May 31, 2000 -- While it has long been known that wine 
and beer can help protect against heart disease, 
researchers now believe that alcohol, consumed in moderation, 
can even reduce the chances of having a repeat heart attack 
and improve longevity.

If you don't drink now, they caution, don't start. But 
people who do, particularly if they have had heart problems, 
should find the news reassuring.

A new study found there were fewer deaths among people 
who drank up to two alcoholic drinks per week, compared 
to those who did not drink at all. The most startling 
aspect of the finding is that the 7,000 or so people who 
were studied all had heart problems. In most cases, they 
had moderate to severe cases of heart failure, a condition 
in which the heart is not able to efficiently pump blood 
to the rest of the body.

Even in this group, the researchers found there were 
fewer deaths from heart attacks and heart failure among 
those who drank moderately. In fact, there were fewer 
deaths overall among the group of drinkers, compared to 
the teetotalers.

The findings mean that even people who've had heart 
attacks don't need to give up drinking, as long as they 
don't exceed two drinks a day, says Howard Cooper, MD, 
the lead researcher on the study, which was published in 
the Journal of the American College of Cardiology. Cooper 
is completing specialty training at the National Heart, 
Lung, Blood Institute, part of the National Institutes of 
Health in Bethesda, Md. Currently, most doctors advise 
such patients to quit drinking. 


"This is a very large group of patients, and I am sure 
that a lot of them would like to enjoy a glass of wine 
now and then," Cooper says. He adds that heart failure 
is the most common diagnosis among people over age 65 who 
are discharged from hospitals. 

"We have not had much data upon which to base our decision" 
about whether heart patients should drink, acknowledges 
J. Michael Gaziano, MD. Gaziano is a cardiovascular researcher 
at Brigham and Women's Hospital in Boston and an assistant 
professor at Harvard, who also studies the effect of alcohol 
on the heart. 

"I have a lot of patients who come to me and say, 'I had a 
heart attack a year ago and I gave up smoking and drinking.' 
I think it is safe to say they can still drink one to two 
drinks a day. That might not be harmful, and in fact, might 
provide some benefit," says Gaziano, who was not involved 
in the new study.

"I am reluctant to tell nondrinkers to start drinking," 
says Albert Lowenfels, MD, who commented on the study for 
WebMD. "It is not really a good public-health message to 
tell people it is OK to drink a little bit; it may even 
help your heart, because then everyone drinks a little bit 
more. You can reassure those that are drinking moderate 
amounts, but people are deceptive about how much they drink." 
Lowenfels is a professor of surgery and preventive medicine 
at New York Medical College in Valhalla.

Just how does alcohol help your heart? It's relatively 
simple -- it seems to raise HDL, or the so-called good 
cholesterol. What isn't yet known is how it elevates HDL. 

And the effect on HDL explains only about half of the 
reduction in heart-related problems, Cooper tells WebMD, 
adding that more research is needed to fully explain the 
positive effects alcohol has on the body. His study showed, 
for example, that the group of light to moderate drinkers 
also had fewer deaths from all causes, not just from heart-
related diseases. Previous small studies have shown that 
moderate alcohol consumption can help prevent the formation 
of blood clots that can cause strokes.


Gaziano and Lowenfels tell WebMD that researchers also 
don't know whether some kinds of alcohol are better for 
you than others, or whether drinking alcohol with a meal 
enhances or reduces any benefit you may get from it. 

"Some say beer is better than wine, and white wine is 
better than red, or red is better than white. There are 
not enough studies on how people drink to say," Gaziano 
says. "The totality of evidence on the topic suggests 
that the benefit is largely due to the alcohol itself, 
and if there is any difference, it is relatively small."

Of course, the "prescription" to drink moderate or light 
amount is not a blanket recommendation. "Certain individuals 
need to be warned about drinking," Gaziano says. That 
includes people with a history of alcohol abuse or liver 
diseases, such as hepatitis C. In addition, diabetics need 
to factor in the calories of any alcoholic beverages they 
consume, and people with high blood pressure need to ensure 
their condition is under control. One study also showed that 
diabetics had a slightly higher risk of having dangerously 
low blood sugar after drinking beer on an empty stomach.

Can there be too much of a good thing? "No one should drink 
more than two or three drinks a day," says Gaziano, adding 
that heavy alcohol use can cause the very heart problems 
moderate use seems to prevent, as well as liver disorders. 

Heavy alcohol use is also linked to head and neck tumors, 
says Lowenfels.

And women should drink about half as much as men, because 
they are generally smaller. Women also need to be cautious 
about how much they drink because the possible link between 
breast cancer and alcohol use still has not been proven or 
disproved, he notes.

Children and adolescents, as well as women who are trying 
to get pregnant, also should not drink, according to 
guidelines from the U.S. Department of Agriculture. 

Ultimately, the value of moderate drinking must be weighed 
against any ill effects and the need for the benefit it may 
convey. For example, a younger person, who is not at high 
risk of heart disease, is unlikely to see much benefit from 
drinking. In contrast, an older male who is likely to develop 
heart disease has a better chance of being helped by moderate 
alcohol consumption, the experts tell WebMD.