“There has been an increasing prevalence of alcohol use among young and middle-aged women as women may feel they’re protected against heart disease until they’re older, but this study shows that even in that age group, women who drink more than the recommended amount of one drink per day or tend to binge drink, are at risk for coronary heart disease,” Jamal Rana, a cardiologist with the Permanente Medical Group and the study’s lead author, wrote in an email.
The study will be presented at the American College of Cardiology’s Annual Scientific Session in early April. It was funded by the National Institutes of Health (NIH) and the National Institute on Alcohol Abuse and Alcoholism.
Risk is highest for binge drinking
The study used data from 432,265 adults, ages 18 to 65, who received care in the Kaiser Permanente Northern California integrated health organization. The group was composed of about 243,000 men and 189,000 women who filled out routine assessments between 2014 and 2015 in which they reported their alcohol intake. Researchers then looked at the coronary heart disease diagnoses among participants over the four years that followed.
Participants were divided into three groups, according to their alcohol intake: low (one to two drinks per week), moderate (three to 14 drinks per week for men and three to seven drinks per week for women), or high (15 or more drinks per week for men and eight or more drinks per week for women).
Participants were also categorized as either engaging in binge drinking or not, with binge drinking being defined for men as having more than four drinks in a single day and for women as having more than three drinks a day, in the prior three months. Those who reported no alcohol use were not included.
During the four-year follow-up period, 3,108 participants were diagnosed with coronary heart disease. Higher levels of alcohol consumption were associated with a higher incidence of coronary heart disease. Both men and women who reported heavy episodic drinking, or binge drinking, had the highest risk.
The link between alcohol and coronary heart disease proved to be especially strong among women, the data showed.
Coronary heart disease, also known as coronary artery disease, is the most common type of heart disease in the United States, according to the Centers for Disease Control and Prevention. The disease develops when the arteries of the heart are unable to deliver enough oxygen-rich blood to the heart because of plaque buildup.
Heart disease is the No. 1 killer of American women, according to the CDC. Symptoms differ, and often there are none until people suffer from a heart attack or other problem, a NIH report said.
“There has long been this idea that alcohol is good for the heart, but more and more evidence is challenging that notion,” Rana wrote.
Alcohol is a risk factor for many health issues
Alcohol is actually a toxin to the heart, said Nieca Goldberg, a clinical associate professor of medicine at NYU Grossman School of Medicine and medical director of Atria New York City. Alcohol raises blood pressure, increases the risk for heart rhythm problems, especially during times of binge drinking, is associated with an enlarged heart and is a toxin to the heart muscle, she said.
“I think this is an important study to do because for a while, people thought that alcohol was protective against the heart because of earlier studies that were done in the past. But in fact, we don’t prescribe alcohol to fight heart disease,” she said.
Alcohol use is rising among women
The link between alcohol and heart disease for women is cause for concern, given that alcohol use among women is on the rise. While men used to drink more, studies over the past several years show that gap is closing.
Approximately 13 percent of adult women report binge drinking, with 25 percent of those women saying they do so at least weekly, on average, and 25 percent saying they consume at least six drinks during a binge drinking occasion, according to the CDC. A study in July in JAMA Network Open showed the number of alcohol-related deaths among women was rising at a faster rate than those among men, particularly for people 65 and older.
“I think this raises an important issue, because oftentimes, we think of heavy drinkers as men only. But we have to have heightened awareness that women may be heavy alcohol drinkers,” Goldberg said.
Occasional binge drinking can affect heart health
But it wasn’t just heavy drinkers who were affected, said Mary Ann McLaughlin, cardiologist at the Mount Sinai Fuster Heart Hospital. The study is interesting because it showed that even occasional drinking, if it reaches the level of binge drinking, can affect heart health, she said.
There are those who thought just drinking on the weekends was not a big deal, because they weren’t drinking every day, she said. “But the fact is, if they have more than four drinks as a woman or more than five drinks as a man on one day, in the past three months, they were at increased risk,” McLaughlin said.
Women are more adversely affected by alcohol
It is not a surprise that alcohol poses a higher risk for women than men when it comes to heart health, said C. Noel Bairey Merz, director of the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute at Cedars-Sinai.
Women are more adversely affected than men by a lot of things such as cigarettes and pharmaceuticals and a bottle of beer or a glass of wine, where the dosage for men and women is the same and yet women are smaller, she said, referring to women being physically smaller, on average. Women also metabolize differently, their blood pressure is different, their liver function is different, they even deposit fat differently, Merz said.
“Women and men are built differently,” she said, noting she wasn’t even referring to the obvious reproductive differences. “It could be that in addition to body surface area … there are just pure biological differences in how the alcohol is metabolized.”
It’s possible to mitigate some of the ill effects of alcohol, the experts said. For instance, when people reduce or stop drinking, their blood pressure can improve and some lose weight as alcohol is a sugar that is no longer being consumed.
But issues such as enlargement of the heart happen with long-term heavy drinking, and even if the person stops, that may not improve, they said.
“If one stops drinking, some of the risk could reverse,” McLaughlin said. “The degree of improvement would depend on the age of the person and number of years of drinking.”
