Should Physicians Counsel Their Patients to Consume Alcohol for Cardiovascular Health?

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The May 29, 1999, issue of the British journal The Lancet includes a thoughtful letter from two physicians in the state of Washington who pondered how to respond when a patient asks "Doctor, is wine good for my heart?"

Studies conducted in many parts of the world have consistently shown an association between the moderate consumption of alcoholic beverages and a decrease in the risk of developing coronary heart disease (CHD). This relationship has been observed in both men and women and in different age, ethnic, and geographic groups. It is independent of dietary and other known risk factors for heart disease, such as smoking and obesity.

The amount of alcohol that one must ingest to decrease one's CHD risk is not large. The daily consumption of one or two standard servings of an alcoholic beverage is associated with a decrease in CHD risk of at least 30 percent. Some studies have shown that higher intakes are not associated with further decreases in CHD risk. Indeed, to get the full preventive effect of alcohol, a daily intake of as little as half the standard serving of a drink is probably enough. And the daily ingestion of alcohol in small quantities is more protective against heart disease than is the occasional ingestion of alcohol in relatively large amounts.

Researchers have hypothesized that regular alcohol consumption is cardioprotective in at least two ways: It increases HDL-cholesterol (so-called good cholesterol), and it inhibits blood clotting.

The evidence that moderate alcohol consumption is healthful is ample and consistent. Should physicians therefore recommend such consumption to their patients? In The Lancet, Washington physicians Katherine Bradley and Joseph Merrill stated: "No patient should be advised to start drinking or to increase alcohol consumption." But many doctors disagree with them. Indeed, some physicians regard nonconsumption of alcohol as among the modifiable risk factors for heart disease (which include cigarette smoking, elevated serum cholesterol, and high blood pressure). While there is no consensus among physicians on whether to inform their patients of healthful effects of moderate alcohol consumption, all concur that the notion "If a little is good, a lot is better" is not applicable to alcoholic beverages.

(From Priorities, Vol. 11, No. 3)