AHA: Effects of Modest Alcohol Use on the Heart Unclear
Several medical groups have concluded regular consumption of alcohol in any amount poses a health risk, but a new scientific statement from the American Heart Association (AHA) offered more qualified guidance.
The premise that moderate alcohol use reduces cardiovascular risk has been widely accepted for decades. The authors of a 1993 editorial in The New England Journal of Medicine concluded 'there now seems little doubt' that such a benefit exists. However, a review of the evidence in 2025 produced a more cautious summary.
'Considering the level of evidence, it remains unknown whether drinking is part of a healthy lifestyle, and therefore, clinicians should reinforce healthy lifestyle behaviors such as regularly engaging in physical activity, avoiding tobacco use, and maintaining healthy body weight,' the AHA document stated.
Complex Mix
'Data from recent studies using new methodologies (eg, individual participant-level data meta-analysis and mendelian randomization [MR]) have challenged the idea that any level of alcohol consumption has positive health effects,' according to authors of the new statement, led by Mariann R. Piano, RN, PhD, senior associate dean for research at the Vanderbilt University School of Nursing, in Nashville, Tennessee.
Prior to the new methodologies, protection against coronary artery disease from moderate alcohol use was derived from many observational studies. These studies used a variety of definitions of moderate drinking but typically considered that threshold to be two or fewer drinks per day for men and one or fewer drinks per day for women. In pooled analyses cited in the AHA statement, reductions in risks of 10%-15% relative to no drinking were common.
Yet analyses of alcohol consumption are complex, even leaving aside how a standard drink is defined or whether the risk calculations are needed for every type of alcohol, according to Piano and her colleagues. In addition, any potential benefit is eliminated by moderate drinkers who binge intermittently, according to several examples in the AHA statement.
The new methodologies for addressing the question of the safety of moderate drinking do not fully reverse conclusions that it is beneficial. They suggest little or no protection rather than harm. In one pooled analysis of MR studies, the finding was a 'weak association' for benefit, which differs markedly from assertions that moderate drinking might be justified for a benefit to cardiovascular health.
Following a detailed review of the evidence for both moderate and heavy alcohol use on cardiovascular risks and risk factors, the AHA statement summarized messages clinicians can deliver to patients, but strict conclusions were limited to the harm of heavy drinking. The messages on moderate drinking largely consisted of talking points.
For coronary artery disease specifically, the AHA statement acknowledged that moderate drinking 'may provide some risk reduction' for the condition even if this reduction has been rendered less clear by studies using analyses designed to apply more rigor for evaluating observational data.
For heart failure, the statement concluded that low-to-moderate alcohol consumption has not been associated with any beneficial or detrimental effect, although this statement is qualified with a citation suggesting five or more drinks per week may contribute to left ventricular dysfunction.
Moderate Alcohol and Hypertension
For patients who already have hypertension, the statement cautioned even moderate consumption of alcohol can contribute to elevated blood pressure — one of the few statements to link moderate alcohol use to a specific adverse effect on a cardiovascular risk factor. The authors characterized alcohol abstention as a reasonable part of lowering blood pressure in hypertensive patients.
For stroke, moderate alcohol use has produced mixed results, according to the AHA statement. One possible explanation for the increased risk for stroke in some studies might relate to the association of moderate alcohol with elevations in blood pressure among those who already have hypertension.
For arrhythmias and cardiomyopathies, low alcohol intake or abstention might be better than moderate or heavier drinking, even if data supporting this contention are limited, according to the AHA statement. For example, although a prospective study associated abstinence with a reduction in the burden of atrial fibrillation, the analysis, like the vast majority of studies cited in the AHA statement, was not a randomized comparison.
The focus of the new document was on cardiovascular health, but several health organizations taking a broader view of health risks have recently cautioned against alcohol use in general. Among them are the World Health Organization, which issued a statement in 2023 that 'no level of alcohol consumption is safe for our health,' and the CDC, which earlier this year called for warning labels on alcoholic beverages linking consumption to cancer.
A 2023 report from the Canada called the Guidance on Alcohol and Health also called for drinking less as a general step to better health.
In the US, where a 2023 governmental survey found more than 50% of adults reported drinking alcohol within the past month, the US Department of Agriculture did not make definitive claims about the relationship between low-level alcohol use and health risks in its recent Dietary Guidelines for Americans.
Despite the recommendations the AHA listed for clinicians when advising patients, an urgent call was made for prospective studies that can confirm benefit, or at least the absence of risk, regarding moderate drinking. The list of gaps in knowledge in the statement was long.
The orientation regarding moderate alcohol use in relation to cardiovascular disease has shifted, according to Jamal S. Rana, MD, PhD, a clinical cardiologist and adjunct investigator in the Division of Research at Permanente Medical Group, Oakland, California.
At this point, 'I think we should move away from the overarching public messaging that one should drink because it is good for heart health,' said Rana, who has been involved in several studies regarding alcohol use and cardiovascular risk.
For moderate use, he suggested the caution about potential risks should not exceed the evidence. Even if newer evidence is challenging the long-held belief that moderate alcohol offers some degree of cardioprotection, significant harm has been most closely associated with heavy alcohol use.
As for advising patients, he said he agrees in general with the AHA statement summary of the evidence: Risks should be emphasized to patients who drink more than moderately, but 'drinking socially with low amounts of alcohol is okay.'
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