The Truth Behind Alcohol and Sudden Cardiac Death

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. However, there are other health repercussions to consider, including alcohol intake and sudden cardiac death.

In this article, I’ll cover common causes of sudden cardiac death, health damage from alcohol intake, how much alcohol may be too much, and more!

Are you ready to read what the research states? Let’s dive in!

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 (1). The heart will either stop beating or not beat adequately enough to maintain 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 of cardiac death, 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

For those under the age of 35 years, the most common cause of sudden cardiac death is fatal arrhythmia. However, there are additional causes that may lead to sudden cardiac death including:

  • congenital diseases
  • heart failure
  • valve disease
  • ischemic heart disease
  • 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 its effects on the cardiovascular system. The research is conflicting. However, a large body of evidence shows that the amount of alcohol consumed seems to be one of the most important things to consider (1, 2).

What is a Standard Serving of Alcohol?

According to the National Institute on Alcohol Abuse and Alcoholism, a standard alcoholic beverage is 14 gm of 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-proof distilled spirits
  • 1 ounce of 100-proof spirits

The alcohol content in 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. Such is the case with the Mediterranean diet which often includes red wine with meals. However, other studies report no benefit and even some risks with light alcohol intake.

While you should use caution when consuming alcohol, I will still discuss some of the reported beneficial 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 (2).

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

Their research shows 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 the number of alcoholic beverages consumed increases.

Moderation is the keyword. This specific study defines light alcohol intake as less than 3 drinks per week. 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.

High triglyceride levels can lead to other health issues such as pancreatitis, stroke, and diabetes (3).

However, some studies link light to moderate alcohol intake with an increase in the “good” high-density lipoprotein (HDL) cholesterol level.

HDL cholesterol acts to absorb other forms of cholesterol, including the “bad” low-density lipoprotein (LDL) cholesterol, which is associated with the 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. However, recent research shows the opposite to be true. 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.

Gender at birthAt-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

Studies show that the population at highest risk for sudden cardiac death with heavy alcohol intake are men aged 50-59 years old. Heavy alcohol intake in this study was defined as more than 6 drinks per day.

The same risk is seen in women with heavy alcohol intake. However, one study reports that the lowest cardiac death risk for women was seen with 1.5 drinks per day. This was an even lower risk than compared to women who abstained from drinking (4).

Overall, studies on both genders are 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 cardiac effects of alcohol 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 are shown to trigger arrhythmic episodes (5).

Cardiomyopathy and Heart Failure from Alcohol

Long-term heavy alcohol use can also weaken and thin your heart muscle. This is because chronic alcohol use can change the shape of your heart by stretching it and enlarging the ventricles of your heart (6). 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 for stroke. For example, alcohol intake may:

  • Increase blood pressure
  • Cause weight gain, leading to obesity
  • Increased risk of atrial fibrillation
  • Make 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” (7).

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 the type of alcohol consumed.

Whether you are drinking beer versus wine versus hard liquor, the impact on heart health does not appear to differ significantly.

What About Red Wine?

You’re probably thinking that red wine is good for you. It contains antioxidants, such as resveratrol, proanthocyanidins, and other polyphenols. Studies link these powerful components to decreased oxidative stress and a reduced risk of heart disease and certain cancers (8).

However, while these components show health benefits, you would need to consume large amounts of red wine to reap the benefits.

With that in mind, it’s best to get your resveratrol in supplement form or a variety of foods that contain resveratrol. For more on this, you can read my article on the Mediterranean diet.

In addition, research also suggests that wine drinkers may make healthier lifestyle decisions that impact health. For example, those who drink red wine are less likely to smoke, have a lower obesity rate, and may consume more fruits and vegetables than individuals who drink beer or spirits or those who abstain from alcohol.

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 every day, 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 arrhythmia. 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.

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 ones listed below. Check out these “Helpful Resources for Alcohol Abuse & Recovery” to get support now.

Conclusion

The literature on alcohol and sudden cardiac death is fuzzy. Some studies show that cardiovascular risk increases no matter the amount of alcohol consumed. Other studies report a risk only when consuming excessive amounts. Still others show actual cardiovascular benefits from light to moderate alcohol intake.

While the 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 a higher risk.

The type of alcohol being consumed does not seem to matter much, but serving size, alcohol proof, and number of drinks consumed do.

Other things to consider are any cardiovascular risk factors or medical conditions you have as well as your gender.

Always think about the bigger picture when deciding to consume alcohol. You should be able to enjoy an occasional alcoholic beverage of choice if that’s what your heart desires. However, practice moderation and don’t overdo it.

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

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