MEDICINE - UP TO THE MINUTE

by

Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina

ALCOHOL AND THE HEART
WHAT TO DRINK AND HOW MUCH

You may have seen an earlier article on Medicine Up to the Minute entitled "A Drink a Day Keep the Doctor Away." The Article was a commentary on recent research suggesting that if you have one drink a day you are less likely to suffer a heart attack than those who abstain from alcohol altogether. The researchers also warned against more than two drinks a day, which can cause such problems as cirrhosis of the liver and alcohol encephalopathy, sometimes known as "wet brain."

A number of people who read the article immediately asked me, "Is it better to drink whiskey? Or beer? Or red wine? Or all of the above?" I replied that I knew of no research that spoke authoritatively on that subject. Then my August issue of the American Journal of Cardiology arrived, and I found the answer to this question.

The article -- entitled "Red Wine, White Wine, Liquor, Beer, and Risk for Coronary Artery Disease Hospitalization" (Vol. 80, pp. 416 - 420) - reported an a study conducted by California-based Kaiser-Permanente, an HMO that has been in business since the 1930's. The 128,934 adult patients surveyed lived in the San Francisco-Oakland area. At the time of their initial medical examination by Kaiser-Permanente physicians, they were also asked about their alcoholic consumption.

In this large group, 5,498 reported they had never in their lives drunk alcoholic beverages. 4,194 said they were ex-drinkers. 27,417 persons reported drinking less than one drink per month. These three groups were classified as "non-drinkers" for purposes of the study.

The remaining 81,825 consisted of those who reported having more than one drink of alcohol a month. These in turn were subdivided into a variety of sub-categories, according to how many drinks per week they consumed and the type of alcoholic beverage they usually drank. With such a large number in each category -- and with a large multi-racial population - the study was sufficiently broad in scope to yield highly credible results.

The big question is: How many developed some form of coronary artery disease, as revealed by hospital records? The results were measured in terms of heart attacks and deaths. The study was concluded on December 31, 1991.

During the period of the study -- xxxxx years -- 1,757 of the subjects suffered heart attacks, and 848 contracted other types of coronary-artery disease syndromes, usually manifested by chest pains. The authors took these hospital reports and correlated them with the amount of alcohol the patients habitually consumed and the type of beverage they habitually drank.

Men drank larger quantities of alcohol and tended to drink liquor or beer, while women were more likely to drink wine. In fact, wine drinkers tended to be white, female, college graduates, and non-smokers.

As in the earlier study, researchers found that moderate drinkers (one a day) had a measurably lower number of heart attacks and coronary pain episodes. The researchers also found that there was no significant benefit in having fewer than one drink a day, though the data did not appear in the article itself. They concluded, therefore, that their study robustly supported the proposition that a drink a day was beneficial.

But did red wine do the job better than white wine or beer or liquor, as red wine merchants and some TV shows (60 Minutes) had been claiming? Researchers found it didn't matter a great deal what the subjects were drinking, though the results were slightly better for beer and wine drinkers than those who drank hard liquor. So I had the answer to the question people kept asking me.

Is this an important study? It depends on your taste. If you drink red wine by choice, and only one glass a day, then this research won't change your life. However, if you hate red wine but have been drinking it daily to improve your survival chances, then this is good news. You can throw out the Beaujolais and stock up on Chablis or light beer. You can even switch to an ounce of sour mash each night and still feel virtuous. But remember -- one drink only.


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