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Long-term excessive alcohol intake can increase the risk of developing cardiovascular diseases. Alcohol abuse is one of the most common reversible causes of high blood pressure. Excessive alcohol intake can cause irregular heartbeats (called dysrhythmias), and it can damage the heart muscle, impeding its ability to circulate oxygen throughout your body.
- Evidence suggests that low or moderate drinking may help prevent coronary artery disease.
- Alcohol and its metabolites can be toxic to the heart, leading to overstretching of the cardiac musculature and dilating of the ventricles, which cause cardiac enlargement. An enlarged heart is a weak heart, as it is unable to pump blood as effectively. This can lead to reduced cardiac output, reduced oxygen delivery to other parts of your body, and heart failure.
- The best way to prevent alcoholic heart disease is to reduce alcohol consumption to low or moderate levels. Women should have no more than one standard drink per day, while men should limit themselves to one or two.
What is alcoholic heart disease?
Alcoholic heart disease refers to several types of cardiovascular diseases (CVD) that may be caused (at least in part) by excessive alcohol intake. [1] Alcoholic heart disease is one of the most life-threatening health conditions caused by excess alcohol intake.
There are seven main types of cardiovascular disease. Of these, at least three are linked to excess consumption of alcohol:
- Coronary artery disease: Coronary artery disease is caused by a build-up of atherosclerotic plaque in the arteries of the heart, which eventually restricts necessary blood flow to heart muscles. Heavy alcohol use raises levels of LDL cholesterol, which is a component of plaque. Eventually, plaque can partially or completely block blood flow, leading to a heart attack.
- Cardiomyopathy: As a disease of the heart muscles (myocardium), which enlarges and weakens the heart, making the heart unable to pump blood as effectively. Heavy alcohol use is a leading cause of cardiomyopathy. Alcoholic cardiomyopathy is estimated to affect 1% to 2% of people who consume more than the recommended amount of alcohol (defined as 14 drinks per week for men and seven for women). Alcoholic cardiomyopathy may also be linked to frequent binge drinking that doesn't rise to the level of diagnosable alcohol use disorder. [2]
- Heart arrhythmias: Dysrhythmias of the heart include irregular heart rhythms, which in severe cases, can cause cardiac arrest, blood clots, and stroke. Acute binge drinking, especially when paired with salty foods, can cause atrial fibrillation, which is a type of dysrhythmia in which the upper chambers of the heart (the atria) don’t contract normally. This condition is dubbed “holiday heart syndrome” for its occurrence as a result of Christmas or New Year's overindulgence. Long-term heavy alcohol use can also damage heart muscles and cause dysrhythmias. [3]
What causes alcoholic heart disease?
Alcohol leads to cardiovascular disease in these ways:
- Contributing to high blood pressure (hypertension), a risk factor for coronary artery disease, heart attack, and stroke
- Directly damaging the heart muscles through its toxicity (called cardiomyopathy)
- Contributing to excess weight, a risk factor for many cardiac problems
- Increasing stroke risk
- Causing cardiac dysrhythmias
- Interacting with medications taken to manage heart conditions and making them less effective
Coronary artery disease
Evidence suggests that low to moderate drinking (especially wine) may help prevent coronary artery disease. [4] The evidence for the beneficial effects of alcohol is conflicting, but there’s no question that heavy alcohol use contributes to coronary artery disease. Heavy alcohol use is known to raise levels of triglyceride fats in the blood, which can lead to high levels of LDL cholesterol, low levels of HDL cholesterol, and the accumulation of plaque on arterial walls. [5]
Alcoholic cardiomyopathy
Alcohol and its metabolites are toxic to the heart, leading to the stretching of heart muscles and enlargement of heart chambers. An enlarged heart is a weak heart, as it is less able to pump blood effectively, leading to reduced cardiac output, lowered oxygen supply to the rest of the body, and heart failure. Additionally, thiamine (vitamin B1) deficiency, which is common in alcoholics due to malnutrition, can contribute to alcoholic heart damage.
Related: How long does alcohol stay in your system?
Consuming more than 80g of alcohol per day (around 5.5 drinks) for five years or more substantially increases the risk of alcoholic cardiomyopathy. In addiction treatment, the prevalence of alcoholic cardiomyopathy is estimated to be found in 21% to 36% of patients. [6] However, many people drink heavily for years without experiencing alcoholic cardiomyopathy, pointing to the influence of genetics on each individual's vulnerability.
Heart dysrhythmias
Alcohol can cause atrial fibrillation, both during acute alcohol intoxication and over time with heavy drinking. The reasons are likely multifactorial. In the short-term, alcohol has been found to increase the activity of the vagus nerve, which may trigger atrial fibrillation.[7] In the long run, alcohol can cause electrical and structural remodeling of the heart, making dysrhythmias more likely.
Cardiac dysrhythmias can also be caused by electrolyte imbalances that are common in acute alcohol consumption (alcohol is a diuretic and can cause dehydration) and in long-term alcohol use, as a result of malnutrition and vomiting.
Each additional standard alcoholic drink per day over recommended limits increases the risk of atrial fibrillation by 8%.[8]
What are the symptoms of alcoholic heart disease?
Alcoholic heart disease can cause various physical symptoms that affect blood pressure, breathing, and heart rate.
