto Di Castelnuovo, head of the Statistic Unit of Research Laboratories and a pioneer in alcohol epidemiological studies - is moderate and regular drinking. I think we will never stress enough this concept. Wine or beer are part of a lifestyle. One glass can pair with healthy foods, eaten at proper time, maybe together with family of friends. There is no place for binge drinking or any other form of heavy consumption.
"The data reported in our meta-analysis – Di Castelnuovo emphasizes- cannot be extrapolated to everybody. In young women still in their fertile age, as an example, alcohol can slightly raise the risk for some kind of cancer. This could counterbalance the positive effect on cardiovascular disease and reduce the overall benefit of alcoholic beverages on health".
In the similarity between wine and beer regarding positive effects on cardiovascular health there is a still unanswered question: the evidence we are observing derives from alcohol alone or from other substances contained in beverages? Wine and beer are different in composition, except for alcohol, so we could think this is the main player. But they both contain polyphenols, albeit different ones. Researchers at Fondazione "Giovanni Paolo II" underline how this is something to look at more closely in the future.
"A research like this - comments Giovanni de Gaetano, director of Research Laboratories at Fondazione "Giovanni Paolo II" – is part of a concept that our group strongly pursues: to look at people's real life. Health and disease are conditions deriving from our lifestyle. New therapies, new drugs, are extremely important. But a healthy life, with a strong attitude toward prevention, is the key element of the medicine in the years to come".
Reduction in risk of coronary heart disease from alcohol consumption
In a prospective, observational study of approximately 150,000 Norwegians, the investigators found that alcohol consumption was associated with a large decrease in the risk of death from coronary artery disease. For men, the fully adjusted hazard ratio for cardiac death was 0.52 (in other words, only about 1/2 the risk of dying) when comparing subjects reporting more than one drink/week in comparison with those reporting never or rarely drinking; for women, it was 0.62 (only about 3/5 the risk of dying). There was little change in the hazard ratio when HDL-cholesterol (HDL) was added to the model, suggesting that very little of the lower risk of heart disease was due to an increase in HDL from alcohol consumption.
Forum members considered this a well-done analysis. They were surprised at the very low amounts of alcohol intake reported by the subjects, with only 16% of males and about 8% of females reporting more than one drink/week. It is possible that the low levels of drinking, or perhaps over-adjustment in the multivariable analysis, led to the lack of effect of HDL. Most other studies have shown a much larger proportion of the effect of alcohol on heart disease risk to be associated with an increase in HDL.
Lower risk of coronary heart disease from alcohol
An analysis assessesd the 12-month prevalence of coronary heart disease (CHD) in individuals according to their category of alcohol use. The 2001 National Epidemiologic Survey on Alcohol and Related Conditions study (the NESARC study, n = 43,093) identified 16,147 abstinent individuals, 15,884 moderate consumers, 9,578 hazardous drinkers — defined as exceeding sex-specific weekly limits established by the World Health Organization, and 1,484 alcohol-dependent subjects. Diagnoses were generated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version.
Both moderate and hazardous drinking were associated with decreased odds of CHD when compared with abstinence, whereas odds of CHD were not significantly different between alcohol-dependent and abstinent participants. A moderate or even a hazardous consumption of alcohol was associated with a decreased likelihood of CHD after controlling for socio-demographic, psychiatric, and addictive risk factors. The study shows that alcohol may have cardio-protective effects not only in moderate drinkers, but also in individuals with patterns of use traditionally considered as hazardous.
Effects of alcohol on risk factors for cardiovascular disease
A summary paper on the effects of alcohol consumption on biologic mechanisms associated with coronary heart disease provides an excellent review of a large number of intervention studies in humans. Appropriate analyses were done and the results are presented in a very clear fashion, although there was little discussion of the separate, independent effects of alcohol and polyphenols on risk factors.
The trials the authors reviewed have demonstrated that the moderate intake of alcoholic beverages leads to increases in HDL-cholesterol (good cholesterol), apolipoprotein A1, and adiponectin and decreases in fibrinogen, all factors associated with a lower risk of heart disease. The findings described in this paper strengthen the case for a causal link between alcohol intake and a reduced risk of coronary heart disease, suggesting that the lower risk of heart disease observed among moderate drinkers is caused by the alcoholic beverage itself, and not by other associated lifestyle factors.
