Alcohol and the Heart: Effects and Treatments
How Much Alcohol Is Recommended?
There is not a universally recognized “safe level” of alcohol consumption. Even moderate levels of drinking may pose a health risk, according to some studies. 2
However, the 2020-2025 Dietary Guidelines for Americans recommend that adults of legal drinking age can choose not to drink, or to drink at moderate levels, which is defined as limiting intake to 2 drinks or less in a day for men or 1 drink or less in a day for women, on days when alcohol is consumed.4
It is important to note, the Centers for Disease Control (CDC) and National Institute on Alcohol Abuse and Alcoholism both define a standard drink contains around 0.6 ounces of pure alcohol, which roughly translates to 12 ounces of 5% ABV (alcohol by volume) beer, 5 ounces of 12% ABV wine, or 1.5 ounces of 40% ABV distilled spirits (e.g., gin, vodka, rum, tequila, whiskey).2 ,3
Some people are advised to avoid alcohol altogether, including:2
- Women who are pregnant or may become pregnant
- If you are under the legal age for drinking.
- People with certain medical conditions.
- People who take medication that may interact with alcohol.
- If you are in recovery from alcohol use disorder (AUD) or can’t control the amount you drink.
- If you plan to drive, operate machinery, or participate in any activity that requires alertness and coordination.
Research indicates that excessive drinking can significantly increase the risk of short-term harm, such as injuries, as well as the risk of long-term health problems. 2,18 Binge drinking can increase an individual’s risk of developing an alcohol use disorder.18
- Binge drinking is a pattern of drinking alcohol that brings a person’s blood alcohol concentration (BAC) to 0.08 percent or higher. This pattern corresponds to an average adult consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours.
- Heavy drinking is defined as consuming 15 or more drinks a week (male) or 8 or more drinks a week (female).
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Effects of Alcohol on the Cardiovascular System
Heavy daily alcohol consumption and binge drinking increase the risk of developing cardiovascular disease.
Some of the cardiovascular conditions associated with high levels of alcohol use include:
- Increased blood pressure, or hypertension.
- Alcoholic cardiomyopathy (weakened heart muscle).
- Atrial fibrillation.
Increased Blood Pressure and Hypertension
Numerous studies have confirmed the association of drinking alcohol at higher than moderate levels with an increase in blood pressure. Binge drinking and chronic, heavy alcohol use is associated with high blood pressure or hypertension.
Consistently elevated blood pressure can cause your heart to have to work harder to pump blood, which can lead to increased stress on your heart.14 Over time, this can lead to a risk of serious cardiac problems such as stroke, heart attacks, heart failure, and coronary artery disease.15
Weakened Heart Muscle
Long-term heavy alcohol consumption can induce cardiomyopathy, a weakening and thinning of the muscles of the heart. When your heart muscle is weakened, it can’t pump blood to your organs efficiently. This can lead to shortness of breath, fatigue, weakness, muscular atrophy, swelling in the hands and feet, and can eventually lead to heart failure. 1,6,7,19
Continuing to drink, particularly heavily, can lead to worsening symptoms, arrhythmias, clots in the cerebral arteries, and ultimately heart failure. Survival is directly associated with the amount of alcohol use and duration of use, and data suggests that abstaining from drinking can result in improved outcomes and reduced inpatient hospital admissions.
