By Lauren Smith

Last updated: 24 February 2023 & medically reviewed by Dr. Kimberly Langdon

Long-term excessive alcohol intake can lead to several types of cardiovascular disease. Alcohol abuse is one of the most common causes of reversible high blood pressure, can cause the irregular beating of the heart, and damage its muscles, impeding its ability to circulate oxygen throughout your body.

Key takeaways:

  • Some high-profile studies have pointed to the preventative effect of moderate drinking on coronary artery disease.

  • Alcohol and its metabolites are toxic to the heart, leading to the stretching of its muscles and dilating of the ventricles. An enlarged heart is a weak heart, unable to pump blood as effectively, leading to reduced cardiac output, reduced oxygen supply to your body, and heart failure.

  • 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.

What is alcoholic heart disease?

Alcoholic heart disease refers to several types of cardiovascular diseases (CVD) affecting the heart that may be caused at least partly by excessive alcoholic intake. alcoholic hear disease is one of the most life-threatening health conditions caused by alcohol. 

There are seven types of cardiovascular disease. Of these, several are linked to alcohol consumption:

  1. Coronary artery disease: the build-up of atherosclerotic plaque in the arteries of the heart, which eventually restricts blood flow to heart muscles. Heavy alcohol use raises levels of bad cholesterol, a component of plaque. Eventually, this build-up can partly or completely block blood flow, leading to a heart attack. 

  2. Cardiomyopathy: a disease of the heart muscles (myocardium), causing them to enlarge and weaken and leaving the heart unable to pump blood as effectively. Heavy alcohol use is a leading cause. Alcoholic cardiomyopathy is estimated to affect 1% to 2% of people who consume more than the recommended amount of alcohol (14 drinks per week for men and seven for women). It may also be linked to frequent binge drinking that doesn't rise to the level of diagnosable alcohol use disorder.[2]

  3. Heart arrhythmias: the irregular beating of the heart which in severe cases can cause cardiac arrest, blood clots, and stroke. Acute binge drinking, especially when paired with salty foods, can cause a type of arrhythmia known as atrial fibrillation in which the upper chambers of the heart (the atriums) quiver rather than beat normally. This condition is dubbed “holiday heart syndrome” for its occurrence as a result of Christmas or New Year's overindulgence. Long-term alcohol use can also damage heart muscles and cause arrhythmias.[3]

What causes alcoholic heart disease?

Alcohol can cause heart disease by:

  • 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 (cardiomyopathy)

  • Contributing to excess weight, a risk factor for many cardiac problems

  • Increasing stroke risk

  • Causing arrhythmias

  • Interacting with drugs taken to manage heart conditions and making them less effective

Coronary artery disease

Some high-profile studies have pointed to the preventative effect of moderate drinking on coronary artery disease.[4] The evidence is conflicting but there’s no question that heavy alcohol use contributes to coronary artery disease. It partly does so by raising levels of triglyceride fats in the blood, which can lead to high levels of bad cholesterol, low levels of good cholesterol, and the accumulation of plaque on artery walls.[5]

Alcoholic cardiomyopathy

Alcohol and its metabolites are toxic to the heart, leading to the stretching of its muscles and dilating of the ventricles. An enlarged heart is a weak heart, unable to pump blood as effectively, leading to reduced cardiac output, reduced oxygen supply to your body, and heart failure. Additionally, deficiencies of thiamine (vitamin B1), common in alcoholics due to malnutrition, 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 at 21% to 36% of patients.[6] However, many people drink heavily for years without experiencing this particular complication, pointing to the influence of genetics on each individual's vulnerability.

Heart arrhythmias

Alcohol causes atrial fibrillation both during acute intoxication and over time with heavy drinking. The reason is likely multifactorial. In the short-term alcohol has been found to increase the activity of the vagal nerve, which runs through the neck and can trigger atrial fibrillation.[7] In the long run, alcohol can cause electrical and structural remodeling of the heart, making arrhythmias more likely.

Cardiac arrhythmias can also be caused by electrolyte imbalances common in acute alcohol consumption (alcohol is a diuretic and can leave you dehydrated) 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

  • Chest discomfort or pain that occurs with activity and after eating. This is called angina. It may present as tightness, heaviness, pressure, squeezing, or fulness

  • Breathlessness

However, many people don’t experience symptoms of coronary artery disease until they’re diagnosed or experience a heart attack.

Alcoholic cardiomyopathy

  • Chest pain, especially with exertion

  • Heart palpitations

  • Fatigue or weakness

  • Feeling lightheaded or fainting

  • Coughing

  • Trouble breathing, especially when you’re active or when you’ve been 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

  • 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[9]

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 arrhythmias.

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 healthily, avoiding saturated and trans fats, reducing salt and sugar, and eating 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 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 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 medication, including:

  • Cholesterol drugs such as statins and niacin: lower bad cholesterol and reduce plaque buildup in the arteries

  • Beta-blockers: slow the heart rate, lower blood pressure, and may reduce the risk of heart attacks

  • Calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin II receptor blockers (ARBs): other medications that lower blood pressure

  • Daily low-dose aspirin: may prevent heart attack and stroke in some people

Sometimes surgery is needed to clear a blocked artery. Methods include

  • Coronary angioplasty and stent placement: the cardiologist guides a thin, flexible tube into the blocked section of the artery, where a small balloon is inflated to widen it and improve blood flow. In some cases, a mesh tube (stent) is put in place to keep the artery open.

  • Coronary artery bypass graft surgery (CABG): an open-heart surgery in which the 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 least a noticeable improvement in symptoms. 

In addition, you may be advised to:

  • 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.

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]

Arrhythmias

The arrhythmia of holiday heart syndrome is usually transient and stabilizes in 24 hours with 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 and the beta blockers sotalol can restore a normal heart rhythm, while other beta blockers and calcium channel blockers can reduce your heart rate.

You may also be given 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.