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Can Modest Alcohol Consumption Have Cardiovascular Benefits?

  • Authors: News Author: Megan Brooks; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 7/21/2023
  • Valid for credit through: 7/21/2024, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for primary care clinicians, cardiologists, psychiatrists, nurses/nurse practitioners, pharmacists, and other clinicians who treat and manage adults who consume alcohol.

The goal of this activity is for members of the healthcare team to be better able to evaluate the potential relationships among alcohol consumption, neural network activity, and the risk for cardiovascular disease.

Upon completion of this activity, participants will:

  • Distinguish the effects of alcohol consumption on mortality outcomes
  • Evaluate the potential relationship between alcohol consumption, neural network activity, and the risk for cardiovascular disease
  • Outline implications for the healthcare team


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News Author

  • Megan Brooks

    Freelance writer, Medscape


    Megan Brooks has no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine


    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: Boehringer Ingelheim; GlaxoSmithKline; Johnson & Johnson

Editor/Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC


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  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships.

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This activity has been peer reviewed and the reviewer has no relevant financial relationships.

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Can Modest Alcohol Consumption Have Cardiovascular Benefits?

Authors: News Author: Megan Brooks; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 7/21/2023

Valid for credit through: 7/21/2024, 11:59 PM EST


Clinical Context

Patients and clinicians can rightly be confused regarding the health effects of alcohol consumption. A study by Xi and colleagues, published in the August 22, 2017, issue of the Journal of the American College of Cardiology, provided context for this important health issue.[1] The authors studied more than 333,000 US adults who participated in 13 waves of the National Health Interview Survey, which was linked to National Death Index records to determine mortality data.

Light to moderate alcohol consumption was associated with a significant reduction in all-cause mortality compared with abstinence from alcohol, with the greatest improvement in mortality at 5 to 10 standard alcoholic drinks per week. However, this effect was counterbalanced by higher risks for all-cause and cancer mortality among heavy drinkers, as defined as more than 14 drinks/week among men and more than 7 drinks/week among women. In addition, binge drinking (defined by at least 5 drinks on 1 occasion) at least once per week was associated with higher risks for all-cause and cancer mortality.

The authors of the current study note several mechanisms that may help explain why light to moderate alcohol consumption can reduce the risk for cardiovascular events, including increased levels of high-density lipoprotein cholesterol, improved insulin sensitivity, and lower levels of fibrinogen. However, these changes do not fully explain the cardiovascular benefit of moderate alcohol consumption. The current research hypothesizes a link between alcohol consumption and a relaxation of neural networks as a mechanism for improved cardiovascular health.

Study Synopsis and Perspective

A new study provides novel insights into why light to moderate alcohol consumption may be associated with reduced cardiovascular disease (CVD) risk.

The study shows that light to moderate drinking was associated with lower major adverse cardiovascular events (MACE), and this was partly mediated by decreased stress signaling in the brain.

In addition, the benefit of light to moderate drinking with respect to MACE was most pronounced among people with a history of anxiety, which is a condition known to be associated with higher stress signaling in the brain.

However, the apparent CVD benefits of light to moderate drinking were counterbalanced by an increased risk for cancer.

“There is no safe level of alcohol consumption,” senior author and cardiologist Ahmed Tawakol, MD, codirector of the Cardiovascular Imaging Research Center at Massachusetts General Hospital, Boston, told | Medscape Cardiology.

“We see cancer risk even at the level that we see some protection from heart disease. And higher amounts of alcohol clearly increase heart disease risk,” Dr Tawakol said.

The study was published online June 12 in the Journal of the American College of Cardiology.[2]

Clear Mechanistic Link

Chronic stress is associated with MACE via stress-related neural network activity (SNA). Light to moderate alcohol consumption has been linked to lower MACE risk, but the mechanisms behind this connection remain unclear.

“We know that when the neural centers of stress are activated, they trigger downstream changes that result in heart disease. And we’ve long appreciated that alcohol in the short term reduces stress, so we hypothesized that maybe alcohol impacts those stress systems chronically, and that might explain its cardiovascular effects,” Dr Tawakol explained.

The study included roughly 53,000 adults (mean age, 60 years; 60% women) from the Mass General Brigham Biobank. The researchers first evaluated the relationship between light to moderate alcohol consumption and MACE after adjusting for a range of genetic, clinical, lifestyle, and socioeconomic factors.

During mean follow-up of 3.4 years, 1914 individuals experienced MACE. Light to moderate alcohol consumption (compared with none/minimal) was associated with lower MACE risk (hazard ratio [HR], 0.786; 95% CI, 0.717-0.862; P<.0001) after adjusting for cardiovascular risk factors.

The researchers then studied a subset of 713 individuals who had undergone previous positron emission tomography (PET) scan and a computed tomography (CT) scan brain imaging (primarily for cancer surveillance) to determine the effect of light to moderate alcohol consumption on resting SNA.