The reviewers independently selected studies that examined adults without known cardiovascular disease and that compared fasting levels of specific biological markers associated with coronary heart disease after alcohol use with those after a period of no alcohol use (controls). A total of 4,690 articles were screened for eligibility, the full texts of 124 studies reviewed, and 63 relevant articles selected. Of 63 eligible studies, 44 on 13 biomarkers were meta-analysed in fixed or random effects models. Quality was assessed by sensitivity analysis of studies grouped by design. Analyses were stratified by type of beverage (wine, beer, spirits).
The authors concluded that favourable changes in several cardiovascular biomarkers (higher levels of high density lipoprotein cholesterol and adiponectin and lower levels of fibrinogen) provide indirect pathophysiological support for a protective effect of moderate alcohol use on coronary heart disease.
Drinking Alcohol in Moderation Protects Against Heart Disease
Individuals who drink alcohol in moderation (about one drink a day or less) are 14-25% less likely to develop heart disease compared to those who drink no alcohol at all, finds research led by Professor William Ghali from the University of Calgary, published online in the British Medical Journal.
The first paper, led by Paul Ronksley from the University of Calgary, emphasizes that a balance needs to be found between the public health message that consuming large amounts of alcohol is bad for you, and the one that drinking in moderation can have health benefits.
An accompanying paper led by Dr Susan Brien, also from the University of Calgary, finds that moderate consumption of alcohol (up to one drink or 15 g alcohol per day for women and up to two drinks or 30 g alcohol per day for men) is good for health. They say moderate amounts of alcohol significantly increase the levels of 'good' cholesterol circulating in the body and this has a protective effect against heart disease.
Brien and colleagues argue that their study strengthens the case that there is a causal link between alcohol consumption and reduced heart disease.
The authors of both papers acknowledge that a number of previous studies have concluded that moderate alcohol consumption has been associated with a decrease in heart disease. However, they say that the research was out-of-date and there was a need for new material. Professor Ghali says his team's research is the most comprehensive to date.
Ghali and colleagues reviewed 84 studies of alcohol consumption and heart disease. They compared alcohol drinkers with non-drinkers and their outcomes in relation to heart disease, death from heart disease, incidences of stroke and death from having a stroke.
In the companion study, Brien and colleagues reviewed 63 studies and investigated alcohol consumption with known physical markers for heart disease such as cholesterol, levels of inflammation, fat cells and the condition of blood vessels. They also assessed the impact of the type of alcohol consumed (wine, beer and spirits).
Interestingly, Brien's research concludes that it is the alcohol content that provides the health benefits not the type of alcoholic beverage (wine, beer or spirits) that is drunk.
Professor Ghali concludes that the debate between the impact of alcohol on heart disease should now centre "on how to integrate this evidence into clinical practice and public health messages.
Alcohol in moderation is good for sick hearts too
A study by the Catholic University of Campobasso, Italy, shows that a regular and moderate alcohol consumption is beneficial for people who had a previous heart attack or other ischemic vascular events
It was still an open question in medicine. Whereas scientific research has shown beneficial effects of moderate alcohol consumption in healthy people, it was not clear whether this could be valid also for patients who already had heart attack, stroke or another ischemic vascular event. A positive answer comes now from a study performed by the Research Laboratories at the Catholic University of Campobasso, Italy: moderate consumption, defined as one or two glasses of wine a day or the equivalent amounts of beer or other alcoholic beverages, significantly reduces the risk of death from any cause in those who already suffered from ischemic vascular disease.
The research, published in the Journal of the American College of Cardiology (JACC), was performed using the statistic procedure of meta-analysis which allows to combine different studies conducted worldwide to achieve more precise results. Researchers analyzed the most important scientific studies performed during the last years. Eight in total in four Countries: United States, Sweden, Japan and Great Britain. Each study took into account patients already affected by an ischemic vascular event. During the years following the disease onset, patients were followed by researchers to know which were the lifestyle habits, including alcohol consumption, able to avoid a new clinical event. The meta-analysis allowed to pool all those studies for a total of 16,351 people examined.
