ALCOHOL AND HEART ATTACKS

The notion that moderate drinking helps to prevent death from heart attack has been considerably strengthened by a 10-year study in California involving people who routinely visited Kaiser-Permanente Hospitals for annual check-ups.

The lowest mortality in these people, according to the British Medical Journal (284:444), was among those consuming one or two alcoholic drinks a day. Taking their heart attack death rate as 1.0, the rate for teetotalers was 1.5 (50 percent higher). The rate for people taking three to five drinks daily was also 1.5. For still heavier drinkers, the rate was two. Three other studies (two in the U.S., one in England) have shown the same sort of U-shaped curve relating mortality rates with alcohol consumed.

However, further study has revealed that those who drink moderately need to be divided into two groups. Group 1 appears to benefit from moderate drinking. These people, according to the Journal of Cardiovascular Medicine (6:309) have a good blood supply to their heart muscle. Persons in Group 2, a majority among moderate drinkers, have one or more narrowed coronary arteries and have a higher than usual incidence of coronary heart attack.

The difference in alcohol’s effect, it appears, depends upon its ability to increase blood flow through the coronary arteries by dilating them. When the coronaries are normal, alcohol therefore increases all of the heart muscle’s blood supply. In people who have a coronary artery which has become narrowed and rigid by atherosclerosis, blood flow is further reduced in the narrow vessel at times when flow is being increased in the healthy wider vessels. This happens because blood always flows along the path of least resistance and is therefore selectively diverted away from narrow vessels when the normal ones open up more widely. Known as the “Coronary Steal Syndrome,” this diversion of blood away from certain vessels can bring on a heart attack.

It is clear, therefore, that people who have angina pectoris (pain or tightness in the chest during exercise due to a narrow coronary) should avoid alcohol entirely.

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