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STATE-OF-THE-ART PAPER

Alcohol and Cardiovascular Health

The Razor-Sharp Double-Edged Sword

James H. O’Keefe, MD, FACC^_*,_*, Kevin A. Bybee, MD^_* and Carl J. Lavie, MD, FACC

^_* Mid America Heart Institute, University of Missouri, Kansas City, Missouri
Ochsner Medical Center, New Orleans, Louisiana.

Manuscript received February 14, 2007; revised manuscript received April 19, 2007, accepted April 30, 2007.

^_* Reprint requests and correspondence: Dr. James O’Keefe, 4330 Wornall Road, Suite 2000, Kansas City, Missouri 64111. (Email: jhokeefe{at}cc-pc.com).

An extensive body of data shows concordant J-shaped associations between alcohol intake and a variety of adverse health outcomes, including coronary heart disease, diabetes, hypertension, congestive heart failure, stroke, dementia, Raynaud’s phenomenon, and all-cause mortality. Light to moderate alcohol consumption (up to 1 drink daily for women and 1 or 2 drinks daily for men) is associated with cardioprotective benefits, whereas increasingly excessive consumption results in proportional worsening of outcomes. Alcohol consumption confers cardiovascular protection predominately through improvements in insulin sensitivity and high-density lipoprotein cholesterol. The ethanol itself, rather than specific components of various alcoholic beverages, appears to be the major factor in conferring health benefits. Low-dose daily alcohol is associated with better health than less frequent consumption. Binge drinking, even among otherwise light drinkers, increases cardiovascular events and mortality. Alcohol should not be universally prescribed for health enhancement to nondrinking individuals owing to the lack of randomized outcome data and the potential for problem drinking.

Abbreviations and Acronyms   CHD = coronary heart disease   CV = cardiovascular   HDL = high-density lipoprotein   MI = myocardial infarction

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