Atrial fibrillation is a form of arrhythmia, which is an irregular, and often rapid or quivering heart rhythm.8 Binge drinking episodes are associated with a higher risk for more severe atrial fibrillation.10 Atrial fibrillation resulting from alcohol use typically resolves following abstinence, with additional episodes of heavy or binge drinking associated with more severe cardiovascular consequences, such as stroke or heart failure.18
Alcohol and Heart Disease
The conditions mentioned above can increase your risk of severe cardiovascular complications, including heart disease. While individual factors can play a role in cardiac conditions, binge drinking, and heavy alcohol use can significantly increase the risk of developing heart problems such as:
- Heart attack, or myocardial infarction. A heart attack can occur when part of the heart muscle isn’t getting enough blood. The more time that passes without blood flow to the heart, the greater the damage to the heart muscle. 1,6
- Stroke. A stroke can happen when blood supply to part of the brain is interrupted, which prevents the brain tissue from getting oxygen. Heavy drinking increases the risk for both hemorrhagic and ischemic strokes. 1,15
- Heart failure. Heavy alcohol use can lead to cardiomyopathy and atrial fibrillation, which can, over time, lead to heart failure.1,6
Studies suggest that continuing to drink when cardiovascular symptoms appear, particularly heavily, can increase the likelihood of more severe symptoms and death.1,19 Conversely, when faced with cardiovascular conditions arising from alcohol, abstinence can provide numerous benefits to your heart, including lowering high blood pressure, resolving atrial fibrillation, and improving cardiac function and prognosis.7 It is recommended to discuss your health situation with your primary care physician, who can conduct an evaluation to help determine the appropriate level of care and treatment for your specific needs.16
Finding Alcoholism Treatment
Choosing to start treatment for an alcohol use disorder can be an important step to improve your overall health and wellbeing. This can be especially important if you or someone you care about are struggling with alcohol misuse and have pre-existing or alcohol-associated heart conditions. As previously mentioned, chronic alcohol use can negatively impact your heart, increase your risk for many heart conditions, and potentially lead to death.7
Treatment can look different for everyone but often includes a combination of detox, inpatient or outpatient rehab, and continued care or aftercare. Most people benefit from some form of treatment.17 More than 30% of people who receive treatment for alcohol use disorder report no further symptoms one year later, while other people can reduce their alcohol use and report fewer alcohol-related problems, according to the NIAAA.16
- Piano, M. R. (2017). Alcohol’s effects on the cardiovascular system. Alcohol research: Current reviews, 38(2), 219–241.
- Centers for Disease Control and Prevention. (2020, December 29). Dietary guidelines for alcohol.
- National Institute on Alcohol Abuse and Alcoholism. (n.d.). What is a standard drink?
- Spaak, J., Tomlinson, G., McGowan, C. L., Soleas, G. J., Morris, B. L., Picton, P…& Floras, J. S. (2010). Dose-related effects of red wine and alcohol on heart rate variability. American journal of physiology. Heart and circulatory physiology, 298(6), H2226–H2231.
- Brunner, S., Drobesch, C., Herbel, R., & Sinner, M. F. (2021). Effects of acute alcohol consumption on cardiac excitation, conduction, and repolarization: results from the Munich Beer Related Electrocardiogram Workup Study (MunichBREW). Clinical research in cardiology, 110(6), 916–918.
- Zakhari, S. (1997). Alcohol and the cardiovascular system: molecular mechanisms for beneficial and harmful action. Alcohol health and research world, 21(1), 21–29.
- Maisch B. (2016). Alcoholic cardiomyopathy: The result of dosage and individual predisposition. Herz, 41(6), 484–493.
- Centers for Disease Control and Prevention. (2021, September 27). Atrial fibrillation.
- Chiva-Blanch, G., & Badimon, L. (2019). Benefits and risks of moderate alcohol consumption on cardiovascular disease: Current findings and controversies. Nutrients, 12(1), 108.
- American Heart Association. (2016, September 30). Tachycardia: Fast heart rate.
- Gopinathannair, R., & Olshansky, B. (2015). Management of tachycardia. F1000prime reports, 7, 60.
- American Heart Association. (2020, October 14). What is cardiomyopathy in adults?
- American Heart Association. (2016, October 31). How high blood pressure can lead to heart failure.
- Husain, K., Ansari, R. A., & Ferder, L. (2014). Alcohol-induced hypertension: Mechanism and prevention. World journal of cardiology, 6(5), 245–252.
- National Blood Clot Alliance. (n.d.). Atrial fibrillation (afib) and clot-provoked stroke.
- National Institute on Alcohol Abuse and Alcoholism. (2021, August). Treatment for alcohol problems: Finding and getting help.
- Chikritzhs T, Fillmore K, Stockwell T. A healthy dose of skepticism: four good reasonsto think again about protective effects of alcohol on coronary heart disease. Drug Alcohol Rev2009;28:441–4.
- National Institute on Alcohol Abuse and Alcoholism. (May 2021). What is Binge Drinking?
- Shaaban, A., Gangwani, M., Pendela, V. and Vindhyal, M., 2021. Alcoholic Cardiomyopathy.