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Moderate
Drinking is Good for the Heart, New Studies Say
Richard
Saltus
Two new reports strengthen the mounting evidence that moderate
drinking is good for the heart, with one study showing alcohol boosts
the odds of survival following a heart attack and the other that it
reduces the risk of heart failure in older people.
The reports show that one or two drinks
a day cut heart disease risk both in healthy people and in those who
already have heart disease.
Those who don't drink at all and people
who are heavy drinkers are at higher risk of death than those who
drink moderately.
While reassuring to moderate drinkers,
the studies create a dilemma for teetotalers and their physicians.
That is, should doctors advise abstaining patients to take up
drinking, when there's a risk that some will go on to be
out-of-control problem drinkers?
``I think, by and large, very few of
these people (abstainers) should change,'' especially since many
teetotalers are motivated by strong religious or cultural beliefs,
said Dr. Arthur Klatsky, a cardiologist at the Kaiser Permanente
Medical Center in Oakland, Calif.
The two research reports and an
editorial in the current Journal of the American Medical Association
are the latest in an estimated 70 to 80 studies showing that moderate
alcohol use lessens the risk of heart attacks, strokes caused by blood
clots and clots that block circulation in the legs.
In the first study, Dr. Kenneth J.
Mukamal of Beth Israel Deaconess Medical Center and Harvard Medical
School in Boston led a team that interviewed 1,913 patients at 45
hospitals shortly after being admitted with a heart attack. The
researchers asked about their drinking pattern in the previous year,
and then monitored their health over the next four years.
Forty-seven percent of the patients
said they didn't drink at all, 36 percent reported seven drinks or
fewer a week (light drinkers) and 17 percent consumed seven or more
drinks a week (moderate drinkers). Only a small number of people
reported they had three drinks a day, and they were excluded from the
analysis.
After four years of follow-up, deaths
among light drinkers were 20 percent less than among teetotalers, and
moderate drinkers' deaths were 30 percent less than among teetotalers.
The patients' drinking habits weren't
monitored following their heart attacks: Researchers assumed that
their pre-heart attack drinking pattern continued after they
recovered.
The drinkers survived longer mainly
because they had fewer subsequent heart attacks. In contrast to some
previous studies suggesting that red wine has a more protective effect
than other alcoholic beverages, the study showed no difference among
those who drank beer, wine or hard liquor.
Moderate alcohol consumption increases
the levels of ``good'' HDL cholesterol in the blood and helps prevent
blood clots. The researchers had to adjust their analysis to take into
account that moderate drinkers tend to be healthier, better educated
and more affluent than nondrinkers, and so would be less likely to die
from heart disease even without the alcohol effects.
In the second study, researchers from
Emory University in Atlanta asked 2,235 elderly people about their
alcohol consumption, then followed their health for up to 14 years.
The light and moderate drinkers were less likely to develop heart
failure, a common illness among older people where the heart's left
pumping chamber, or ventricle, becomes weakened and patients get short
of breath. It can be fatal and is a leading cause of hospitalization
in older people.
Klatsky, who wrote an editorial
accompanying the two reports, said the findings would seem to say that
people who have had heart attacks or weakened left ventricles should
be advised to drink moderately.
But, he pointed out, moderate drinking
isn't free of other risks, particularly in relation to fetal alcohol
syndrome, strokes caused by bleeding, colon cancer and breast cancer
in women. And no one can predict which teetotalers might become
problem drinkers if they began consuming alcohol.
The most important message, Klatsky
said, is that people who drink moderately need not be told to stop
drinking following a heart attack or if they have mild heart failure.
Many doctors, he said, have a hard time telling patients it's OK to
drink because they have ``moralistic attitudes.''
Dr. J. Michael Gaziano, a researcher at
Brigham and Women's Hospital in Boston, said the benefits of moderate
drinking haven't sunk in with many heart patients.
``I have patients who come in following
a heart attack and say, `I stopped smoking and I stopped drinking,
what else should I do?''' Gaziano said. ``I say to them, `I'm glad you
stopped smoking, but how much do you drink?'''
What to recommend about drinking
depends on the individual patient and how responsibly he or she has
been drinking, he said.
Even when giving a patient the green
light to continue moderate drinking, it's important to warn about the
problems of binge drinking and drinking and driving, ``which are major
causes of preventible death,'' he said.
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