"We observed – says Simona Costanzo, epidemiologist and first author of the study – that regular and moderate consumption has beneficial effects even for people already affected by heart attack, or stroke. Not only they are less likely to be affected by similar diseases again, but all-cause mortality too resulted to be lower than in those who did not consume any alcoholic beverage".
The effect is very similar to that observed in healthy people. "Risk reduction - Costanzo argues - is about 20%. This means that one event out of five can be spared. It is a huge advantage, comparable to the one already recorded for healthy individuals".
"Studied by our research group for a long time – says Augusto Di Castelnuovo, Head of the Statistic Unit at the Research Laboratories of the Catholic University in Campobasso and co-author of the study - the beneficial effects of moderate alcohol consumption in healthy people are well established. Now we have reason to believe that alcoholic beverages work by the same protective mechanisms also for people already affected by ischemic vascular diseases".
But, as all researches state, the key word is moderation. "When we talk about moderate alcohol consumption, we mean something quite far from what we use to see in TV fictions – says Licia Iacoviello, Head of the Laboratory of Environmental and Genetic Epidemiology and responsible of the Moli-sani Project – We refer to moderation as drinking regularly, at low doses, within a healthy lifestyle, such as the Mediterranean diet. A glass of wine or beer during meals has always been an integral part of the Mediterranean way of eating. Our research highlights another crucial issue: drinking has not only to be moderate, but also regular. A moderate consumption spread along the week is positive. The same amount of weekly alcohol, concentrated in a couple of days is definitely harmful".
"Despite these new positive results- argues Giovanni de Gaetano, Director of the Research Laboratories - we do believe that teetotallers, either healthy or ill, should not start drinking with the aim to earn more health. Our study, as those conducted by our group in the past, is not a kind of invitation to start drinking, but the recognition of a particular lifestyle. This time we need to be cautious since we deal with sick people. We recommend to them to discuss with their own doctor the best choice in terms of alcoholic beverage consumption".
Champagne Is Good for Your Heart
Research from the University of Reading suggests that two glasses of champagne a day may be good for your heart and circulation. The researchers have found that drinking champagne wine daily in moderate amounts causes improvements in the way blood vessels function.
Champagne does this by increasing the availability of nitric oxide, a vascular active molecule which controls blood pressure. It is able to induce these effects because it contains polyphenols, plant chemicals from the red grapes and white grapes used in champagne production.
When you drink champagne, these polyphenols get absorbed into the circulation where they are able to act on the vascular system. Specifically, they appear to slow down the natural removal of nitric oxide from our blood, meaning that it will have a longer time to act on blood vessels and so improve the flow of blood around the body.
High nitric oxide levels in the blood, as a result of drinking champagne, can have beneficial effects, because as well as increasing blood flow, it may help to decrease both blood pressure and the likelihood of blood clots forming. This could therefore reduce the risks of suffering from cardiovascular disease and stroke, but more research needs to be done to determine the long term effects of daily champagne consumption.
Dr Jeremy Spencer, from the Department of Food and Nutritional Sciences said: "Our research has shown that drinking around two glasses of champagne can have beneficial effects on the way blood vessels function, in a similar way to that observed with red wine. We always encourage a responsible approach to alcohol consumption, but the fact that drinking champagne has the potential to reduce the risks of suffering from cardiovascular diseases such as heart disease and stroke, is very exciting news."
Light to moderate drinking and socialization are jointly good for cardiovascular health
While heavy drinking is associated with a greater risk of stroke, light-to-moderate drinking has been linked to a lesser risk of ischemic stroke and coronary heart disease. Other studies have shown that more social support is linked to less risk of mortality and cardiovascular disease. A Japanese examination of the effects of social support on the relationship between drinking and cardiovascular disease has found that the health benefits of light-to-moderate drinking are more pronounced in men with greater social support.
Results were published in the June, 2009 issue of Alcoholism: Clinical & Experimental Research.
"In Japan, drinking is divided into two main patterns," said Hiroyasu Iso, a professor of public health at Osaka University and corresponding author for the study. "One pattern is drinking alone and/or with family at home during the evening. Another pattern – especially for middle-aged business men – is social drinking with co-workers, friends, and neighbors. Social drinking is common."
