The truth behind alcohol and sudden cardiac death

The Truth Behind Alcohol and Sudden Cardiac Death

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I think we all know that too much alcohol is not a good thing. It gives us a hangover, decreases our ability to make decisions, and impairs our motor skills and judgment. And then there are the health repercussions, such as liver damage and cirrhosis, if drinking chronically. But what’s the truth behind alcohol intake and sudden cardiac death?

Is this something that happens at an alarming rate? What’s the most common cause of sudden cardiac death? Is it dependent on how much or how often we consume alcohol? Does it even matter what type of alcohol we consume? What other heart-related damages can consuming alcohol lead to?

Ready to read what the research states? Let’s dive in by first explaining what sudden cardiac death is.

Note: If you or a loved one has a problem with alcohol intake, it may be difficult to know what to do. >> Click here to view some “Helpful Resources for Alcohol Abuse & Recovery”. <<

What is Sudden Cardiac Death (SCD)?

Sudden cardiac death, or sudden cardiac arrest, is death that occurs due to a cardiovascular cause. It usually happens within an hour of having symptoms. The heart will either stop beating or not beat adequately enough to maintain your normal functioning.

Symptoms of SCD

While the only symptoms of sudden cardiac death are a lack of breathing, responsiveness, and collapse, there are some warning signs you can look out for.

Any of the following symptoms should be a red flag:

  • Chest pain or pressure
  • Heart palpitations
  • Abnormal heart beating
  • Wheezing or shortness of breath
  • Fainting or near fainting
  • Becoming lightheaded or dizzy

What is the Most Common Cause of Sudden Cardiac Death?

Depending on your age and previous medical history, the most common cause of sudden cardiac death differs. In most cases, coronary artery disease (CAD) is the most common cause, accounting for about 80% of cases.

For cases of non-ischemic sudden cardiac death (meaning it is not involving an inadequate blood supply), the most common causes include:

  • cardiomyopathy related to obesity
  • alcoholism
  • fibrosis

And for those under the age of 35 years, the most common cause is fatal arrhythmia. However, there are also additional causes that may lead to SCD such as congenital diseases, heart failure, valve disease, ischemic heart disease, or dysfunctions in the ion channels of one’s heart.

Relationship Between Alcohol and Sudden Cardiac Death

There is quite a bit of literature out there that shows the relationship between alcohol intake and effects on the cardiovascular system. The research is conflicting. However, research thus far show that the amount of alcohol consumed seems to be one of the most important things to consider.

What is a Standard Serving Size?

According to the National Institute on Alcohol Abuse and Alcoholism, a standard alcoholic beverage is 14 gm alcohol per serving. This is equivalent to:

  • One 12-ounce regular beer
  • 8-9 ounces of malt liquor
  • 5 ounces of wine
  • 1.5 ounces of 80-proff distilled spirits
  • 1 ounce of 100-proof spirits

The alcohol content of these serving sizes also plays a factor. See the image below to view the standard alcohol percentages of these servings.

standard alcoholic beverage size

With Light to Moderate Alcohol Intake

Some research shows cardiovascular benefits with light to moderate alcohol intake. However, other studies report no benefit and even some risk with light alcohol intake.

While you should use caution and common sense when consuming alcohol, I will still discuss some of the reported effects, albeit questionable, of light to moderate alcohol intake. These include:

  • A lowered risk of cardiovascular disease and all-cause mortality
  • Increased HDL cholesterol level

Lowers Risk of Cardiovascular Disease and All-Cause Mortality

The American College of Cardiology has reported that light to moderate alcohol intake may decrease overall all-cause mortality and cardiovascular disease.

One specific study of 333,247 participants obtained through the National Health Interview Surveys from 1997 to 2009, shows benefits with light to moderate intake. However, researchers made sure to state that the balance between alcohol intake and associated health benefits is very “delicate”.

In fact, their research show a J-shaped relationship between alcohol consumption and mortality. This means there is initially a low risk which quickly increases to a high risk as number of alcoholic beverages consumed increases.

Moderation is the key word. This specific study defines light alcohol intake as: less than 3 drinks per week. And moderate alcohol intake is: more than 3 drinks per week to less than 14 drinks per week for men, and less than seven drinks per week for women.

