KLATSKY, Arthur L.; Kaiser Permanente Medical Care Program, Oakland, CA: Alcohol and Modern Human Health

Substantial medical risks of heavy drinking and existence of a safe limit have long been evident. Modern epidemiologic studies also indicate a lower morbidity and mortality risk among lighter drinkers. Defining “heavy” as 3+ drinks/day, the alcohol-mortality relationship is a J-curve with risk highest for heavy drinkers, lowest for light drinkers and intermediate for abstainers. Cardiovascular (CV) and non-CV problems contribute to the increased risk of heavier drinkers. Lower risk of light drinkers is due mostly to lower risk of coronary heart disease (CHD). We should consider 3 sets of disparities: 1) Differences between harmful effects of heavy and beneficial effects of lighter drinking, 2) Disparate alcohol relationships to specific CV conditions, and 3) Disparate effects of beverage types (wine, liquor, beer). Increased CV risks of heavy drinking include: 1) Alcoholic cardiomyopathy (heart muscle disease), related to heavy sustained drinking in susceptible persons, 2) Systemic hypertension (high blood pressure), an association confirmed by consistent epidemiologic data and clinical experiments, 3) Certain heart rhythm disturbances in binge drinkers (the “holiday heart syndrome”) and 4) Hemorrhagic stroke (due to ruptured blood vessels on or in the brain). Lighter drinking is unrelated to increased risk of any CV condition and, in observational studies, is consistently related to lower risk of CHD and ischemic stroke (due to blocked brain blood vessels). A protective hypothesis is supported by plausible biological mechanisms attributable to ethyl alcohol. International comparisons and some prospective data suggest that wine is more protective against CHD than liquor or beer. Possible non-alcohol beneficial components in wine (especially red) support possible extra protection by wine, but a healthier pattern of drinking or more favorable risk traits in wine drinkers may also be involved.