"Alcohol can play a key role," concurred Takeshi Tanigawa, a professor in the department of public health at Ehime University Graduate School of Medicine, "for socializing as well as some business discussions. In urban areas, alcohol consumption is often used as a business tool. In rural areas, people often have a drink with classmates and people in the same community. Alcohol consumption can be used to maintain human relationships between father and son, senior and junior, community to community. Collectively, these socializing customs may help to create a stress-free space for those persons surrounded by dozens of stresses, especially in the workplace."
"Prior to our research," said Iso, "no study had examined whether psychosocial factors modify the association between alcohol consumption and risks of stroke and coronary heart disease."
Iso and his colleagues examined 19,356 men 40 to 69 years of age who were enrolled in the Japan Public Health Center-based Prospective Study. Their alcohol consumption was classified into seven categories: never, past, occasional, 1-149, 150-299, 300-449, or ≥450 grams/week. Measures used were alcohol consumption, risk of cardiovascular disease, and social support.
"We found the reduced risks of total stroke, ischemic stroke, and total cardiovascular disease associated with light-to-moderate drinking were more pronounced in men with high social support, probably due to avoidance of unhealthy behaviors and enhancement of stress buffering," said Iso. "In our study, compared with light-to-moderate drinkers with high social support, those with low social support had more unhealthy lifestyles such as physical inactivity, no job and fewer opportunities for medical checkups. Also, a potential pathway by which poor social support may lead to cardiovascular disease is mental stress. Mental stress activates neuro-endocrine components, including the hypothalamic-pituitary-adrenal-axis and autonomic nervous system, which lead to an increased risk of cardiovascular disease."
"In short," said Tanigawa, "moderate to light alcohol consumption with high social support is good for your health. Drinking with a good friend appropriately makes you feel happy and healthy. So drink with good friends for health," he advised. Tanigawa also recommended karaoke bars as one way for business persons to cope with stress. "Singers use deep breathing, which is good for the parasympathetic nervous system. After singing, they usually receive applause. It is a good kind of social support, and helps in the face of adverse occasions or stressful events."
Iso agreed that moderate alcohol consumption and socialization is good for one's health. "But remember that this beneficial effect of social support is confined to light-to-moderate drinking," he said. "Heavy drinking is risky irrespective of social support level. We believe that this also holds for other ethnic populations."
Men who drink alcohol every day have a lower risk of heart disease
Men who drink alcohol every day have a lower risk of heart disease than those who drink less frequently suggests research in the British Medical Journal. It is widely known that moderate drinkers have a lower risk of coronary heart disease than those who abstain, but most research in this field has been done on men and little is known about drinking patterns and risk of heart disease among women.
Researchers in Denmark studied over 50,000 men and women aged 50-65 years who were taking part in a national health study. Details on alcohol intake and drinking frequency over the preceding year were collected, and participants were monitored for an average of 5.7 years.
Coronary heart events were recorded and results were adjusted for known risk factors, such as age, smoking, education, physical activity and diet.
A total of 28,448 women and 25,052 men took part in the study. Women consumed an average of 5.5 alcoholic drinks a week and men consumed 11.3. During the study, 749 women and 1,283 men developed coronary heart disease.
Women who drank alcohol on at least one day a week had a lower risk of coronary heart disease than women who drank alcohol on less than one day a week.
However, risks were similar for drinking on one day a week (36% reduced risk), or seven days a week (35% reduced risk), suggesting that the amount of alcohol consumed is more important than drinking frequency among women.
In contrast, for men, risks were lowest for the most frequent drinkers. For example, men who drank on one day a week had a 7% reduced risk, while men who drank daily had a 41% reduced risk. This suggests that it doesn’t matter how much men drink, as long as they drink every day.
Moderate drinking lowers women's heart attack risk
Women who regularly enjoy an alcoholic drink or two have a significantly lower risk of having a non-fatal heart attack than women who are life-time abstainers, epidemiologists at the University at Buffalo have shown._
Moderation is the key, however. Women in the study who reported being intoxicated at least once a month were nearly three times more likely to suffer a heart attack than abstainers, results showed.
One difference in the protective pattern among drinkers involved those who drank primarily liquor. Women who preferred liquor to wine experienced a borderline increase in risk of heart attack, results showed.
The study is published in the May 2007 issue of the journal Addiction.