Increases HDL “Good” Cholesterol

Once you consume alcohol, it is processed in your liver and reconstructed as cholesterol and triglycerides. This is why heavy drinkers tend to have high triglyceride levels. As you can imagine, this is not a good thing. As high triglyceride levels can lead to other health issues such as pancreatitis, stroke, and diabetes.

But some studies link light to moderate alcohol intake with an increase in high density lipoprotein (HDL) cholesterol level. HDL cholesterol acts to absorb other forms of cholesterol, including low density lipoprotein (LDL) cholesterol, which is associated with build up of a waxy substance on blood vessel walls. This build up can cause blockages leading to atherosclerosis. As atherosclerosis progresses, it leads to heart attack or stroke.

However, while higher HDL cholesterol levels are associated with a lower risk of heart disease. There is an upper limit and range to which you should aim for.

It used to be thought that the higher your HDL level, the better. Recent literature however, shows the opposite. A very high HDL may be a risk factor for all-cause death.

Therefore, HDL levels between 41 and 60 mg/dL are optimal. See the chart below for optimal levels of HDL cholesterol.

At-Risk HDL LevelDesirable HDL Level
MenLess than 40 mg/dL41 to 60 mg/dL
WomenLess than 50 mg/dL41 to 60 mg/dL

With Chronic Heavy Alcohol Intake

The results are in. The only outcomes you’ll get with heavy alcohol intake are negative ones. As far as the cardiac repercussions, they include, but are not limited to:

  • Sudden cardiac death
  • Irregular or abnormal heart rhythms (atrial fibrillation)
  • Cardiomyopathy and heart failure
  • Stroke

Sudden Cardiac Death from Alcohol

With heavy alcohol intake, one study shows the population at highest risk of sudden cardiac death are men aged 50-59 years old. Heavy alcohol use in this study, is defined as more than 6 drinks per day.

The same risk is also seen in women. Lowest risk for women is seen with 1.5 drinks per day or less according to one report.

Studies on both men and women are still conflicting on the association between alcohol intake and SCD. Some research shows an initial benefit with light alcohol intake while others do not.

Abnormal Heart Rhythms from Alcohol

Many of the negative effects from alcohol intake are related to its arrhythmogenic properties. Meaning the more alcohol you consume, the more irregular or abnormal heart rhythms you are likely to have, called atrial fibrillation. Even small amounts of alcohol have been shown to trigger arrhythmia episodes.

Cardiomyopathy and Heart Failure from Alcohol

Long-term heavy alcohol use can weaken and thin the heart muscles. This is because chronic alcohol use can change the shape of your heart by stretching it, enlarging the ventricles of your heart. This makes it harder for your heart to pump properly.

If your heart cannot pump properly, your body cannot get enough oxygen.

Physical signs of alcoholic cardiomyopathy and heart failure may include:

  • Swelling to your legs, ankles or other extremities
  • Bulging of neck veins
  • Crackling sound in your lungs (when listening with a stethoscope)
  • Heart murmur (whooshing or swishing sound when listening with a stethoscope)

Stroke from Alcohol

Alcohol increases your risk of having a stroke for a few reasons. Most of which involve increasing risk factors of stroke. For example, alcohol intake:

  • Increases blood pressure
  • Causes weight gain, leading to obesity
  • Increases risk of atrial fibrillation
  • Makes controlling blood sugars more difficult

According to one 2019 study, “alcohol contributed to 8% of all strokes caused by a clot in the brain and 16% of bleeding strokes”.

And like most other studies, the more you drink, the higher your risk seems to be.

Does Type of Alcohol Being Consumed Matter?

The short answer to this is NO. There does not seem to be any difference in risk for sudden cardiac death in terms of type of alcohol consumed.

Whether you are drinking beer versus wine versus hard liquor, your body reacts to alcohol the same way.

What About Red Wine?

You’re probably thinking that red wine is good for you. It contains antioxidants, such as resveratrol and proanthocyanidins. Studies link these powerful components to decreased oxidative stress and reduced risk of heart disease and certain cancers.

However, while these components have been shown to yield benefits, you would have to consume large amounts of red wine in order to reap the benefits. With that in mind, it’s likely best to get your resveratrol from supplement form.

In addition, newer studies report that the benefits seen from red wine drinkers may be attributed to their lifestyle characteristics. For example, those who drink red wine are also less likely to smoke, have lower obesity rate, and may consume more fruits and vegetables than those that do not drink red wine.

