"One of the most surprising findings... is that people who abused alcohol are at increased risk for heart attack or myocardial infarction," said Dr. Gregory M. Marcus, director of clinical research in the Division of Cardiology at the University of California, San Francisco
and senior author of the study. Past data suggests that moderate drinking
may be protective, he said, helping ward off this disease.
Dr. Suzanne Steinbaum, director of women's heart health at Lenox Hill Hospital in New York City, believes that both scientists and the media have been highlighting the good components of alcohol, such as resveratrol in wine, and "been really pushing that a glass of wine is good for our health."
But the bottom line of this new study is clear, she said.
"When we look at alcohol, we have almost glamorized it as being this substance that can help us live a really heart-healthy life," said Steinbaum, who was not involved in the research. "I think, ultimately, drinking in excess leads to heart conditions, and we should really understand the potential toxicity of alcohol and not glamorize it as something we should include as part of our lives -- certainly not in excess."
Millions of patient records
The National Institutes of Health frequently highlight the ways in which too much drinking can lead to accidents, cirrhosis and some cancers. Yet cardiovascular studies have suggested that moderate consumption of alcohol is good for our heart health.
The authors of the new study cite a 2007 study published in the journal Circulation
. Not only did moderate drinking lead to no negative effects, the study authors concluded that "moderate drinking may lower the risk of heart failure."
Since many of us believe that "more of a good thing is always better," Marcus and his colleagues decided to investigate how excessive drinking might impact our risk of developing atrial fibrillation, or arrhythmic beating of the heart; myocardial infarction, or heart attack; and congestive heart failure, a chronic condition in which the heart cannot effectively push blood through the arteries and circulatory system to the body's other organs and tissues.
For data, Marcus and his colleagues turned to the Healthcare Cost and Utilization Project's California State Ambulatory Surgery Databases, Emergency Department Databases and State Inpatient Databases. They looked at California residents, 21 or older, who had been hospitalized anytime between 2005 and 2009.
All told, Marcus and his team analyzed the medical records of 14,727,591 patients.
Of these, 1.8%, or approximately 268,000, had been diagnosed with alcohol abuse. Marcus said there was no specific cutoff regarding a specific amount of alcohol or time period and admitted that this was a limitation of the study.
Within the study, then, alcohol abuse was defined as instances in which a health care provider flagged a patient as having a problem with excessive alcohol use, either "acutely"-- showing up for an appointment drunk, for example -- or chronically -- such as having an addiction or reliance on alcohol, explained Marcus.
According to Dr. Scott Krakower, assistant unit chief of psychiatry at Zucker Hillside Hospital in New Hyde Park, New York, alcohol abuse is generally not dependence. Instead, it's when "you're using it excessively at times and it's getting in the way of functioning."
"Abuse doesn't necessarily lead to a pattern where you use it every day and you're developing a tolerance or developing withdrawal symptoms," said Krakower, who was not involved in the study. He added that alcohol abuse is when "you start having problems with alcohol it might affect you physically, but it can also have social implications and psychological implications," such as trouble with relationships or problems at work.
Some heart risks double
In surveying the data on millions of patients, Marcus and his colleagues discovered that alcohol abuse was associated with atrial fibrillation, heart attack and heart failure.
Specifically, they found that alcohol abuse was associated with a doubled risk of atrial fibrillation, a 1.4-fold higher risk of heart attack and a 2.3-fold increased risk of congestive heart failure.
"It didn't matter if you had a conventional risk factor for these diseases or not. In every case, alcohol abuse increased the risk," Marcus said.
That said, Marcus and his colleagues discovered that the number of people who would develop either atrial fibrillation, heart attack or heart failure in three years was much higher if they had an established risk factor and abused alcohol.
They also compared alcohol abuse to the conventional risk factors for heart disease, such as high blood pressure and diabetes.
"In general, if someone abused alcohol, it appeared to increase the risk to a similar magnitude to other conventional risk factors," Marcus said.
Eliminating alcohol abuse would result in over 73,000 fewer atrial fibrillation cases, 34,000 fewer heart attacks and 91,000 fewer patients with congestive heart failure in the US alone, the researchers estimated.
Motivation to quit
When it comes to helping patients with alcohol abuse, Krakower said, primary care doctors can use the latest step-by-step guidance tools to screen patients and "see if a person has a problem with alcohol and from there determine what level of intervention is necessary."
From there, Krakower said, treatment options include motivational interviewing, a type of therapy in which the goal is for a patient to "find some motivation to quit." There's also group therapy, family-based therapy techniques and, of course, Alcoholics Anonymous.
Still there are nuances when it comes to drinking.
"We have an understanding (by the American Heart Association) that a glass of wine a day for women and two glasses of wine a day for men are good," Steinbaum said. "What is a glass? Four to 6 ounces."
Yet if you go out to dinner and order a glass of wine, she said with a laugh, "it's like 12 ounces!"
The exact equation of how much is too much has never really been answered, and "part of the reason for that is metabolism is different in everyone," Steinbaum said. Metabolism of alcohol is slower for women than for men, and individual fat distribution and muscle mass also play into how quickly alcohol is metabolized.
"It becomes a very individual thing," she said. "The American Heart Association has given us very conservative guidelines, saying if you're going to drink, this is how much but the big picture is alcohol in excess -- and excess is more than a very minimal amount -- is bad for your heart."
Still, no matter the characteristics of any individual patient, excessive alcohol is an important risk factor for atrial fibrillation and heart failure, Marcus said: "Increasing awareness of this both among practitioners and individuals may actually reduce or prevent those important diseases."