Alcohol Use Disorders (37) Do people understand the harms of alcohol? (9) How can they be better informed? (5)

9 February, 2024

Thank you Neil for bringing up the topic of cardio protection by consuming low amounts of alcohol, especially wine. [ ]

As a cardiologist I would like to add my “ 2 cents” to this topic.

A 2022 review article from the World Heart Federation ( ) has cast doubt on this claim.

The article states that the controversy over the role of low to moderate alcohol use and future heart attack relates to inconsistent results among the many studies on the topic.

Historically, studies have shown a J-shaped distribution of outcomes. The lowest rates of heart attacks have been in those with low to moderate alcohol consumption and higher rates in those who did not drink or have high rates of alcohol consumption.

However, new research has challenged this interpretation by not confirming the J point relationship in Chinese and Indian populations , where alcohol consumption is relatively lower, binge drinking is common and among people less than 55 years of age. Furthermore, there has been heterogeneity in the type and pattern of alcohol consumption in most parts of the world.

Research in the latest decade has led to major reversals in the perception of alcohol in relation to health in general and CVD in particular. These developments have prompted health authorities in a number of countries, e.g. the Netherlands, England and Australia, to lower their recommended amount of alcohol for low-risk drinking.

The WHF revision also states that: the use of red wine has been promoted through various diets as a “heart-healthy” beverage for the longest time. The presence of resveratrol in wine has been known for its cardioprotective characteristics in light to moderate drinkers. However, there are multiple reasons that the belief that alcohol is good for cardiovascular health is no longer acceptable:

- Such evidence has been based on observational studies

- No randomized controlled trials (RCTs) have confirmed health benefits of alcohol

- The presence of unaccounted confounding factors further weakens the quality of evidence

- Studies misclassify unhealthy exdrinkers as abstainers

- Most evidence is observed only in the Caucasian population

- Studies that show positive effects are funded by the alcohol industry.

The alcohol industry has also perpetuated misleading information about the benefits of drinking alcohol. This interference by the alcohol industry closely reflects the universally vilified activities of tobacco companies. Alcohol industries deceptively promote their products under the labels of “healthy” and “safe”. Portrayal of alcohol in print and electronic media as necessary for a vibrant social life has diverted attention from the harms of alcohol use. Youth-targeted advertisement and encouraging alcohol as “heart-healthy” have created a conducive environment for young adults to relate alcohol with ‘having a good time’. Contrary to this belief, evidence from all around the world exists to link alcohol with a range of non-communicable and infectious diseases.

In the same sense, the page of a prestigious US University such as John Hopkins University, raises doubts about the protective effect of wine.

Despite some studies have shown an association between moderate alcohol intake and a lower risk of dying from heart disease. It is very hard to determine cause and effect from those studies.

Perhaps people who sip red wine have higher incomes, which tend to be associated with more education and greater access to healthier foods. Similarly, red wine drinkers might be more likely to eat a heart-healthy diet.

There is some evidence that moderate amounts of alcohol might help to slightly raise levels of “good” HDL cholesterol. Researchers have also suggested that red wine, in particular, might protect the heart, thanks to the antioxidants it contains.

But you don’t have to pop a cork to reap those benefits. Exercise can also boost HDL cholesterol levels, and antioxidants can be found in other foods, such as fruits, vegetables and grape juice.

Therefore, I think we should be cautious when recommending the consumption of low amounts of wine to protect cardiovascular health.


HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Masters in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Biancos research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. ebianco AT