How Does Alcohol Affect the Heart?
Teasing out the relationship between alcohol consumption and healthy heart function is challenging. The relationship between alcohol consumption and heart disease, especially heart attacks, is controversial and highly debated, which has led to hundreds of scientific studies attempting to better understand whether alcohol is bad for your heart.1
Small amounts of alcohol, especially red wine, are said to be beneficial because they are high in antioxidants like resveratrol. Consuming moderate to large amounts of alcohol can increase your heart rate, blood pressure, and risk of an irregular heartbeat.
Heart disease risk is higher in women for the same amount of alcohol consumed, likely due to body fat distribution, body size, and alcohol solubility.1 However, research suggests that women who consume one to two standard alcoholic drinks daily have a lower risk of cardiovascular disease. Any more than that increases the risk.2,3
Another global study states that no level of alcohol consumption improves health. The small reductions in heart attack risk associated with low levels of alcohol consumption are offset by an increased risk of other health conditions, including cancer.4
Table of Contents
Types of Alcohol and How They Affect Heart Health
The research is pretty clear that consuming more than a moderate amount of alcohol per day, especially in the long term, will increase your risk of heart disease. According to the Centers for Disease Control and Prevention, moderate drinking is defined as one standard drink or none in a day for women and two drinks or fewer per day for men.
A standard drink contains 14 grams (0.6 fluid ounces) of alcohol.
Beer
A standard drink of regular beer is defined as 12 ounces and is usually about 5% alcohol by volume.
Wine
Red wine contains the antioxidant resveratrol, which is associated with a reduction in cholesterol and blood pressure.5 A standard glass of wine is defined as 5 ounces and is typically 12% alcohol by volume.
Spirits
A standard glass of malt liquor is 8 ounces, typically 7% alcohol by volume. A standard shot of distilled spirits is about 1.5 ounces and is typically about 40% alcohol by volume.
Researchers report that a J-shaped risk relationship between alcohol consumption and heart disease is found in all people. Lifetime alcohol abstainers are at increased risk for heart disease, as are people who consume alcohol at a moderate or higher level. The type of alcoholic beverage consumed does not seem to affect heart disease risk.1
Effects of Alcohol on Heart Health
It is important to remember that it is difficult to isolate alcohol consumption alone as a risk factor for heart disease, as other lifestyle factors will also affect risk.
High Blood Pressure (Hypertension)
Blood pressure is the amount of pressure blood puts on the inner wall of blood vessels. Systolic blood pressure (top number) is measured when the heart contracts, and diastolic blood pressure (bottom number) is measured when the heart relaxes.
High blood pressure causes cardiovascular disease by putting unnecessary pressure on the inner walls of blood vessels, leading to damage. Damage to blood vessels can cause a stroke, a heart attack, or an aneurysm, which is an abnormal bulge in the weakened wall of a blood vessel.
Research indicates the relationship between alcohol consumption and blood pressure is causal and reversible. A reduction in alcohol consumption leads to a reduction in blood pressure.6
For every 10 grams of alcohol consumed, blood pressure increases by about 1 mm Hg. After 2 to 4 weeks of abstinence, the effect of alcohol on blood pressure declines to baseline. The relationship between alcohol consumption and blood pressure is the same regardless of the type of alcohol consumed.7
In an analysis of studies that enrolled over 350,000 people from 20 scientific studies, over 90,000 participants had high blood pressure. High blood pressure risk was higher in people who consumed alcohol than in people who did not. The risk for former drinkers declined and was equal to that of people who did not consume alcohol.8
Stroke
Alcohol consumption affects many known risk factors for stroke. Moderate alcohol consumption is associated with an increase in high-density lipoprotein (good cholesterol), improved insulin sensitivity, and decreased levels of inflammatory markers.9 This suggests that low-to-moderate levels of alcohol consumption may reduce stroke risk.
Researchers analyzed 27 medical studies to determine the association between alcohol consumption and three types of strokes:
- Ischemic stroke: A blood clot cuts off blood flow to a section of brain tissue.
- Intracranial hemorrhagic stroke: A weakened blood vessel wall leaks blood into the brain tissue.
- Subarachnoid hemorrhagic stroke: A weakened blood vessel leaks blood onto the brain’s surface.
Researchers found that light and moderate alcohol consumption (2 drinks or fewer) was associated with a reduced risk of ischemic stroke but not a reduced risk of intracranial or subarachnoid hemorrhagic stroke. Heavy alcohol consumption was associated with an increased risk of all stroke types.9
Arrhythmia
Palpitations are the sensation that your heart is flip-flopping or skipping a beat. In some cases, this sensation is due to an abnormality in the heart’s rhythm called an arrhythmia.
Alcohol causes an imbalance in the autonomic nervous system. It increases your body’s “fight-or-flight” response. This is followed by activation of the parasympathetic nervous system to calm things down and restore homeostasis. Activating the parasympathetic nervous system may trigger arrhythmias, such as atrial fibrillation.
