How does drinking alcohol affect my risk of heart failure?
The heavy, long-term use of alcohol can damage the heart muscle by causing it to weaken and stretch, resulting in a condition called alcoholic cardiomyopathy.1-3 Alcoholic cardiomyopathy, also called alcoholic heart muscle disease, can eventually lead to heart failure in both women and men.1-4 It is not known exactly how long-term, heavy drinking damages the heart, but about 4% of all heart muscle diseases are caused by alcohol abuse.1 Alcoholic cardiomyopathy is generally caused by the long-term consumption of at least 6 alcoholic drinks a day (about the same as one bottle of wine).5 A woman who drinks a bottle of wine a day for 20 years is at risk of developing alcoholic cardiomyopathy.1, 3
The majority of alcoholic cardiomyopathies happen in men because men have a higher rate of alcohol abuse than do women.1, 6 However, women seem to be more sensitive than men to the toxic effects of alcohol. Women have a higher amount of alcohol in their blood after drinking the same amount as men, so their hearts are exposed to more alcohol. A small study of 200 adults (half were women) found that women who drank about 60% of what men drank had the same risk as men of developing alcoholic cardiomyopathy.3
Drinking alcohol heavily for a long time can also raise your blood pressure and increase your risk of developing many other medical problems linked to heart failure, including atrial fibrillation, obesity, and stroke.7
If you drink alcohol, do so in moderation. If you don't drink alcohol, don't start. Some doctors advise women at high risk for heart failure, or who already have heart failure in its early stages, to stop drinking alcohol completely to prevent gradual damage to the heart.
How much alcohol is too much?
According to the 2005 Dietary Guideline for Americans, heavy drinking means more than 1 drink daily for women and 2 for men. Moderate drinking for women means having no more than 1 drink a day. The following count as 1 drink: 5 fluid ounces of wine, 12 fluid ounces of beer, or 1.5 fluid ounces of 80-proof spirits such as whisky or vodka.
Is drinking alcohol more harmful for women than men?
Women's hearts and other organs are exposed to more alcohol even if they drink the same amount as men. Women tend to have a higher concentration of alcohol in the blood because women, being smaller than men, have less water in their bodies with which to dilute the alcohol. A woman's body also breaks down alcohol more slowly, so the toxins stay in a woman's body longer. This is why the drinking limit for women (no more than 1 drink a day) is lower than for men (no more than 2 drinks a day).
Women seem to be more vulnerable than men to the development of alcoholic cardiomyopathy (heart muscle disease) and other medical consequences of alcohol, despite drinking less than men.3, 4, 8, 9
Is moderate drinking harmful?
Light-to-moderate drinking—no more than 1 drink a day—isn't considered harmful for most women. Some studies have found that light-to-moderate drinking may actually slightly lower the risk of developing heart failure.9-13 Exactly how this happens isn't clear, but the moderate consumption of alcohol has been found to reduce the risk of coronary artery disease and heart attack, major risk factors for heart failure, in women and men.14, 15 Alcohol has also been shown to increase HDL ("good") cholesterol, decrease LDL ("bad") cholesterol, and reduce clot formation.14, 16 Most news reports have concentrated on the benefits of red wine, but the choice of alcoholic beverage is not as important as limiting the quantities to no more than one drink a day.
However, these benefits need to be weighed against the small risk of developing breast cancer that may be associated with alcohol, even with an amount as small as one drink a day in some cases.17-19 Women who have a strong family history of breast cancer and postmenopausal women who use hormone therapy may be particularly at risk, and need to carefully discuss the risks and benefits of moderate drinking with their doctors.19 Likewise, women who have a personal or family history of alcohol addiction or liver disease should avoid drinking alcohol.
I don't drink alcohol. Should I start having one drink a day to protect my heart?
Having one drink a day may help protect against heart disease. However, the American Heart Association recommends against nondrinkers starting drinking as a way to protect their heart because it is not known who may be at risk for alcohol abuse. Having two or more drinks actually increases your risk of heart disease (including heart failure), stroke, high blood pressure, breast cancer, and other serious health problems.1 Your doctor can help you decide whether you may benefit from having one drink a day.
Pregnant women should avoid alcohol, as should women with a strong personal or family history of alcoholism, uncontrolled high blood pressure, liver disease, or inflammation of the pancreas (pancreatitis). Alcohol may also interact badly with some medications.
The best way to improve your heart's health is by eating a heart-healthy diet, being more physically active, keeping a healthy weight, and not smoking.
Will quitting alcohol help prevent heart failure?
If you are a heavy drinker, the sooner you stop, the better it will be for your heart. Studies of longtime, heavy drinkers who developed alcoholic cardiomyopathy have shown that abstinence can improve the heart's pumping action and reduce the heart muscle damage caused by alcohol abuse.20, 21 However, if the damage to the heart is too severe and extensive, it may not be possible to reverse it and improve the heart's pumping ability. The studies did not provide women-specific information.
Illicit Drugs & Heart Failure
The heart is a hard-working muscle, and is often the first muscle affected by toxins, including illicit drugs. Illicit drugs are drugs that are illegal to have, use, or sell; about 11% of women aged 18 or older used an illicit drug in 2007.22 The use of illicit drugs—particularly cocaine and amphetamines (for example, methamphetamine)—may increase the risk of heart failure.23
Cocaine is very toxic to the heart.24 When a person uses cocaine he or she is 24 times more likely to suffer a heart attack in the next 60 minutes.25, 26 About one third of people with cocaine-induced heart attacks develop heart failure or heart rhythm disorders.27, 28 The long-term use of cocaine can also cause the heart muscle to stretch and sometimes thicken, limiting the heart's ability to fill with and pump out blood.24, 25
- Piano MR. Alcoholic Cardiomyopathy: Incidence, Clinical Characteristics, and Pathophysiology. Chest. May 1, 2002;121(5):1638-1650.