They found that light to moderate alcohol consumption correlated with decreased SNA (standardized beta, −0.192; 95% CI, −0.338 to −0.046; P=.010). Lower SNA partially mediated the beneficial effect of light to moderate alcohol intake on MACE risk (odds ratio [OR], −0.040; 95% CI, −0.097 to −0.003; P<.05).

Light to moderate alcohol consumption was associated with larger decreases in MACE risk among individuals with a history of anxiety (HR, 0.60 [95% CI, 0.50-0.72] vs HR, 0.78; 95% CI, 0.73-0.80; P interaction=.003).

The coauthors of an editorial say that the discovery of a “new possible mechanism of action” for why light to moderate alcohol consumption might protect the heart “deserves closer attention in future investigations.”[3]

However, Giovanni de Gaetano, MD, PhD, from the Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy, emphasizes that individuals who consume alcohol should not “exceed the recommended daily dose limits suggested in many countries and that no abstainer should start to drink, even in moderation, solely for the purpose of improving his/her health outcomes.”

Dr Tawakol and colleagues say that, given alcohol’s adverse health effects, such as heightened cancer risk, new interventions that have positive effects on the neurobiology of stress, but without the harmful effects of alcohol, are needed.

To that end, they are studying the effect of exercise, stress-reduction interventions such as meditation, and pharmacologic therapies on stress-associated neural networks, and how they might induce cardiovascular benefits.

Dr Tawakol told | Medscape Cardiology that one “additional important message is that anxiety and other related conditions like depression have really substantial health consequences, including increased MACE. Safer interventions that reduce anxiety may yet prove to reduce the risk of heart disease very nicely.”

The study was supported by the National Institutes of Health. Dr Tawakol and Dr de Gaetano have disclosed no relevant financial relationships.

J Am Coll Cardiol. Published online June 12, 2023.[2]

Study Highlights

  • Study data were derived from a US-based biobank with information on more than 53,000 individuals. The current analysis focuses on 1038 participants who provided data on alcohol consumption and also underwent PET for assessment of their neural network activity.
  • PET was performed in a resting state after an overnight fast. Researchers focused on neural activity in the amygdala divided by the activity in ventromedial prefrontal cortex, which corresponds to symptoms of anxiety.
  • MACE were the study’s main outcome and were defined by myocardial infarction, coronary revascularization, unstable angina, cerebrovascular accidents, transient ischemic attacks, peripheral vascular disease, and heart failure.
  • The study analysis focused on alcohol consumption, PET results indicating neural network activity, and incident cardiovascular events. These results were adjusted to account for cardiovascular risk factors, mental health disorders, physical activity, and socioeconomic variables.
  • Researchers also accounted for a genetic profile associated with stress-related syndrome.
  • In the total cohort of 53,064 adults, 23,920 had less than 1 drink/week (minimal intake), 27,053 had between 1 and 14 drinks/week (light/moderate intake), and 2,091 had more than 14 drinks/week (heavy intake).
  • The median age of participants was 60 years, and 59.9% of the cohort were women. The prevalence rates of depression and anxiety disorders were 27.7% and 33.8%, respectively.
  • Participants with minimal alcohol intake were more likely to be female, have diabetes or hypertension, and have a history of anxiety or depression. Light/moderate alcohol consumption was associated with being male, smoking, higher socioeconomic status, and higher levels of physical activity.
  • The study analysis focused on minimal vs light/moderate drinkers in the study cohort.
  • 1914 participants experienced MACE during a median follow-up period of 3.4 years. There was a U-shaped relationship between alcohol consumption and the risk for MACE, meaning that light/moderate drinking was associated with the lowest rates of MACE (hazard ratio vs minimal drinking, 0.79; 95% CI, 0.72-0.86).
  • Light/moderate drinking was associated with reductions in all of the individual component diagnoses of MACE when compared with minimal drinking, but it was also associated with a higher risk for cancer.
  • There was also a U-shaped relationship between alcohol consumption and neural network activity, with the lowest levels among light/moderate drinkers. The lower activity associated with alcohol use was a result of functional change in the amygdala vs the ventromedial prefrontal cortex.
  • Higher neural network activity was associated with a higher risk for MACE. The interaction between alcohol consumption, neural network activity, and MACE was significant when adjusted for age and sex.
  • Researchers performed a subgroup analysis of participants with anxiety. Light/moderate alcohol consumption was not only associated with a lower risk for MACE after full adjustment among these adults, but it appeared to have a stronger effect vs adults without anxiety.

Implications for the healthcare team

  • Light/moderate alcohol consumption appears to improve the risks for all-cause and cardiovascular mortality compared with abstinence from alcohol, but both regular heavy alcohol consumption and frequent binge drinking increase the risks of all-cause and cancer mortality.
  • The current study finds that light/moderate alcohol consumption is associated with lower risks for MACE and reduced neural network activity in the amygdala. The results strongly suggest that light/moderate alcohol consumption may reduce the risk for MACE through its impact on neural network activity and anxiety.
  • The healthcare team can reassure patients who already drink small to moderate amounts of alcohol that doing so does not promote a higher rate of cardiovascular events. But recommending the initiation of alcohol consumption for health reasons is discouraged.

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