Two patients inquired about the benefits of alcohol consumption for their cardiac health.
He told them that an average of one drink a day helps the heart.
He said he didn't give it a second thought.
He saw a paper that changed his thinking about what to tell patients. He said the paper changed his life.
There is no level of drinking that does not increase the risk of heart disease. If people have an average of seven drinks a week, the risk is small. As the level of alcohol consumption increases, it increases quickly.
Dr. Krishna G. Aragam is a preventive cardiologist at Massachusetts General Hospital.
The study involved analyses of genes and medical data from 400,000 people who participated in the U.K. Biobank. The average age of the subjects was 57, and they reported consuming 9.2 drinks a week.
Moderate drinkers have less heart disease than heavy drinkers and abstainers, according to some researchers. The effect was also seen by Dr. Aragam and his colleagues. The reason is not that alcohol protects the heart. Light to moderate drinkers have other characteristics that decrease their risk, like smoking less, exercising more and weighing less than heavy drinkers.
Moderate drinkers are more healthy than nondrinkers. The Biobank study didn't ask why people drank. It tried to tease apart the effects of alcohol on the heart from the effects of other habits, behaviors and characteristics. The researchers used a randomization method.
People with certain genetic variations are more likely to drink heavier or lighter. The variant can be used in a study as the equivalent of randomly assigning people to abstain or drink at different levels. Researchers can ask if those with a variant that is linked to higher alcohol consumption have more heart disease and high blood pressure than those with a variant that is linked to lower alcohol consumption.
The investigators used statistical analysis to show a curve of risk with the genes that suggest they drink more. As the number of drinks increased, the risks of heart disease and high blood pressure increased, but they quickly gained steam, as people got into the abusive drinking range of 21 or more drinks a week.
The risks to an individual depend on whether or not the person has other conditions. A typical middle-aged person in the study who did not drink had an estimated 9 percent chance of having coronary heart disease, according to Dr. Aragam. A person who had one drink a day had a small chance. The risk increases quickly after that.
Observational studies of alcohol consumption and heart health used to show if the amount of drinking was linked to heart health.
Researchers say that such studies are only able to find correlation. The Biobank study's use of randomization is suggestive of causality.
We have to start thinking about the moderate ranges and inform patients accordingly, according to Dr. Aragam. If you choose to drink less, you will get most of your benefit if you drink seven drinks a week.
A large randomized clinical trial is the gold standard to assess the heart effects of drinking, according to the author of the study. The National Institutes of Health planned a study in which high risk people would be randomized to drink or not drink. The study was terminated because the researchers had inappropriate contact with the alcohol industry.
When a gold standard hasn't been done, or can't be done, mundian randomization techniques are helpful.
One recent study in Australia offered clues despite the difficulties in doing a randomized trial of drinking. A form of heart disease was involved in 140 people. Participants in the study drank an average of 17 drinks a week. A group of 70 people were asked to abstain and reduce their consumption to an average of two drinks a week. Those in the control group had a 1.2 percent incidence of the disease compared to only a small incidence for those randomized to abstain.
The new Biobank study made Dr. Hazen wonder about the effects of increased drinking during the Pandemic. The number of alcohol-related deaths shot up 25 percent in 2020 according to a recent report.
Blood pressure went up. Dr. Hazen and his colleagues found that it rose on average by 3 millimeter of mercury.
Dr. Hazen said they had no idea how it was happening.
Body weight changes did not account for the rise in blood pressure. In all 50 states and in Washington, D.C., the increase was a puzzle.
He has a new thought.
Oh, my gosh. Increased drinking may be the reason for the increase in blood pressure.
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