I. Alcohol and Coronary Heart Disease II. Alcohol and Hypertension
III. Alcohol and Heart Failure
IV. Alcohol and Cardiomyopathy
V. Alcohol and Abnormal Heart Rhythms and Abnormal Electrocardiograms
VI. Alcohol and Coagulation Factors and Stroke VII. Type of Alcohol Consumption VIII. Perspective
GLOSSARY

arrhythmia general term for an irregularity or rapidity of the
heartbeat, an abnormal heart rhythm. cardiomyopathy heart muscle disease. cardioprotection protection of the heart from serious events
that include coronary artery disease and its complications,
angina, myocardial infarction and heart failure. HDL cholesterol high density lipid; the good cholesterol. heart failure a failure of the heart to pump sufficient blood
from the chambers into the aorta; inadequate supply of blood
reaches organs and tissues. hypercholesterolemia high levels of cholesterol in the blood.

• I. ALCOHOL AND CORONARY HEART DISEASE
  The regular consumption of small quantities of alcohol — two drinks per day for men and one drink per day for women — appears to be associated with lower rates of cardiovascular events in most studies. These studies, however, do not have sound methodology. In most of these epidemiologic studies actual mortality rates are not stated and mainly relative risks are described.
• II. ALCOHOL AND HYPERTENSION
  One drink daily does not significantly alter systolic blood pressure. Three or more drinks, however, may increase systolic blood pressure significantly in hypertensive individuals.
• III. ALCOHOL AND HEART FAILURE
  More than 4 oz of alcohol causes the heart muscle to pump less forcefully. Eight ounces of gin given to normal healthy students caused a 33% reduction in the amount of blood ejected from the left ventricle into the arteries.
• IV. ALCOHOL AND CARDIOMYOPATHY A. Susceptibility and Pathogenesis
  Fortunately, only in susceptible individuals does more than about four drinks six days per week for five to ten years result in damage to the heart muscle. This condition is called alcoholic cardiomyopathy. (See the chapter Heart Failure for information regarding reversible temporary cardiac muscle dysfunction versus permanent damage.) With cardiomyopathy, the heart becomes dilated and the muscle becomes flabby. Dilated cardiomyopathy is an important cause of heart failure. This is a disease of unknown cause where the heart muscle becomes swollen and enlarged and heart failure becomes severe. Genetic predisposition and viral infections may play a role, but approximately one-third of all cases of dilated cardio-myopathy is caused by excessive alcohol consumption (see the chapter, Cardiomyopathy).
• V. ALCOHOL AND ABNORMAL HEART
  RHYTHMS AND ABNORMAL
• VI. ALCOHOL AND COAGULATION FACTORS AND STROKE
  Alcohol consumption is associated with an increased incidence of hemorrhagic stroke. Alcohol consumption alters coagulation factors as outlined above in the analysis of the Framingham study.
• VII. TYPE OF ALCOHOL CONSUMPTION A. Red Wine versus White Wine
  Mild alcohol consumption causes a modest reduction in cardiovascular events. There has been considerable contro¬versy, however, regarding what type of alcoholic beverages provides the greatest cardioprotection. Studies of the French population indicate that wine, particularly red wine, offers greater protection. Studies in the UK and other countries indicate that beer is as good or even slightly better. Studies in the United States indicate that spirits are as good as wine.
• VIII. PERSPECTIVE
  The evidence that alcohol consumption is significantly cardioprotective is growing but inconclusive. If one or two drinks daily provides some beneficial effects, then these effects are modest. Most important, only those at higher risk for coronary heart disease may benefit. Thus individuals aged 20–40 should not use alcohol for cardioprotection, because these individuals are at low risk for heart disease. Individuals from age 40 to 80 with a strong family history of heart attack before age 60 and presence of hypertension or diabetes may obtain some protection, but studies have not provided a clear analysis. In any event the protection is expected to be approximately 10% risk reduction versus approximately 33% with use of statins to lower LDL cholesterol levels. It is noteworthy that trials on antioxidants such as beta-carotene have been shown to be noncardioprotective. The antioxidants in alcohol are unlikely to be sufficiently protective for individuals at high risk. Individuals at risks for coronary heart disease are advised to take medications that have been shown in randomized clinical trials (RCTs) to decrease mortality and cardiac events and not to rely on alcohol or herbal remedies that offer modest protection, if any at all.
• BIBLIOGRAPHY
  Appeldoorn, C. C. M., Bonnefoy, A., Lutters, B. C. H. et al. Gallic acid

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