- Piano M. Effects of gender on alcohol's heart dysfunction. In: Watson R.R., Myers AK, eds. Alcohol and Heart Disease. London and New York: Taylor & Francis; 2002:28-47.
- Urbano-Marquez A, Estruch R, Fernandez-Sola J, Nicolas JM, Pare JC, Rubin E. The greater risk of alcoholic cardiomyopathy and myopathy in women compared with men. JAMA. July 12, 1995;274(2):149-154.
- Fernandez-Sola J, Estruch R, Nicolas J.M., et al. Comparison of Alcoholic Cardiomyopathy in Women Versus Men. Am J Cardiol. 1997;80(4):481-485.
- Heart Failure Society Of, America. HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail. Feb 2006;12(1):10-38.
- Pleis JR, Lethbridge-Cejku M. Summary Health Statistics for US Adults: National Health Interview Survey, 2006. National Center for Health Statistics. Vital Health Stat. 2007;10(235).
- Schocken DD, Benjamin EJ, Fonarow GC, et al. Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation. May 13, 2008;117(19):2544-2565.
- Fernandez-Sola J, Nicolas-Arfelis JM. Gender differences in alcoholic cardiomyopathy. J Gend Specif Med. Jan-Feb 2002;5(1):41-47.
- Lund LH, Mancini D. Heart failure in women. Med Clin North Am. Sep 2004;88(5):1321-1345, xii.
- He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK. Risk Factors for Congestive Heart Failure in US Men and Women: NHANES I Epidemiologic Follow-up Study. Arch Intern Med. April 9, 2001;161(7):996-1002.
- Bryson CL, Mukamal KJ, Mittleman MA, et al. The Association of Alcohol Consumption and Incident Heart Failure: The Cardiovascular Health Study. J Am Coll Cardiol. July 18, 2006;48(2):305-311.
- Walsh CR, Larson MG, Evans JC, et al. Alcohol Consumption and Risk for Congestive Heart Failure in the Framingham Heart Study. Ann Intern Med. February 5, 2002;136(3):181-191.
- Abramson JL, Williams SA, Krumholz HM, Vaccarino V. Moderate Alcohol Consumption and Risk of Heart Failure Among Older Persons. JAMA. April 18, 2001;285(15):1971-1977.
- O'Keefe JH, Bybee KA, Lavie CJ. Alcohol and Cardiovascular Health: The Razor-Sharp Double-Edged Sword. J Am Coll Cardiol. September 11, 2007;50(11):1009-1014.
- Mukamal KJ, Jensen MK, Gronbaek M, et al. Drinking Frequency, Mediating Biomarkers, and Risk of Myocardial Infarction in Women and Men. Circulation. September 6, 2005;112(10):1406-1413.
- Freiberg MS, Samet JH. Alcohol and Coronary Heart Disease: The Answer Awaits a Randomized Controlled Trial. Circulation. September 6, 2005;112(10):1379-1381.
- Longnecker MP. Alcoholic beverage consumption in relation to risk of breast cancer: meta-analysis and review. Cancer Causes Control. January 1994;5(1):73-82.
- Smith-Warner SA, Spiegelman D, Yaun S-S, et al. Alcohol and Breast Cancer in Women: A Pooled Analysis of Cohort Studies. JAMA. February 18, 1998;279(7):535-540.
- Horn-Ross PL, Canchola AJ, West DW, et al. Patterns of Alcohol Consumption and Breast Cancer Risk in the California Teachers Study Cohort. Cancer Epidemiol Biomarkers Prev. March 1, 2004;13(3):405-411.
- Nicolas JM, Fernandez-Sola J, Estruch R, et al. The Effect of Controlled Drinking in Alcoholic Cardiomyopathy. Ann Intern Med. February 5, 2002;136(3):192-200.
- Ballester M, Marti V, Carrio I, et al. Spectrum of alcohol-induced myocardial damage detected by indium-111-labeled monoclonal antimyosin antibodies. J Am Coll Cardiol. January 1, 1997;29(1):160-167.
- Substance Abuse and Mental Health Services Administration--Results from the 2007 National Survey on Drug Use and Health: National findings (Office of Applied Studies). http://www.oas.samhsa.gov/nsduh/2k7nsduh/2k7Results.pdf, 2008.
- Diercks DB, Fonarow GC, Kirk JD, et al. Illicit Stimulant Use in a United States Heart Failure Population Presenting to the Emergency Department (from the Acute Decompensated Heart Failure National Registry Emergency Module). Am J Cardiol. 2008;102(9):1216-1219.
- McCord J, Jneid H, Hollander JE, et al. Management of Cocaine-Associated Chest Pain and Myocardial Infarction: A Scientific Statement From the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation. April 8, 2008;117(14):1897-1907.
- Lange RA, Hillis LD. Cardiovascular Complications of Cocaine Use. N Engl J Med. August 2, 2001;345(5):351-358.
- Mittleman MA, Mintzer D, Maclure M, Tofler GH, Sherwood JB, Muller JE. Triggering of myocardial infarction by cocaine. Circulation. Jun 1 1999;99(21):2737-2741.
- Afonso L, Mohammad T, D. T. Crack Whips the Heart: A Review of the Cardiovascular Toxicity of Cocaine. Am J Cardiol. 2007;100(6):1040-1043.
- Hollander JE, Hoffman RS, Burstein JL, Shih RD, Thode HC, Jr. Cocaine-associated myocardial infarction. Mortality and complications. Cocaine-Associated Myocardial Infarction Study Group. Arch Intern Med. May 22 1995;155(10):1081-1086.