How Alcohol Affects Heart Failure

Cardiologist David Brown, MD, questions heart failure patients every day about their drinking habits. So he was surprised when one of them, an older man who always told Brown he didn’t drink, was contradicted by his wife when she came for his exam.

“She looked at me incredulously and said, ‘I would have been divorced a long time ago if I hadn’t allowed her her only martini every night,’ recalls Brown, professor of medicine in the cardiovascular division of Washington University School of Medicine in Saint Louis. “I think he assumed I was asking him about his drinking because if he answered yes, I would tell him to stop.

Many people with heart failure are reluctant to talk to their doctor about alcohol, even if they aren’t heavy drinkers, heart experts say. There is no standard recommendation on whether it is suitable for people with heart failure. But this is an important issue, because people with heart failure usually need to make lifestyle changes to manage their symptoms well.

“The issue was important enough to him that he kept the truth from his doctor,” says Brown. “We owe it to our heart failure patients to tell them that there really is no evidence of harm and perhaps a benefit from alcohol and to recognize that quality of life is as important as the amount.”

Does Alcohol Improve Heart Health?

Much research has focused on the link between alcohol and heart health, with conflicting results. Some studies have shown that moderate alcohol consumption – one drink per day for women and two for men – reduces the risk of dying from heart disease. One drink usually means a 12 ounce beer, a 6 ounce glass of wine, or a 1½ ounce glass of alcohol.

Other studies have suggested that moderate alcohol consumption may slightly increase the levels of “good” HDL cholesterol. And alcohol appears to reduce the risk of blood clots that can lead to heart attacks and strokes, Brown says.

“In general, alcohol is considered protective against heart disease,” says Brown. “And based on all the studies, there really is no sign that a small amount of alcohol consumed on a regular basis is harmful to the heart.”


But is it true that a little alcohol can help fight heart failure? There isn’t enough research on this problem, he notes.

Brown is a co-author of one of the few studies that has looked at it. It showed that people 65 and older who suffered from heart failure and drank moderately lived on average about a year longer than those who never drank.

As with studies suggesting that alcohol benefits overall heart health, Brown says, his research couldn’t prove that it made heart failure patients live longer. Other factors could also have influenced the results, he says.

“If you’re not drinking, I wouldn’t recommend you start,” Brown says. “But if you enjoy a cocktail or a glass of wine, having one per night for women and one to two per night for men probably won’t hurt you.”

Negative cardiac effects?

It’s important to note that one form of heart failure is directly caused by alcohol, experts say. Alcoholic cardiomyopathy (ACM) can be attributed to binge drinking or binge drinking.

“Alcoholic cardiomyopathy is a weakness of the heart caused by alcohol. It’s rare, and you have to drink a lot of alcohol on a regular basis, and there’s probably some kind of genetic predisposition to that as well, ”says Brown. “Certainly no one should drink eight or ten glasses or a case of beer a day.”

For those who already have heart failure, there is little scientific evidence that light or moderate alcohol consumption can make your condition worse, says Kenneth Mukamal, MD, associate professor of medicine at Beth Israel Deaconess Medical Center in Boston, who studied heart failure and alcohol consumption. .

“Interestingly, many people have taken a rather simplistic view that if alcohol can cause cardiomyopathy, then it must make heart failure worse at even lower doses,” says Mukamal. “But there is really no proof of that.”

But excessive alcohol consumption could indirectly make your heart failure or its symptoms worse, experts say. It could:

  • Increase your blood pressure. “One noticeable effect of excess alcohol is that it can increase blood pressure,” says Brown. “We like to keep heart failure patients with the lowest possible blood pressure because it means their hearts have to do less work.”
  • Increase your heart rate, which also makes the heart work harder.
  • Contributes to obesity. “Mixed drinks and cocktails in particular tend to have high amounts of sugar, so they’re high in calories,” Brown says. “A glass of wine has 60 to 90 calories, but a margarita can have 300 to 400 calories. If you have two, that’s a lot of extra calories that can be unhealthy over time.”

In addition to adding to the workload on the heart, Brown says, the extra pounds can slow you down and interfere with physical activity. This could lead to more swelling of the legs, a common symptom of heart failure.


Talk to your doctor

When you drink alcohol, your liver breaks it down. But excessive alcohol consumption can affect the liver’s ability to make proteins that help control blood clotting. This is the main way that alcohol consumption can interfere with medications commonly taken by people with heart failure – especially certain blood thinners, say Brown and Mukamal.

“My biggest concern with drinking alcohol is with blood thinners, because we know that alcohol acts like a bit of a blood thinner on its own,” says Mukamal. “If you take blood thinners your risk of bleeding increases, and you should definitely talk to your doctor to find out if it is safe to drink.”

Like Brown, many doctors are already asking heart failure patients about their drinking habits. But you can also bring up the topic yourself, especially if you’re having trouble controlling your blood pressure, says Mukamal. Certain medications for many types of conditions can lower your blood pressure when you stand up, especially if your heart is not pumping well, and drinking can make your dizziness worse.

If your heart failure is controlled with medication and you are not retaining fluids, Mukamal and Brown will accept alcohol, but no more than one drink per day for women and two for men.

“There are studies that clearly suggest that low levels of alcohol consumption within recommended limits” tend to be linked to better outcomes for people with heart failure, says Mukamal. “This is not a recommendation for drink, but maybe proof that they don’t need to stop.



David Brown, MD, Washington University School of Medicine.

Kenneth Mukamal, MD, Beth Israel Deaconess Medical Center.

Treatment time: “Should people with heart failure avoid alcohol?” A review of the evidence. “

Hopkins Medicine: “Alcohol and Heart Health: Separating Fact from Fiction.”

JAMA network open: “Association of Alcohol Use After Development of Heart Failure and Survival in the Elderly in the Cardiovascular Health Study.” “Reduced or increased risk of blood clots from alcohol consumption.”

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