The debate on whether alcohol consumption is good for the heart or not is ongoing. Paul Cacciottolo, cardiology registrar at Cambridge, UK, maintains that alcohol should retain its place in the drinks cabinet, not the medicine chest.

It has long been established that alcohol consumption plays a big role in the development of liver disease and a variety of cancers, but its role in cardiovascular disease is not as clear-cut. We hear very frequently that red wine in particular is supposed to be good for the heart, although studies carried out to investigate this relationship have had mixed results.

Extensive epidemiological studies have shown the cardioprotective effect of moderate alcohol consumption, but have failed to elucidate the underlying mechanism.

It is thought that alcohol in small amounts will increase high density lipoprotein (HDL), thought of as the ‘good cholesterol’ which works to reduce atherosclerosis, or furring up of the arteries. It also reduces platelet aggregation, making blood less sticky and therefore less likely to clot and block an artery, which could cause strokes and heart attacks. It is also thought of as a relaxant, decreasing blood pressure and reducing coronary artery spasm.

The American Heart Association in particular reports that alcohol has a strong dose-response relationship with protection against heart disease, and that this holds true regardless of sex or ethnicity of the person in question.

The debate still continues whether it is any alcohol type that has this effect, or whether specific drinks provide greater cardioprotection. Red wine in particular contains high levels of flavonoids, also known as tannins, which play a role in reducing heart disease risk. It is important to state that there are plenty of other non-alcoholic foodstuffs suchas tea and red apples that can provide these molecules.

Moreover, moderate drinkers of red wine also display other characteristics, suchas a more balanced diet and taking more exercise, which also have a positive effect on heart health and confound the results.

Tannins are also found in beer, but it is thought that the greater calorific content in beer outweighs the benefits the tannins bestow.

Alcohol should only be consumed in moderation if at all and non-drinkers shouldn’t take this as a call to start drinking

This brings us to the flip side of the coin: alcohol can also have detrimental effects on our cardiac health. The relationship between HDL and alcohol described above is extremely dose-sensitive, which means that it is dependent on the amount of alcohol consumed.

While moderate alcohol consumption increases HDL, excessive alcohol intake (more than two units a day for a man and one unit a day for a woman) will increase LDL and triglyceride levels instead (the ‘bad’ cholesterol, which actually will cause heart disease).

Excessive alcohol intake will also increase the daily calorie intake, and can result in obesity and subsequently, high blood pressure and Type 2 diabetes, both of which are associated with heart disease.

In severe cases, persistent heavy alcohol intake can even lead to a disease of the heart muscle called alcoholic cardiomyopathy: the heart stops functioning efficiently and can result in heart failure.

Indeed, alcohol is a double-edged sword. There is certainly enough evidence to say that it should only be consumed in moderation if at all and non-drinkers shouldn’t take this as a call to start drinking.

There are much more effective ways of improving your cardiovascular health, such as diet and exercise. Alcohol should retain its place in the drinks cabinet, not the medicine chest.

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