"These findings have important implications, because heart disease is the leading cause of death for women," said Joan M. Dorn, Ph.D., associate professor of social and preventive medicine in the UB School of Public Health and Health Professions and first author on the study.
Women seem to have a quicker reaction to a smaller amount of alcohol, she noted: "Overdoing it is harmful, and what is too much depends on each individual. In some women, one drink can cause intoxication."
Moderate alcohol consumption has been shown to lower the risk of heart attack, but most studies have been done with men. The current study compared alcohol drinking volume and drinking patterns of women who had been hospitalized due to a heart attack, with age-matched controls without heart problems.
Alcohol Can Benefit the Hearts of New Drinkers
A Medical University of South Carolina’s (MUSC) Department of Family Medicine study concluded that people who began moderately consuming alcohol in middle-age experience a quick benefit of lower rates of cardiovascular disease morbidity with no change in mortality after four years. In addition, the study found that those who consumed alcohol for the heart health benefits rarely drank more than recommended amounts. The study has been published in the American Journal of Medicine, and was conducted by MUSC’s Dana E. King M.D., Arch G. Mainous III, Ph.D, and Mark E. Geesey.
“Most people are aware that moderate alcohol use can be part of a healthy lifestyle, yet current guidelines caution non-drinkers against starting to drink in middle age,” said King, lead author of the study. “We wanted to evaluate whether adopting moderate alcohol consumption in middle-age would lower cardiovascular risk. We were excited to find that moderate alcohol consumption, or one to six servings a week, lowered cardiovascular risk for our participants.”
In contrast to a recently published study in the British Public Library of Science journal, PLoS Medicine, MUSC’s study showed no increase in blood pressure for participants at moderate consumption levels (two drinks per day or fewer for men, one drink per day or fewer for women) during the four years of the study. New moderate drinkers had a 38% lower chance of developing cardiovascular disease than did their persistently non-drinking counterparts. This difference remained after adjustment for demographic and cardiovascular risk factors.
Alcohol’s impact on heart and stroke risk may differ for men, women
The volume of alcohol consumption may have a significantly different effect on heart and stroke risk in men and women, according to a study of Japanese people published in Stroke: Journal of the American Heart Association.
“An amount of alcohol that may be beneficial for men is not good for women at all,” said Hiroyasu Iso, M.D., co-author of the study and professor of public health at Osaka University in Japan.
Researchers analyzed data from a survey of 34,776 men and 48,906 women (ages 40 to 79) selected from the larger Japan Collaborative Cohort Study (JACC) to determine the association of alcohol use with the risks of stroke and heart disease. Participants who had not experienced cancer, stroke or heart disease before the study completed questionnaires about their lifestyles and medical histories and provided information about their drinking of sake (rice wine), shochu (a type of brandy), beer, whiskey and/or wine.
Researchers calculated the risks and benefits of alcohol consumption after adjusting for age and several other risk factors, including smoking, weight, body mass index, the presence of high blood pressure or diabetes, exercise habits, stress, education and diet.
During a 14.2-year follow-up, 1,628 participants died from stroke and 736 died from heart disease.
Men who reported drinking heavily (at least 46 grams of alcohol per day, equivalent to four or more standard alcoholic beverages) at the time of the survey had a 19 percent lower risk of dying from coronary heart disease than nondrinking men.
In stark contrast, women who drank that much quadrupled their risk of heart disease death over that of nondrinking women. Light drinking (less than 23 grams of alcohol per day, about two drinks a day) reported on the survey was associated with a lower risk of heart disease death in women by 17 percent; while intake between 23 and 46 grams per day was associated with an increased risk of 45 percent.
“In women, we found a slightly reduced risk with light consumption but a much greater risk with heavy alcohol use,” Iso said.
In men, heavy alcohol use was associated with an increased risk of death from all types of stroke by 48 percent. The risk of hemorrhagic stroke (caused by a blood vessel bursting in the brain) was increased 67 percent. The risk of ischemic stroke (caused by a blocked blood vessel in the brain or leading to it) was higher by 35 percent.
In women, heavy alcohol use was associated with a higher risk of stroke death by 92 percent. Hemorrhagic stroke death risk was increased by 61 percent. The risk of ischemic stroke death was increased 2.43 times.