High levels of alcohol consumption are associated with abnormal heart rhythms, commonly called holiday heart syndrome.10
Both short-term and long-term alcohol consumption can increase the risk of arrhythmias.11 In one study, researchers demonstrated a causal relationship between acute alcohol intake and atrial fibrillation in patients with the condition.12
Heart failure
Ischemic heart disease, high blood pressure, and cardiomyopathy (changes in heart function due to excessive or weak heart muscle) increase the risk of heart failure. Chronic heavy drinking can weaken heart muscle, leading to a condition called alcoholic cardiomyopathy.
In an analysis of studies that enrolled over 350,000 participants, researchers found that light drinking was associated with a decreased risk of heart failure, but there was an increased risk as alcohol consumption increased above a low level. Heavy drinkers have a substantially increased risk of heart failure.1,13 Former drinkers were also found to have an increased risk of heart failure when compared to lifetime abstainers.13
Cholesterol levels
Light to moderate alcohol consumption is associated with an increase in high-density lipoproteins (HDL, good cholesterol), but heavy drinking can increase low-density lipoproteins (LDL, bad cholesterol), total cholesterol, and triglycerides.
LDL cholesterol is deposited in the inner lining of blood vessels, forming plaques. Cholesterol plaques decrease blood flow to the heart, which can increase the risk of heart attacks.13
Proactively Managing Heart Health
It is important to note that the effects of alcohol on heart health are not the same for all people. Besides monitoring your alcohol consumption, make lifestyle adjustments associated with cardiovascular and heart health improvements.
Eating a balanced diet
For optimal heart health, consume a diet rich in fruits, vegetables, whole grains, lean protein sources, and low-fat dairy products. Diets similar to the Mediterranean diet are associated with a reduced risk for cardiovascular disease. Limit added sugars, highly processed foods, sugary beverages, sodium, saturated fats, refined carbohydrates, and processed meats.
Exercising regularly
Overweight and obesity are associated with an increased risk of heart disease. Exercise can reduce stress and blood pressure and strengthen heart and respiratory muscles.
- Engage in regular aerobic exercise, such as brisk walking, jogging, swimming, or cycling. Aim for at least 150 minutes of moderate-intensity exercise per week.
- Incorporate strength-training exercises to improve muscle tone and metabolism at least twice per week.
- Incorporate movement throughout your day. Long stretches of sitting increase your risk for cardiovascular disease.
Limiting sodium intake
Excessive sodium intake can increase your risk of high blood pressure. Increased blood pressure is a major risk factor for heart disease and stroke. Try to limit your sodium intake to no more than 2,300 milligrams per day. Restaurant and processed foods are typically very high in sodium.
Maintaining healthy cholesterol levels
Choosing a healthy diet, exercising regularly, monitoring alcohol consumption, and maintaining a healthy weight can help maintain healthy cholesterol levels.
Current guidelines for cholesterol suggest the following healthy cholesterol levels:
- Total cholesterol: ideal is about 150 mg/dL, upper limit is 200 mg/dL
- LDL cholesterol: optimal 100 mg/dL, high above 160 mg/dL
- HDL cholesterol: 40 mg/dL (1 mmol/L) or higher in men and 50 mg/dL (1.3 mmol/L) or higher in women
Avoiding unhealthy behaviors (smoking, excessive drinking)
If you are concerned about your alcohol consumption or have other risk factors for heart disease, such as being a smoker or carrying excess weight, contact a doctor on call on the TelegraMD platform to discuss smoking cessation or obesity treatment options.
Telehealth doctors are available 24 hours a day to provide an online diagnosis and individualized guidance on how to improve your heart health and reduce any risk factors you may have for heart disease.
If you have been diagnosed with high cholesterol or high blood pressure, TelegraMD doctors can review your medical history and write online prescriptions that are transmitted to your local pharmacy. You may find that telehealth is a better alternative to costly in-person doctor visits.
Disclaimer
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
References
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3. Kwo PY, Ramchandani VA, O’Connor S, Amann D, Carr LG, Sandrasegaran K, Kopecky KK, Li TK. Gender differences in alcohol metabolism: relationship to liver volume and effect of adjusting for body mass. Gastroenterology. 1998 Dec;115(6):1552-7. doi: 10.1016/s0016-5085(98)70035-6. PMID: 9834284.
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8. Roerecke M., Tobe S.W., Kaczorowski J., Bacon S.L., Vafaei A., Hasan O.S.M., Krishnan R.J., Raifu A.O., Rehm J. Sex-Specific Associations Between Alcohol. Consumption and Incidence of Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies. J. Am. Heart Assoc. 2018;7 doi: 10.1161/JAHA.117.008202.
9. Larsson, S. C., Wallin, A., Wolk, A., & Markus, H. S.. (2016). Differing association of alcohol consumption with different stroke types: a systematic review and meta-analysis. BMC Medicine, 14(1). https://doi.org/10.1186/s12916-016-0721-4
10. Samokhvalov AV, Irving HM, Rehm J. Alcohol consumption as a risk factor for atrial fibrillation: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil. 2010 Dec;17(6):706-12. doi: 10.1097/HJR.0b013e32833a1947. PMID: 21461366; PMCID: PMC3065072.
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