Effects of Alcohol on the Heart: How Much is Too Much?

David Kopin, MD, is a general cardiologist who is board certified in cardiovascular disease, echocardiography and nuclear cardiology.

You eat well, exercise and try to stay healthy — but you also enjoy a beer while watching the game, or a glass of wine at dinner. Can alcohol ever be part of a heart-healthy diet? Here’s what you should know before you drink. 

Alcohol and Heart Disease

Drinking to excess harms health in all sorts of ways, including liver damage, impaired brain function and an increased risk of many cancers. The science is also clear that overuse of alcohol can also lead to a number of heart-related problems:

• Heavy drinking can increase blood pressure and raise blood levels of cholesterol and triglycerides. High blood pressure, cholesterol and triglycerides are risk factors for heart disease, heart attack and stroke.
• At high doses, alcohol is directly toxic to the heart. Chronic heavy drinkers can develop cardiomyopathy, a condition in which the heart muscle is weakened and has trouble pumping blood throughout the body.
• Binge drinking can lead to heart rhythm problems such as atrial fibrillation, which can lead to blood clots, stroke and heart attack.

Moderate Alcohol Use: Healthy or Harmful?

Most of the harmful effects of alcohol are associated with heavy drinking. What if you imbibe less frequently? Occasional alcohol can be a part of a healthy lifestyle, but there are some things to keep in mind.

• Don’t overdo it. Federal guidelines and the American Heart Association recommend that if you do drink, you should do so in moderation. That’s defined as 1-2 drinks per day for men, and 1 for women.
• Be careful of generous pours. One drink is defined as 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of high-proof spirits. A typical wine glass holds a lot more than 5 ounces, so be mindful of how much you’re actually consuming.
• Alcohol has calories. The calories in alcohol (and mixers like juice or soda) can add up quickly. Obesity is associated with health problems such as diabetes and heart disease. If you’re trying to maintain a healthy weight, be mindful of how many calories you’re drinking.
• Alcohol is addictive. After one drink, it’s all too easy to pour a second. Over time, that can become a problem. I urge my patients to consider their family history and other risk factors for developing alcohol dependence. That should inform your decision about how much, or how often, to drink.
• Consider your history. While drinking occasionally may be safe in otherwise healthy people, I don’t recommend it for people with heart disease — especially if they have some form of cardiomyopathy, congestive heart failure or an arrhythmia (Atrial Fibrillation or “AFib” in particular).
• Remember: The key is moderation.

Red Wine and Heart Health

Lots of people ask: What about red wine? There have been studies that suggest drinking a moderate amount of red wine might be associated with better health, including a lower risk of dying of heart disease. But it’s important to realize that there’s no study showing cause and effect.

It may be that people who enjoy the occasional glass of red are more likely to follow a heart-healthy diet, such as the Mediterranean-style diet. If you enjoy red wine and you’re healthy, it’s probably fine to enjoy it in moderation. But I wouldn’t recommend starting because you think it’s good for your heart.

When deciding whether to drink alcohol and how much is too much, the best thing you can do is talk to your doctor.

People are often reluctant to admit how much they drink to healthcare providers. But we’re not here to judge you. When you’re honest with your doctor, he or she will be able to help you understand potential risks and find ways to address them. Begin your discussion today with your primary care provider (PCP). If you do not have a PCP, we welcome you to make an appointment with an Inova provider at any of our Primary Care locations.

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