Does alcohol contribute to heart disease?

By Craig M. Walker, M.D.
Medical Director,
Cardiocascular Institute of the South

The short answer to that question is "only in cases of excessive consumption, as far as we know." Indeed, there is some preliminary evidence that very limited consumption of alcohol -- the equivalent of a glass or two of wine a day -- may raise levels of high-density lipoprotein (HDL), in the blood, reducing the tendency of cholesterol plaque to accumulate in arteries..

The principal cause of heart attacks is atherosclerosis -- the buildup of cholesterol plaque in the arteries that serve the heart itself. So raising the levels of HDL, a sort of detergent which bonds with the cholesterol and reduces its rate of accumulation in the arteries, is beneficial.

However there are two important caveats to that statement. The HDL raised by alcohol may not be the subtype of HDL that reduces the risk of coronary artery disease. Second, there is a quirk of our national character that renders hazardous any positive statement about a potentially dangerous substance. If there's anything we Americans are bad at, it's doing things in moderation. On the contrary, our national motto could be "If a little is good, a lot must be better."

Vitamins are vital components of nutrition, in proper amounts. Only in America would you have to warn the public that some vitamins are poisonous if taken in hundredfold or thousandfold doses! And where else would a public health warning have to be issued that a diet consisting entirely of brown rice can be fatal?

There are indications that some long-term alcoholics may suffer from cardiomyopathy -- degeneration of the heart muscle -- as a result of their drinking. That condition can lead to congestive heart failure. But alcoholism's other lethal effects tend to overshadow this late-developing condition.

Alcohol in excess is one of our leading health and social problems. It kills upwards of 100,000 people a year in this country -- three times as many as illegal drugs. Alcoholism is a leading factor in auto accidents, domestic and societal violence, homelessness and poverty, all of which deliver their victims by the thousand to the door of the hospital and the doctor's office. So you will forgive me if, as a physician, I feel compelled to add a very ancient prescription to any positive statement about alcohol: "Nothing in excess."

1995 Cardiocascular Institute of the South

For further information, call Jane Arnette at CIS/Houma, 1-800-425-2565, or Jim Keyser at 1-800-848-2715, or e-mail questions or comments to jakeyser@cardio.com

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