Coronary artery disease
Coronary artery disease may manifest as chest discomfort or pain that occurs with activity or after eating, which is called angina. The pain and discomfort may present as tightness, heaviness, pressure, squeezing, breathlessness, or fullness.
However, many people don’t experience symptoms of coronary artery disease until they have a heart attack.
Alcoholic cardiomyopathy
Alcoholic cardiomyopathy may cause the following signs and symptoms:
- Chest pain, especially with exertion
- Heart palpitations
- Fatigue or weakness
- Lightheadedness or feeling faint
- Coughing
- Trouble breathing, especially when you’re active or lying down
- Bulging in the veins of your neck
- Fluid build-up and swelling (edema), especially in the feet, ankles, and lower legs
- Loss of muscle mass
- Decrease in appetite [2]
Atrial fibrillation, including holiday heart syndrome
Signs and symptoms of atrial fibrillation may include these:
- Heart palpitations (the feeling that the heart is pounding, fluttering, beating erratically, or beating very fast)
- Fatigue
- Weakness
- intolerance to exercise
- Feeling lightheaded or fainting
- Chest pain
- Shortness of breath
- Anxiety[8]
How to prevent alcoholic heart disease
The best way to prevent alcoholic heart disease is to moderate your drinking. Women should have no more than one standard drink per day, while men should limit themselves to one or two.
You should also restrict binge drinking—defined as when women consume four standard drinks in two hours or less and when men consume five in the same time frame—which has been linked to heart dysrhythmias.
In addition to drinking less, there are other ways you can limit your risk of cardiovascular diseases, including:
- Quitting smoking
- Keeping your weight in check
- Exercising
- Eating healthfully, including avoiding saturated and trans fats, reducing intakes of salt and sugar, and increasing consumption of fruits, vegetables, whole grains, legumes, nuts, and fish
- Managing stress
- Treating high blood pressure
How is alcoholic heart disease treated?
If you’ve developed a cardiovascular disease as a result of heavy alcohol consumption, you should stop drinking and seek help if you’re unable to do so alone. Abstinence can improve many of the symptoms of alcoholic heart disease and, in some cases, may lead to complete recovery.
In other cases, treatments are available, depending on the type of cardiac disease and its severity.
Coronary artery disease
For many people, lifestyle changes such as exercising more, quitting alcohol and smoking, and eating healthy can manage coronary artery disease.
Others may need to take medications, including:
- Cholesterol drugs such as statins and niacin: Help lower LDL and total cholesterol levels, may increase HDL cholesterol, and reduce plaque buildup in the arteries.
- Beta-blockers: These act to slow the heart rate, lower blood pressure, and potentially reduce the risk of heart attacks.
- Calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II receptor blockers (ARBs): These are other medications that lower blood pressure.
- Daily low-dose aspirin: Aspirin may be beneficial to prevent heart attacks and strokes in some people.
Sometimes surgery is needed to clear a blocked artery.
- Coronary angioplasty and stent placement: During this procedure, a specially-trained cardiologist guides a thin, flexible tube into the blocked section of the artery, where a small balloon is inflated to widen the artery and improve blood flow. In some cases, a mesh tube (stent) is put in place to keep the artery open. [9]
- Coronary artery bypass graft surgery (CABG): This is an open-heart surgery in which the cardiac surgeon removes a healthy blood vessel from another part of the body and uses it to create a new, unblocked path for blood in the heart. [10]
Alcoholic cardiomyopathy
In many people, abstaining from alcohol can lead to recovery from alcoholic cardiomyopathy or, at minimum, a noticeable improvement in symptoms.
If you have alcoholic cardiomyopathy, you also may be given this advice:
- Follow a low-salt diet.
- Reduce how much liquid you drink to reduce fluid retention, which can put pressure on the heart.
- Take diuretics to increase the removal of water and salt from your body.
- Take medications, such as beta-blockers and ACE inhibitors, to lower blood pressure and reduce the workload of the heart.
Surgery may be used to repair damage to the heart’s valves or to implant a defibrillator or pacemaker to regulate your heart’s beating. [11]
Dysrhythmias
The dysrhythmia of holiday heart syndrome is usually transient and may improve within 24 hours of abstinence from alcohol. In the meantime, patients may be monitored in the emergency department and given beta-blockers or calcium channel blockers to lower their heart rate.
In the cases of longer-term atrial fibrillation brought on by chronic alcohol use, treatment options include medications and surgery. Medications, such as flecainide, amiodarone, and calcium channel blockers, can restore a normal heart rhythm, while beta blockers and calcium channel blockers can also reduce your heart rate.
You may also be given blood thinning medication to reduce your risk of stroke. In some cases, the heart is shocked with electricity to restore a normal rhythm, a process called cardioversion. Pacemakers can also be implanted to keep your heart beating regularly. [12]
Alcohol addiction treatment
Symptoms of heart disease or life-threatening cardiac events are a sign you should rein in your drinking. Even a bout of holiday heart syndrome should be a wake-up call that alcohol is affecting your health.
If you’re struggling to stop drinking despite the impact on your heart, help is available. It could include medical detox, inpatient rehab, therapy, medication, and support groups. To see treatment near you, click here.
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