Two new large meta-analysis studies published yesterday in BMJ provide further evidence for a view which ACSH has promoted for years: moderate alcohol consumption protects against cardiovascular disease.
In the first meta-analysis, led by Professor William Ghali and Paul E. Ronksley from the University of Calgary, researchers reviewed 84 studies and analyzed the relationship between alcohol consumption and heart disease. They found that individuals who had one drink a day or less were 29 percent less likely to develop heart disease and 25 percent less likely to succumb to it than teetotalers. In addition, the risk of all-cause mortality was 13 percent lower among moderate drinkers compared to non-drinkers, and there was a 25 to 35 percent risk reduction in coronary heart disease for all drinkers, regardless of the degree of alcohol consumption.
Dr. Ross was perplexed by this latter finding since he says that excessive alcohol intake increases blood pressure, which “I would think would have a negative effect on the heart.”
In the second meta-analysis, which was also from the University of Calgary, Dr. Susan Brien and colleagues (the same group as in the previous study) reviewed 44 studies to investigate the relationship between alcohol consumption and biomarkers for heart disease, such as levels of cholesterol and inflammation and the condition of blood vessels. They found that for women who ingest 15 grams of alcohol (one drink) per day and men who ingest up to 30 grams of alcohol, levels of high-density lipoprotein (HDL), or “good” cholesterol, actually increased. The relationship showed a dose-response, meaning that the more alcohol consumed, the higher the HDL levels, and the results were independent of the type of alcohol consumed (beer, wine or spirits).
The authors note that the studies fulfilled the Bradford Hill criteria for causation — a set of nine conditions needed in order to establish a causal relationship — thus demonstrating a cause-and-effect link between moderate alcohol consumption and reduction in heart disease. The question now is how this information should be integrated into an effective public health message.
“There has been a centuries-old fear and loathing of alcohol intake among health authorities,” says Dr. Ross. “But if a patient were to walk into a doctor’s office with cardiovascular risk factors, including just being older, and they don’t drink, would the physician be well advised to recommend that patient have a shot or two of alcohol per day? Absent any contraindication, including a history of alcohol abuse, drug interactions, bleeding tendency, or liver disease, I think that would be good advice.”
ACSH’s Dr. Elizabeth Whelan remembered that many years ago, an ACSH advisor lectured that among the best ways to reduce your risk of heart disease was to run regularly and consume moderate amounts of alcohol daily. “He said his motto for healthy living was ‘run from bar to bar.’ More evidence is accumulating supporting that general principle, although the actual advice is facetious, of course,” she added.
