One drink a day doesn't protect your heart!

Alcohol consumption has long been a controversial topic.

We’ve come a long way from the days when the slogan in France was “Two glasses a day are good for your arteries.”

Currently, Santé Publique France is promoting the message “One drink a day, but not every day.”

The Scientific Evidence

What does the science actually say?

All major studies that claimed alcohol had cardiovascular benefits collapsed once researchers took into account the “health-related cessation of drinking” effect. The data do not show a safe dose.

It reveals a dose-response relationship between alcohol and various diseases, starting with the very first drink.

In older studies, the abstinent group included former drinkers who had stopped due to illness. This gave the impression that moderate drinkers were healthier compared to other people. Once researchers distinguished long-term abstainers from those who had stopped drinking for health reasons, the protective effect disappeared entirely. The moderate beneficial effect observed among drinkers is because they are generally younger, healthier, and more active.

Genetic studies have confirmed this. People with certain genetic variants that slow down alcohol metabolism naturally drink less.

They also have lower rates of cardiovascular disease. This is not a coincidence; it is a cause-and-effect relationship. Genetic analyses conducted on more than 500,000 participants showed no protective effect on the cardiovascular system, regardless of the amount of alcohol consumed.

The Global Burden of Disease study found that the safest level of alcohol consumption for overall health is zero drinks per week.

A 2024 analysis of 180,000 participants from the UK Biobank showed that even moderate alcohol consumption increased the risk of atrial fibrillation (a common heart rhythm disorder) compared to total abstinence.

It triggers this atrial fibrillation through inflammation and direct cardiac toxicity. Some cardiologists rightly refer to the acute phase of this syndrome as “holiday heart syndrome ” or “holiday heart syndrome.”

Alcohol directly increases blood pressure by activating the sympathetic nervous system and triggering the release of cortisol.

Excessive and chronic alcohol consumption leads to alcoholic heart disease because alcohol has a direct toxic effect on the heart’s muscle cells (alcoholic cardiomyopathy). The heart dilates, blood ejection decreases, and patients develop heart failure.

There is no threshold below which these risks disappear.

The risk curve for atrial fibrillation begins with the consumption of just one drink per day. The curve for hypertension begins at three drinks per day. As for the risk curve for dilated cardiomyopathy (a form of heart failure), it rises steadily in proportion to cumulative lifetime consumption.

In addition to behavioral problems associated with alcoholism, we must also consider the impact on the liver, which can lead to fatty liver disease and cirrhosis.

For cancers—whether of the breast, liver, colon, or mouth—the risk, unfortunately, begins with the very first drink.

Is this true regardless of the type of alcoholic beverage?

It has long been said that red wine, with its tannins and antioxidant properties, has a slight protective effect, whereas hard liquor and beer have a bad reputation.

Researchers took an original and somewhat provocative approach to investigate whether there were differences between wine drinkers and beer drinkers!

To do this, they compared no fewer than 3.5 million supermarket receipts from Denmark, looking at what had been purchased along with the beverage:

With wine: olives, cooking oils, low-fat milk, low-fat cheeses, and lean meats—all of which are good for a healthy diet.

And what about beer drinkers?

Soda, butter, whole milk, full-fat cheeses, lamb, pork, sauces, ketchup, potato chips…

These are clearly not the same people, and a very reputable British journal, the British Medical Journal that one cannot compare them solely based on the type of alcohol, that the difference—if there is one—lies in overall dietary habits, and that drinking a little wine is a sign of better eating habits.

And in real life?

Patients are unaware of the problem—due to misinformation?—or they often downplay it, and we see this reality in clinical practice.

A patient who claims to drink “just one glass of wine” every evening and doesn’t understand why their blood pressure is 146/92 mm Hg and their sleep is disrupted.

The one who has atrial fibrillation while insisting they drink only very little.

Or the patient with heart failure after ten years of daily drinking.

By completely stopping alcohol, a patient can see their blood pressure drop by 4 to 6 mm Hg, the frequency of atrial fibrillation decrease significantly, and the quality of their sleep improve in just 30 days. That’s the difference between having to manage a preventable arrhythmia indefinitely and never developing it in the first place.

The protective effect was nothing more than an artifact.

It was not based on any solid medical data. It was a bias that persisted for two decades simply because it reinforced what people wanted to hear.

The best available data, covering hundreds of thousands of patients, show that alcohol increases cardiovascular risk in a linear, dose-dependent manner, with no protective threshold. Stop waiting for a safe dose to be identified; it does not exist. Eliminate alcohol or reduce it as much as possible, while monitoring your blood pressure, heart rate, and sleep quality.

The question is no longer whether moderate drinking is beneficial to health. Rather, it is a matter of determining what level of cardiovascular risk you are willing to accept for a substance that has no nutritional value.

What would you do differently if your doctor explicitly told you that your evening glass of wine is causing your high blood pressure?

In conclusion

The consensus of the “World Heart Federation” on cardiovascular disease and mortality is: “The safest choice is zero!”

To optimize cardiovascular health and life expectancy, the evidence-based choice is to stop all consumption.

This is, of course, an extreme view; the point is not to be moralistic and ban everything.

The advice to “drink in moderation” applies, especially if you don’t (yet) have any health issues.

A glass of rosé during the summer is nice…

but don’t forget to drink… water!

Reference:

Mayer C.S. Alcohol consumption and its correlation with medical conditions: a UK Biobank study. Frontiers in Public Health 2024 doi:10.3389/fpubh.2024.1294492