This Article Full Text Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kloner, R. A. Articles by Rezkalla, S. H. Search for Related Content PubMed PubMed Citation Articles by Kloner, R. A. Articles by Rezkalla, S. H. Pubmed/NCBI databases Medline Plus Health Information Alcohol Consumption Related Collections Acute myocardial infarction Arrhythmias, clinical electrophysiology, drugs Cerebrovascular disease/stroke Congestive Other hypertension Lipids Acute Cerebral Hemorrhage

(Circulation. 2007;116:1306-1317.)
© 2007 American Heart Association, Inc.

Cardiovascular Involvement in General Medical Conditions

To Drink or Not to Drink? That Is the Question

Robert A. Kloner, MD, PhD; Shereif H. Rezkalla, MD

From the Heart Institute, Good Samaritan Hospital, and Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles (R.A.K.); and Department of Cardiology, Marshfield Clinic, Marshfield, Wis (S.H.R.).

Correspondence to Robert A. Kloner, MD, PhD, Heart Institute, Good Samaritan Hospital, 1225 Wilshire Blvd, Los Angeles, CA 90017. E-mail rkloner{at}goodsam.org

Numerous studies have used a J-shaped or U-shaped curve to describe the relationship between alcohol use and total mortality. The nadir of the curves based on recent meta-analysis suggested optimal benefit at approximately half a drink per day. Fewer than 4 drinks per day in men and fewer than 2 per day in women appeared to confer benefit. Reductions in cardiovascular death and nonfatal myocardial infarction were also associated with light to moderate alcohol intake. Although some studies suggested that wine had an advantage over other types of alcoholic beverages, other studies suggested that the type of drink was not important. Heavy drinking was associated with an increase in mortality, hypertension, alcoholic cardiomyopathy, cancer, and cerebrovascular events, including cerebrovascular hemorrhage. Paradoxically, light-to-moderate alcohol use actually reduced the development of heart failure and did not appear to exacerbate it in most patients who had underlying heart failure. Numerous mechanisms have been proposed to explain the benefit that light-to-moderate alcohol intake has on the heart, including an increase of high-density lipoprotein cholesterol, reduction in plasma viscosity and fibrinogen concentration, increase in fibrinolysis, decrease in platelet aggregation, improvement in endothelial function, reduction of inflammation, and promotion of antioxidant effects. Controversy exists on whether alcohol has a direct cardioprotective effect on ischemic myocardium. Studies from our laboratory do not support the concept that alcohol has a direct cardioprotective effect on ischemic/reperfused myocardium. Perhaps the time has come for a prospectively randomized trial to determine whether 1 drink per day (or perhaps 1 drink every other day) reduces mortality and major cardiovascular events.

Key Words: alcohol • arrhythmia • cardiomyopathy • heart failure • myocardial infarction

This article has been cited by other articles:

				S. Stranges, M. Russell, A. Z. Fan, J. Dorn, and M. Trevisan Letter by Stranges et al Regarding Article, "To Drink or Not to Drink? That Is the Question" Circulation, February 12, 2008; 117(6): e159 - e159. [Full Text] [PDF]

				R. A. Kloner and S. Rezkalla Response to Letter Regarding Article, "To Drink or Not to Drink? That Is the Question" Circulation, February 12, 2008; 117(6): e160 - e160. [Full Text] [PDF]