Alcohol, Cardiovascular, and All-Cause Mortality

Jewish Hospital Cholesterol Center Update 1/20/11
CJ Glueck MD, Medical Director, Alex Cusmano MD, Medical Resident, Jewish Hospital of Cincinnati

Alcohol is one of the most widely used drugs in the nation.  According to the 2009 CDC data, 54% of adults had 1 drink in the past 30 days1.  Numerous studies have been published regarding the health effects of alcohol, some demonstrating positive effects and others negative.  More recently, there has been literature that supports light to moderate alcohol consumption in lowering the mortality from cardiovascular disease.  In 1991 60 Minutes introduced the “French Paradox”.  This paradox showed that despite the French consuming on average three times the amount of saturated fat, there was about one third the amount of coronary disease2.  Interestingly, in this study, a more potent protective factor was fish intake, and it is known that the omega-3 fatty acids in ocean fish protect against cardiovascular events. Although mortality from ischemic heart disease may be decreased by alcohol, what are the overall effects of alcohol on mortality from all other causes?  A current review of the recent literature is provided below.

In Scotland, 5766 men were followed for 21 years to determine the effect of alcohol on mortality.  The findings suggest that mortality increases when more than two alcoholic beverages per day are consumed3. 

 

In the US population, 89,299 male physicians were followed for 5.5 years.   As compared to non-drinkers, people who consumed 1 to 7 alcoholic drinks per week had a lower mortality.  The risk of death from any cause approached that of non drinkers when alcohol consumption was greater than 2 alcoholic beverages per day4.

 

In Japan 39, 076 men and women were followed for 11 years.  All cause mortality was then assessed.  From this study it appears that any amount of alcohol increases all cause mortality for Japanese men and women5.

 

In 2006 a meta-analysis was performed on 34 studies relating to alcohol and mortality.  The findings suggested that 1-2 drinks per day for women and 2-4 drinks per day for men may confer a survival benefit6.

 

In 2007 a population of 8,877 women and 5,101in California was followed for 23 years regarding their alcohol consumption and mortality risk.  The study concluded that moderate alcohol intake among the elderly exhibited a mortality benefit7. 

 

A 2010 study by Chinese researchers found that up to 3 drinks a day lowered all cause mortality, but slightly increased the risk of hemorrhagic stroke8, 9. 

 

 

However, alcohol has been shown to affect the levels of lipids in patients with familial hyperlipidemia, specifically, type IV hyperlipoproteinemia (Familial Hypertriglyceridemia) 10.  For this population alcohol abstention or very limited quantities are recommended.

Summary

In summation, it appears that a moderate amount of alcohol intake (1-2 drinks for women, and 2-3 drinks for men per day) is associated with a reduction of risk of death from any cause.  However, effects of alcohol intake on all cause mortality and cardiovascular mortality differ widely by populations and ethnic groups. Provided that one does not have familial hypertriglyceridemia, 1-2 alcoholic beverages per day should not increase all cause mortality in USA residents. Should people ingest 1 to 2 alcoholic beverages per day as a therapeutic approach to prevent cardiovascular disease. NO, but intake at this level should not be harmful.   

 

References:

1. National Center for Chronic Disease Prevention & Health Promotion Behavioral Risk Factor Surveillance System. http://apps.nccd.cdc.gov/brfss/display.asp?cat=AC&yr=2009&qkey=4411&state=UB
2. Alcohol Consumption and Cardiovascular Mortality Among U.S. Adults, 1987 to 2002.  J Am Coll Cardiol, 2010; 55:1328-1335, doi:10.1016/j.jacc.2009.10.056
3. Alcohol consumption and mortality from all causes, coronary heart disease, and stroke: results from a prospective cohort study of Scottish men with 21 years of followLight-to-moderate alcohol consumption and mortality in the Physicians' Health Study enrollment cohort.  J Am Coll Cardiol. 2000 Jan;35(1):96-105 up. BMJ. 1999 Jun 26;318(7200):1725-9
4. Light-to-moderate alcohol consumption and mortality in the Physicians' Health Study enrollment cohort.  J Am Coll Cardiol. 2000 Jan;35(1):96-105
5. Alcohol consumption and mortality in Japan: the Miyagi Cohort Study.                 J Epidemiol. 2004 Feb;14 Suppl 1:S18-25
6. Alcohol dosing and total mortality in men and women. Arch Intern Med 2006; 166: 2437-2445
7. Type of alcohol consumed, changes in intake over time and mortality: the Leisure World Cohort Study. Age Ageing (2007) 36 (2): 203-209
8. Alcohol consumption and coronary heart disease in Eastern Asian men: a meta-analysis of prospective cohort studies.  Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Nov;38(11):1038-1044
9. Alcohol intake and stroke in Eastern Asian men: a systemic review and meta-analysis of 17 prospective cohort studies. Zhonghua Yi Xue Za Zhi. 2010 Nov;90(40):2834-2838
10. Life-style and serum lipids and lipoproteins.  J Atheroscler Thromb. 2000;7(4):177-97