Just more reason to look at the bigger picture when it comes to your health.

So when it comes to red wine, my recommendation is to use caution and drink only in light to moderate amounts.

Does Frequency of Alcohol Consumption Matter?

You might think, “I don’t drink large amounts everyday, so this doesn’t apply to me.” However, you may not be aware of a condition called holiday heart syndrome.

This condition is defined as alcohol-induced arrhythmias. It most often occurs after a combination of binge drinking and eating unhealthy foods around the holidays.

Symptoms of holiday heart syndrome may include:

  • Heart palpitations or flutters
  • Lack of energy
  • Dizziness or lightheadedness
  • Chest discomfort, pain, or pressure
  • Shortness of breath during normal activities or even while at rest

Therefore, moderation is encouraged even around the holidays. It is more than possible to develop serious heart problems drinking only once or twice a year, depending on how much you consume.

Help for Alcohol Abuse

If you or someone you know has a problem with drinking, you may be doing irreparable damage.

There are many resources available to you, such as the one’s I have listed for you below. Check out these “Helpful Resources for Alcohol Abuse & Recovery” to get support now.

Conclusion

The literature on this topic is fuzzy. Some studies show that cardiovascular risk increased no matter the amount of alcohol consumed. Other studies show that the risk is only when consuming excessive amounts. And still others show actual cardiovascular benefits from light to moderate alcohol intake.

While the overall consensus varies on how much alcohol is acceptable, you still have to consider your own situation. There are short-term effects, long-term effects, and even situational and circumstantial events that may put you at higher risk.

Type of alcohol being consumed does not seem to matter much, but the amount and other factors do. For example, do you already have some cardiovascular risk factors? Any other medical conditions? What is your gender?

Therefore, my suggestion is to consider the full picture when deciding to have a drink or more. You should be able to enjoy your occasional alcoholic beverage of choice, if that’s what your heart desires. However, practice moderation and don’t overdo it. Chances are, once you get to the point of starting to feel negative effects, you’ve reached the breaking point. Be smart and take care my friends.

And if you or a loved one needs help with their alcohol use, get the support you need ASAP.

References

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  2. Ding, C., O’Neill, D., Bell, S. et al. Association of alcohol consumption with morbidity and mortality in patients with cardiovascular disease: original data and meta-analysis of 48,423 men and women. BMC Med 19, 167 (2021). https://doi.org/10.1186/s12916-021-02040-2
  3. https://www.health.harvard.edu/blog/alcohol-and-heart-health-2018070614199
  4. Roth, S. Light-to-Moderate Alcohol Consumption May Have Protective Health Effects. American College of Cardiology. Published August 14, 2017. Accessed May 25, 2022. Available at: https://www.acc.org/about-acc/press-releases/2017/08/14/14/04/light-to-moderate-alcohol-consumption-may-have-protective-health-effects#:~:text=Light%2Dto%2Dmoderate%20drinking%20can,the%20American%20College%20of%20Cardiology.
  5. Khan SS, Fonarow GC. Very Elevated High-Density Lipoprotein Cholesterol and Mortality—The Good Gone Bad? JAMA Cardiol. Published online May 18, 2022. doi:10.1001/jamacardio.2022.0924
  6. Fernández-Solà, J. Cardiovascular risks and benefits of moderate and heavy alcohol consumption. Nat Rev Cardiol 12, 576–587 (2015). https://doi.org/10.1038/nrcardio.2015.91
  7. Chiuve, S, et al. Light-to-moderate alcohol consumption and risk of sudden cardiac death in women. Sudden Cardiac Arrest Clinical. 2010; 7(10):1374-1380. doi:https://doi.org/10.1016/j.hrthm.2010.05.035
  8. Das DK, Mukherjee S, Ray D. Erratum to: resveratrol and red wine, healthy heart and longevity. Heart Fail Rev. 2011;16(4):425-435. doi:10.1007/s10741-011-9234-6
  9. Brown L, Kroon PA, Das DK, et al. The biological responses to resveratrol and other polyphenols from alcoholic beverages. Alcohol Clin Exp Res. 2009;33(9):1513-1523. doi:10.1111/j.1530-0277.2009.00989.x
  10. Brown KN, Yelamanchili VS, Goel A. Holiday Heart Syndrome. [Updated 2022 Feb 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537185/

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