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Ask a cardiologist: Alcohol and heart health

Q: I’ve heard that drinking a glass of wine a day is good for the heart. Is this true?
Woman standing at kitchen counter in front glass of red wine, bread and cheese

A: Drinking a small amount of alcohol (one drink a day) is likely not harmful for your heart. But the idea that drinking alcohol might be good for your overall health isn’t fully backed by science. 

Over the years some studies have associated drinking small amounts of alcohol with lowered risk of heart disease. 

In those studies, people who drank moderate amounts of alcohol (less than two drinks a day most days) had about a 20% lower risk of dying from heart disease — including heart attack, atrial fibrillation, heart failure and coronary artery disease — when compared to those who didn’t drink. 

This trend seems to hold for people who are living with heart disease and those who aren’t. And the benefits were seen whether drinking wine, beer or spirits. 

These findings can be reassuring for most folks — but they are certainly not a recommendation to start drinking for health benefits. 

Why you shouldn’t start drinking for health

What’s not clear from these studies is whether the lower risk of dying from heart disease comes from alcohol or other factors. 

For example, the complications become evident when you look at the abstainers who participated in these studies. It's very challenging in the surveys to tease out why people avoid alcohol. Some people abstain because they're ill. Others don’t drink because they may have a predisposition to alcoholism. Unfortunately, we don't always get an honest answer from participants because of social stigma. 

So it’s entirely possible that the benefits seen in these studies among mild to moderate drinkers have less to do with the alcohol and more to do with the individuals participating in the studies.    

There's also the strong effect of socioeconomic status. Where you live, education level and income are factors that heavily influence your health. Studies show that when you adjust for these factors and certain behaviours like tobacco use, diet and exercise, a lot of the protective effects of alcohol dilute away and sometimes even reverse.
 
In fact, there’s an interesting paradox that comes with alcohol consumption. While small amounts can be good for you, overconsumption is a serious risk factor for both heart disease and stroke. In all cases, once you start drinking heavily, your risk increases. 

Benefits don’t outweigh risks 

Chronic consumption of large amounts of alcohol can result in a condition called alcoholic cardiomyopathy. You can actually drink your heart muscle into a weakened state when you consume heavily (four to five drinks a day over several years). 

The picture becomes even more pronounced with binge drinking.

Binge drinking (4 or more drinks in a single session for women; 5 or more drinks in a single session for men) and heavy drinking can increase your blood pressure and risk of developing an irregular heart rhythm, such as atrial fibrillation. This could increase your risk of mortality whether you’re living with heart disease or not. Survivors of heart attacks who reported binge drinking are twice as likely to die from any cause, including heart disease, compared with non-binge drinkers. There’s no question that binge drinking — even if it's only one day a week — puts you at higher risk.

We tend to minimize this point but if you're trying to lose weight in a healthy way, cutting down on alcohol saves you a lot of calories too! Changing to light or non-alcoholic beer is probably better than regular beer in that regard as well as the alcohol content. 

Bottom line: if you don’t drink alcohol, you are not missing out, it’s not recommended that you start. Other negative effects of alcohol include risk of cancer, liver disease, pancreatitis, accidents, violence and suicide. 

There are better ways to reduce your risk of heart disease, such as exercising, eating a balanced diet and quitting smoking. These all offer benefits without the added risks that alcohol carries. On the other hand, if you drink a small amount of alcohol occasionally, it’s not necessarily harmful. The key is moderation. 

There are exceptions which is why it’s important to talk to your doctor about how much alcohol you’re drinking. There are people who need to abstain from alcohol because it can aggravate their condition. Mixing alcohol with certain medications can also lead to harmful side effects.
If you drink alcohol, limit yourself to no more than:

  • two drinks a day most days, to a weekly maximum of 10 for women.*
  • three drinks a day most days, to a weekly maximum of 15 for men.

    “A drink” means

  • 341 mL / 12 oz (1 bottle) of regular strength beer (5% alcohol).
  • 142 mL / 5 oz wine (12% alcohol).
  • 43 mL / 1 1/2 oz spirits (40% alcohol).

 

Dr Jay Udell stands before a white screenDr. Jay Udell is a cardiologist at Women’s College Hospital and the Peter Munk Cardiac Centre of the University Health Network, and a clinician-scientist at the Women’s College Research Institute and Faculty of Medicine, University of Toronto. He received a 2015 CP Has Heart Cardiovascular Research Award through Heart & Stroke to study the impact of failed fertility treatment on women’s heart health.