Charleston, SC - People who newly begin consuming moderate amounts of alcohol in middle age experience a relatively prompt benefit of lower rates of cardiovascular disease morbidity, a new study suggests [1].

The study, published in the March 2008 issue of the American Journal of Medicine, was conducted by a group led by Dr Dana King (Medical University of South Carolina, Charleston).

They explain that several epidemiologic studies have concluded that moderate alcohol intake is associated with reduced cardiovascular risk, but whether such findings should be used to modify healthcare recommendations about initiation of alcohol use in middle age remains controversial. The American Heart Association guidelines state that moderate alcohol consumption is beneficial for cardiovascular health but that nondrinkers should not begin drinking alcohol in middle age due to the possible counterbalancing ill consequences of alcohol consumption. For example, alcohol intake has been associated with an increased risk of hypertension, motor vehicle crashes, certain types of cancer, liver disease, and other problems.

King et al suggest that recommendations about initiating moderate alcohol consumption in middle age should be made cautiously on a case-by-case basis in consultation with a personal physician, but the strength of such recommendations may be altered if more research supports the idea that initiating moderate alcohol consumption is beneficial.

To further examine this issue, they analyzed participants in the Atherosclerosis Risk in Communities (ARIC) study, a prospective epidemiologic study of men and women aged 45 to 64 years at enrollment in four US communities. They identified 7697 participants who were nondrinkers at baseline. Of these, 6% started drinking moderate amounts of alcohol (defined as two drinks per day or fewer for men and one drink per day or fewer for women) during the initial six-year assessment. The whole group was followed for an additional four years, and those who had started drinking were compared with those who continued not to drink any alcohol.

Results showed that the new moderate drinkers had a 38% lower chance of developing cardiovascular disease (defined as cardiovascular death, MI, diagnosed CHD, a CHD procedure, or a definite or probable stroke) than did their persistently nondrinking counterparts, a difference that remained after adjustment for demographic and cardiovascular risk factors. There was, however, no difference in all-cause mortality between the new drinkers and the nondrinkers.

The new drinkers also showed a modest improvement in HDL-cholesterol levels and no adverse effect on blood pressure. The researchers say that these data support the idea that initiating alcohol use in middle age may have an overall positive impact on cardiovascular health and that, for carefully selected individuals, a "heart-healthy diet" may include limited alcohol consumption, even among individuals who have not included alcohol previously. But they warn that starting drinking is not recommended to anyone with a personal history of problem drinking, cirrhosis, liver disease, depression, gastric or duodenal ulcers, and many other conditions that could be exacerbated by drinking alcohol.

King commented to heartwire: "Our results showed a 38% reduction in cardiovascular events in those who had started drinking, which was not explained by differences in age, gender, race, education, exercise, body mass index, or a history of diabetes, hypertension, or hyperlipidemia. Many previous studies have suggested that modest alcohol consumption is protective to the cardiovascular system, but our study was novel in that it included just middle-aged people who had not drunk alcohol before.

"We are not recommending yet that people take up drinking on the basis of these results, but I would advise perhaps that they could consider doing so. But moderation is the important word here. Alcohol may be good for you, but not in large quantities. Seven to 14 units a week may be beneficial, but it is definitely not advisable to drink all these units in one evening. One to two units per day is the way to go," he said.

King said he would like to follow the population for longer, but that this would depend on the public release of additional data from the ARIC study. His next project is a prospective study in which current nondrinkers are assigned to specific quantities of either wine or grape juice for a three-month period, and various biochemical markers measured, including CRP, IL-6, TNF-alpha, isoprostanes, glutathione, and lipids. This is hoped to shed more light on the mechanism behind the suggested cardiovascular benefit of moderate alcohol consumption.