“We expected to find an increased risk of hemorrhagic stroke,” Iso said. “But since alcohol reduces the ability of the blood to clot, we didn’t expect to find the increases in ischemic stroke and coronary heart disease.”
Only 15 percent of women in JACC drank any alcohol, far less than the 45.9 percent of U.S. women who reported using alcohol in 2005, Iso said.
Before this study, evidence suggested that light-to-moderate alcohol consumption might be associated with a lower risk of cardiovascular disease in women. But data on heavy drinking was limited and the question had not been addressed in an Asian country, where both drinking and heart disease are less common.
“One limitation of the study is that, in Japanese culture, there are social restrictions against women drinking as they get older,” Iso said. “In that culture, the women who do drink may have different types of jobs or other aspects of their lifestyle that may help explain the excess risk as well as the alcohol exposure itself.”
Iso said more research could help determine how alcohol affects cardiovascular risk.
The American Heart Association does not recommend drinking wine or other forms of alcohol, since there is clear evidence that alcohol use is associated with injury to the heart in many ways. Instead, the association recommends that people talk to their doctor about lowering their cholesterol and blood pressure, controlling weight, getting enough physical activity and following a healthy diet and quitting smoking. There is no scientific proof that drinking alcoholic beverages can replace these conventional measures.
A little wine boosts omega-3 in the body: Researchers find a novel mechanism for a healthier heart
Results from the European study IMMIDIET show that moderate wine intake is associated with higher levels of omega-3 fatty acids considered as protective against coronary heart disease
Moderate alcohol intake is associated with higher levels of omega-3 fatty acids in plasma and red blood cells. This is the major finding of the European study IMMIDIET published in the American Journal of Clinical Nutrition, an official publication of the American Society for Nutrition and is already available on line (www.ajcn.org ). The study suggests that wine does better than other alcoholic drinks. This effect could be ascribed to compounds other than alcohol itself, representing a key to understand the mechanism lying behind the heart protection observed in moderate wine drinkers.
The IMMIDIET study examined 1,604 citizens from three geographical areas: south-west London in England, Limburg in Belgium and Abruzzo in Italy. Thanks to a close cooperation with General Practitioners of these areas, all participants underwent a comprehensive medical examination, including a one year recall food frequency questionnaire to assess their dietary intake, alcohol consumption included.
Omega-3 fatty acids, mainly derived from fish, are considered as protective against coronary heart disease and sudden cardiac death, thus their high blood concentration is definitely good for our health.
Now European researchers found that moderate alcohol drinking acts like a 'trigger', boosting the amount of omega-3 fatty acids in our body.
"Several studies have shown that moderate alcohol consumption, including wine, is associated with protection against coronary heart disease and ischemic stroke - says Romina di Giuseppe, lead author of the study, from the Research Laboratories at Catholic University of Campobasso - Although the mechanisms are not completely defined, there was some evidence that alcohol intake might influence the metabolism of essential polyunsaturated fatty acids, as omega-3. That is exactly what we found in our population study. People drinking moderate amounts of alcohol, one drink a day for women and two for men, had higher concentration of omega-3 fatty acids in plasma and red blood cells independently of their fish intake".
However important these results appear to be, the best is yet to come. Researchers from Catholic University of Campobasso, in Italy, and from University of Grenoble, in France, turned their attention on the variety of alcoholic beverages consumed in order to see whether the high levels of omega-3 fatty acids detected might be ascribed to alcohol itself or to other substances.
"From our previous studies we know that association between wine drinking and increased concentration of omega-3 fatty acids have been observed – says Michel de Lorgeril, from the University of Grenoble, partner of the IMMIDIET project and co-leader of the study - Nevertheless, it was not possible to separate the effects of wine from those of beer or spirits. Our study of 3 populations with different dietary habits and different consumption of alcoholic beverages types allowed us to explore this aspect.".
"Analysis carried out on different alcoholic beverages –argues Licia Iacoviello coordinator of the IMMIDIET study at Catholic University of Campobasso - showed that the association between alcohol and omega-3 fatty acids was present in both wine drinkers and beer or spirits drinkers. However, the association was stronger between wine drinking and omega-3 fatty acids levels. This suggests that components of wine other than alcohol is associated with omega-3 fatty acids concentration. We may guess this effect can be ascribed to polyphenols".
