Ethyl alcohol is a colorless, volatile, pungent liquid. It’s the intoxicating element of whiskey, wine, beer and other fermented or distilled liquors.
Different beverages contain different amounts of ethyl alcohol. Consequently, a standard has been set for the quantity of ethyl alcohol in various drinks. In general, a 12-ounce bottle of beer containing 4% alcohol by volume (some craft beer can range up to 9% in alcohol by volume), a 4-ounce glass of wine, and a 1.5-ounce shot of 80-proof spirits all contain the same amount of ethyl alcohol (one half ounce). Each of these is considered a "drink equivalent."
The relation between alcohol and cardiovascular disease is complex, and there is a well-known association of heavy alcohol consumption with a large number of health risks. Any advice about consuming alcohol must balance these two considerations. One approach is to recommend not consuming any alcohol at all. However, a large number of observational studies have consistently demonstrated a reduction in coronary heart disease with moderate alcohol consumption. Prohibiting alcohol consumption would deny a potentially sizable health benefit to people who would otherwise choose to drink.
If you drink alcohol, do so in moderation. This means an average of one to two drinks per day for men and one drink per day for women. (Again, a drink is one 12-ounce beer, 4 ounces of wine, 1.5 ounces of 80-proof spirits or 1 ounce of 100-proof spirits.) Drinking more alcohol increases such dangers as alcoholism, high blood pressure, obesity, stroke, breast cancer, suicide and accidents. Also, it's not possible to predict which people will develop problems with alcoholism. Consumption of alcohol can have beneficial or harmful effects, depending on the amount consumed, age and other characteristics of the person consuming the alcohol.
Therefore, these recommendations may be made for patients who are considering beginning or continuing to drink alcohol:
- Consult a physician to assess the benefits and risks. These people should not consume any alcohol: anyone with a personal or family history of alcoholism, hypertriglyceridemia, pancreatitis, liver disease, certain blood disorders, heart failure, and uncontrolled hypertension, as well as pregnant women and people on certain medications that interact with alcohol. Any recommendations should be tailored to the patient's risks and potential benefits.
- For people who do not have the conditions mentioned in the first point above, moderate consumption of alcohol (one or two drinks per day) may be considered safe.
- Alcohol should never be consumed by individuals who plan to or are in the process of driving or operating machinery, including motor vehicles.
- The risks and benefits of alcohol consumption should be reviewed periodically as part of regular medical care. Recommendations should be revised when excess consumption, problem drinking or harmful consequences of drinking occur.
- Adolescents and young adults should be targeted for assessment and advice before they develop potentially harmful drinking habits.
Cardiovascular risks associated with drinking alcohol
Drinking too much alcohol can raise the levels of some fats in the blood (triglycerides). It can also lead to high blood pressure, heart failure and a higher calorie intake. (Too many calories can lead to obesity and a higher risk of developing diabetes.) Excessive drinking and binge drinking can lead to stroke. Other serious problems include fetal alcohol syndrome, cardiomyopathy, cardiac arrhythmia and sudden cardiac death.
Potential benefits of drinking wine or other alcoholic beverages
Research is being done to find out why some groups of people seem to benefit from drinking wine or other alcohol. Factors being studied include the role of antioxidants, an increase in HDL ("good") cholesterol or anti-clotting properties.
Clinical trials of other antioxidants such as vitamin E have not shown any cardio-protective effect. Also, even if they are protective, antioxidants can be obtained from many fruits and vegetables, including red grape juice.
The best-known effect of alcohol is a small increase in HDL (“good”) cholesterol. However, regular physical activity is another effective way to raise HDL cholesterol. Niacin also can be prescribed to raise HDL cholesterol.
Alcohol or some substances found in alcoholic beverages may prevent platelets in the blood from sticking together. That may reduce clot formation and reduce the risk of heart attack or stroke. (Aspirin may help reduce blood clotting in a similar way.)
How alcohol or wine affects cardiovascular risk merits further research, but right now the American Heart Association does not recommend drinking alcohol for these potential benefits. The association recommends that, to reduce your risk, you talk to your doctor about lowering your cholesterol and blood pressure, controlling your weight, getting regular physical activity and following a healthy dietary pattern that is right for your level of activity. There’s no scientific proof that drinking alcoholic beverages can replace these conventional measures.
According to the 2010 U.S. Dietary Guidelines Scientific Advisory Report, an average daily intake of one to two alcoholic beverages is associated with a low risk of coronary heart disease among middle-aged and older adults. Binge or heavy irregular drinking should be avoided.
Red wine and heart disease
Over the past several decades, many scientific studies have addressed moderate alcohol consumption and its association with reduced deaths from heart disease in certain populations. Some researchers have suggested that the benefits may be due to wine, especially red wine. Others are examining the potential benefits in reducing heart disease risk of components in wine and other alcoholic beverages such as flavonoids and antioxidants. Some of these components may be found in other foods such as grapes or red grape juice. The linkage reported in many of these studies may be due to lifestyle factors rather than alcohol, as well as the consumption pattern. These factors include increased physical activity, and a diet high in fruits and vegetables and low in saturated fats. No direct comparison trials have been done to determine the specific effect of wine or other alcohol on the risk of developing heart disease or stroke.
Alcohol and aspirin
People who take aspirin regularly have a risk of stomach problems, including stomach bleeding. Alcohol use can increase these risks, so ask your doctor if you can safely drink alcohol in moderation.