Alcohol and Heart Disease

Shortly after my internship at Walter Reed Army Medical Center in 1955, another myth was added to my
growing repertoire of what every young doctor should know.

The first had been the misguided promotion of the national low fat / low cholesterol diet. The second had been the ADA mandated diabetic diet in diabetes management and now, the merits of daily or moderate alcohol consumption in curtailing the risk of cardiovascular disease.

Having acquired a fair amount of pharmacology and physiology over the years, I have remained skeptical of these claims despite the glowingly positive reports of supposedly competently research studies. And now Joel Kauffman has done what very few have the time, inclination and background to do - he has done a much needed in-depth review of these studies and challenged their validity.

When I was undertaking the study of Biostatistics at Johns Hopkins in 1957 we had a saying as we sat at our mechanical calculators pulling the cranks, "Figures don't lie but liars figure." We realized that misrepresentation of statistical information rarely was intentional but, in our young minds then, those twisting the data whether intentional or not, were liars, at least in the functional sense.

Dr. Kauffman has reviewed dozens of epidemiological studies on the relationship of alcohol consumption to cardiovascular disease and found almost all studies were "fatally flawed" in basing their findings on relative rather than absolute risks.

Since we all are destined to die, a reduction in specific death rate from heart disease while increasing deaths from accidental injury is hardly a social gain. Most of these studies failed to show total death rates so gave a misleading view of the benefit (or loss) associated with alcohol consumption.

One of the few studies not flawed was that reported in 2001 by Theobald and all of the Karolinska Institute. The all-cause death rates are included in this group of some 28,000 volunteers studied for up to 20 years and the results are sobering (pardon the pun). End result was neither benefit nor gain - whether minimal drinker or heavy drinker the statistical difference is insignificant.

So if you like the effect of moderate alcohol intake you will continue after reading this knowing that in so doing you are not significantly hurting yourself. However, if you are not a drinker, please do not start because of any perceptions of health promotion for these are false.

There might be one additional, worthy comment on this subject, that should be mentioned - the use of alcohol for stress control. When one is consumed by sudden stress, a condition known to have dire consequences thoughout the body, if alcohol is all you have readily at hand, it is far better than nothing at all.

The reader is referred to the results of McElduff & Dobson cited by Kaufmann of the apparent benefit of 1-2 drinks in the 24 hours preceding a non-fatal myocardial infarction. At least one mechanism to explain this relationship is stress management.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

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