Polyphenols are naturally occurring compounds contained in a different variety of food and beverages, such as wine. Due to their strong antioxidant activity, they are able to reduce oxidation processes caused by free radicals.
"We consider these data to be a major finding - de Lorgeril concludes - opening a new window in the field of cardiovascular prevention. Beyond the alcohol issue, our results raise crucial questions regarding the effects of polyphenols on lipids (both in blood and cell membranes) and possibly of lipids on polyphenols".
The IMMIDIET study
Funded by the European Union under Key Action 1: Food, Nutrition and Health QLK1-CT-2000-00100, IMMIDIET aims to acquire fundamental knowledge in the field of cardiovascular disease, especially regarding the interaction between genetics and lifestyle.
At the core of the study there is an important episode of Italian migration: Belgium, a country that became the new home for thousands of Italians, mostly from the Abruzzo region, who came to work in the mines. Many of those emigrants didn't come back to Italy but remained in their new country. Some of them married a Belgian partner. Their genes remained the same, of course, but how much "Italy" is still there in their diet? And how much did they transmit it to their spouses? Moreover, how many Italian emigrants assimilate dietary habits of the country in which they were guests? In this framework, the role of genetic factors and lifestyle can be assessed to explore new ways in prevention of cardiovascular diseases.
To carry on the research, married couples have been recruited in three European areas: South-East London in England, Limburg in Belgium and Abruzzo in Italy. In the first phase of the study the couples involved were formed by people from the same area, Italians married with Italians (in the Abruzzo region), Belgians married with Belgians (in the Limburg area) and English married with English (in the South-East part of London)".
The second phase of IMMIDIET recruited mixed Italian–Belgian couples to understand if, acquiring dietary habits from Abruzzo, the Belgian partner changed his own risk regarding heart diseases.
Alcohol & polyphenols in red wine both fight cardiovascular disease
Observational epidemiologic studies relating wine and alcohol to health all suffer from the fact that they, of necessity, compare people who prefer certain beverages, but not the beverages themselves. While there have been many intervention trials in animals, randomized trials in humans are less common. Randomized crossover trials, in which each subject receives all interventions in sequence, can be especially important as they tend to avoid baseline differences among subjects and can detect effects of different interventions with smaller numbers of subjects.
This study published in the American Journal of Clinical Nutrition, included 67 male volunteers in Spain who were considered to be at "high-risk" of cardiovascular disease on the basis of increased BMI, smoking, diabetes, hypertension, or other risk factors. About one half of the individuals were taking ACE inhibitors, statins, aspirin, and/or oral hypoglycemic drugs, so the results of this study may be especially relevant for patients in the real world.
The subjects agreed to not consume any alcohol for a baseline period, then for three one-month periods consumed 30 g/day of alcohol as red wine or as gin, or an equivalent amount of phenolics from dealcoholized red wine. The polyphenol contents of the RW and the DRW interventions were the same. A very high degree of compliance of the subjects with the assigned interventions is evidenced by results of counting numbers of empty bottles of the intervention beverage returned, dietary records, urinary metabolites, etc. Further, there is good evidence that there were no important changes between periods in diet or exercise habits. The effects of each intervention on a large number of adhesion molecules and chemokines that affect inflammation and relate to the development of vascular disease were evaluated.
The key results of the study were that both ethanol and nonalcoholic compounds in red wine have potentially protective effects that may reduce the risk of vascular disease. Specifically, the authors conclude that "the phenolic content of red wine may modulate leukocyte adhesion molecules, whereas both ethanol and polyphenols of red wine may modulate soluble inflammatory mediators in patients at high risk of cardiovascular disease."
Specific comments on the study: Most reviewers considered this to be a well-done, comprehensive study. As one reviewer commented: "This is an excellent paper. The results strongly indicate an effect of wine polyphenols on inflammation (in broad and modern terms) and this is just what we expect from the biochemistry and nutritional effects of fruits and vegetables. The effect of ethanol, on the other hand, likely fits a hormetic mechanism, where low doses regularly supplied are protective while high doses in a single shot are worsening the progression of disease." Another reviewer added: "We need more information on separating the effects of beer, wine, and various types of spirits. Some spirits like brandy and whisky can have useful antioxidant effects, so distinguishing effects among different types of beverages may be informative."
