As of Thursday, August 29, 2013
DEAR DOCTOR K: My husband recently had a mild heart attack. He’s never been much of a drinker, but now he wants to have wine with dinner every night because he’s heard that it’s good for the heart. What do you think?
DEAR READER: Not long ago a patient of mine, a 45-year-old man, asked me if he should have a drink every night to lower his risk of heart disease. I replied, “Absolutely.” A few months later, another man in his 40s asked me the same question. I replied, “I wouldn’t.”
Am I confused? No, they were two different people, and different advice can be needed for different people. There are few “one size fits all” answers in medicine.
Most people who drink alcoholic beverages regularly, and in moderation, have a reduced risk of heart attack. Many studies involving tens of thousands of people have shown that.
Although red wine gets most of the praise, regular moderate intake of white wine, beer and liquor all have similar effects. Moderate alcohol intake may protect the heart by boosting levels of HDL (“good”) cholesterol to a similar degree.
For men, the best “dose” is one to two drinks a day, counting 5 ounces of wine, 12 ounces of beer, or 1 1/2 ounces of liquor as one drink. Women should limit themselves to one drink a day. (Heavy drinking takes a toll on the heart and circulation, along with the liver and other organs.)
So moderate alcohol consumption is good for a healthy heart. But you are asking if it is safe or beneficial after a heart attack.
To find out, French scientists evaluated 353 men who had recovered from a first heart attack. They observed them from within two months of the attack for about four years. During that time, men who averaged two drinks a day were 59 percent less likely to have additional cardiovascular events than the men who abstained from alcohol. Heavier drinking was less protective.
Providing further evidence, a 2010 analysis of more than 16,000 patients found that moderate drinking is safe and beneficial for people with cardiovascular disease.
That’s reassuring — but it doesn’t necessarily mean that alcohol is right for your husband. Fortunately, moderate alcohol intake does not have a negative interaction with the medicines prescribed most often to heart attack patients: statins, beta blockers, ACE inhibitors and low-dose aspirin.
Why did I discourage one patient from having a drink each day? I knew the patient had gotten into trouble with alcohol when he was younger. For that reason, he no longer drank. While a drink a day probably would have reduced his risk of heart troubles, it might also have started him back on the road to alcohol abuse. And excessive alcohol use could have led to many health problems, including heart disease.
Alcohol can have powerful effects on the body (and mind), for good or ill. Used in moderation, it can contribute to your husband’s continued recovery.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.