Another Forum reviewer commented: "This is a very interesting paper that goes a way towards answering the question whether it is the alcohol or polyphenols in red wine that confer the health benefits. The trial was well conducted and controlled, with very detailed analyses. It would have been interesting to analyse any changes in conventional risk factors after the interventions. It would also have been interesting in the study to determine the effects on vascular function by, for example, brachial artery activity (flow mediated dilatation)."
Given that the effects of both alcohol and polyphenols on physiologic factors (e.g., platelet function, fibrinolysis) are transient, generally lasting for no more than 24 hours, it was appropriate that the subjects in this study were instructed to consume the intervention substance (RW, gin, DRW) on a daily basis. When drinking is moderate, there is no evidence that having "alcohol-free days" is beneficial to health. Indeed, most epidemiologic studies show better health effects from daily consumption rather than from drinking on a few days per week.
Concerns about the present study: One Forum reviewer stated: "This appears to be a carefully designed and well executed study, but I have four concerns: (1) The study has been undertaken in high-risk individuals, more than half of whom are hypertensive, a quarter dyslipidaemic, and a quarter diabetic. It is not described what happened to the conventional risk factors during the interventions. (For example, any improvement in inflammatory markers may have come at the cost of higher blood pressure with the alcohol interventions.) (2) Was there any weight change that could have confounded any of the outcomes? (3) Both polyphenol and alcohol biomarkers were measured – did the change in these biomarkers correlate with the changes in any of the inflammatory markers; i.e., any suggestion of a dose response relationship? (4) Even though at least 30 outcome variables were assessed, the authors do not describe any correction for multiple comparisons."
Another Forum reviewer: "This is a well conducted study, and adds to our understanding of the potential cardiovascular benefits of alcohol and the non-alcoholic compounds of alcoholic beverages. However, in this study more than one-half of the high-risk subjects consumed drugs with known anti-inflammatory effects, which could be a confounding factor. The anti-inflammatory effects of these pharmaceuticals may be responsible for the beneficial results, and may not be related to the RW, DRW and gin interventions." However, others think that this concern is unlikely to be important since this was a crossover study, and there were no changes in lifestyle or medication use between the intervention periods.
The key results of the study were that both ethanol and nonalcoholic compounds in red wine have potentially protective effects that may reduce the risk of vascular disease. Specifically, the authors conclude that "the phenolic content of red wine may modulate leukocyte adhesion molecules, whereas both ethanol and polyphenols of red wine may modulate soluble inflammatory mediators in patients at high risk of cardiovascular disease." Thus, this study provides important new mechanistic evidence that the reduced risk of cardiovascular disease among red wine drinkers observed in most epidemiologic studies may result from a combination of both the alcohol and the polyphenols in the wine.
Moderate Alcohol Consumption Reduces the Risk of Hypertension for Women, Increases It For Men
Drinking too much alcohol can raise BP to unhealthy levels, especially among men. Moderate amounts of alcohol actually protect women, but not men. The meta-analysis evaluated a total of 16 prospective studies, which included 158,142 men and 314,258 women. Among men, a linear dose–response relationship between alcohol intake and risk of development of hypertension was noted. As compared to non-drinkers, men consuming < 10g/day of alcohol had a relative risk (RR) of 1.006, those consuming 10-20 g/day had a RR of 1.091, and those consuming > 30g/day had a RR of 1.416.
Among women, the meta-analysis indicated protective effects at < 10g/day (RR -0.867) and 10-20g/day (RR – 0.904) of alcohol consumption, while the risk increased in women consuming > 30g/day (RR – 1.188). The risk of hypertension significantly increases with consumption of more than 30g/day in men and women alike.
Note: 30 grams is equal to about 2 5oz. glasses of wine, or 2 12 oz. beers:
12 ounces beer = 153 calories and 13.9 grams alcohol
12 ounces lite beer = 103 calories and 11 grams alcohol
5 ounces wine (red) = 125 calories and 15.6 grams alcohol
5 ounces wine (white) = 121 calories and 15.1 grams alcohol
3 ounces sake = 117 calories and 14.1 grams alcohol
1 1/2 ounces liquor (80 proof or 40% alcohol) = 97 calories and 14 grams alcohol