Heart and brain and alcohol, 2018

For the Daily Prompt: infect. Maybe heart and brain health could be an infectious idea…..

Heart disease is the number one cause of death in the US, around 24% of deaths every year. Strokes are fifth most common cause of death at 5%, dementia sixth most common at 3.6%, data here from 2014. Accidents have beaten strokes out for fourth place because of “unintentional overdose” deaths.

I did a physical on a man recently, who said what was the best thing he could do for his health?

“Reduce or better yet quit alcohol.” is my reply. Even though he’s within “current guidelines”. I showed him the first of these studies.

Two recent studies get my attention for the relationship between the heart and the brain and alcohol.

In this study: http://www.onlinejacc.org/content/64/3/281, 79,019 Swedish men and women were followed after completing a questionnaire about alcohol consumption.

They were followed from 1998 to 2009 and 7,245 cases of atrial fibrillation were identified. The relative risk for atrial fibrillation was alcohol dose dependent: that is, the people who did not drink had a relative risk of atrial fibrillation set at 1.0. At 1-6 drinks per week the risk was 1.07, at 7-14 per week the risk was 1.07, at 14-21 drinks per week 1.14 and at >21 drinks per week 1.39. They also break it down by number of drinks per day. So why do we care about atrial fibrillation? “Atrial fibrillation (AF)/atrial flutter (AFL), the most common cardiac arrhythmia, is accompanied with a 4- to 5-fold increased risk for stroke, tripling of the risk for heart failure, doubling of the risk for dementia, and 40% to 90% increase in the risk for all-cause mortality.”

Atrial fibrillation, stroke, congestive heart failure, dementia and 40-90% increase in all-cause mortality. Want to protect your brain and live longer? Quit alcohol.

Well, that instantly decreased my enthusiasm for alcohol, now down to one drink per week if that.

Here is a second study: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30134-X/fulltext?code=lancet-site

In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10–1·17), coronary disease excluding myocardial infarction (1·06, 1·00–1·11), heart failure (1·09, 1·03–1·15), fatal hypertensive disease (1·24, 1·15–1·33); and fatal aortic aneurysm (1·15, 1·03–1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91–0·97). In comparison to those who reported drinking >0–≤100 g per week, those who reported drinking >100–≤200 g per week, >200–≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1–2 years, or 4–5 years, respectively.”

Ok, over half a million people followed, 40K+ deaths, 39K+ heart events (heart attack, atrial fibrillation, new congestive heart failure, etc), that’s a pretty impressive study.

A 5% 12 ounce beer is 14 grams of alcohol. Here: https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink. Our local brewery and pourhouse usually serve pints, 16 oz, and the range is from 5% to over 9% alcohol. Two 9% pints is how many standard drinks? You do the math. Currently the recommendations in the US are no more than seven drinks per week for women (98 grams) and fourteen for men (196 grams) per week, no saving it up for the weekend, no bingeing. The UK stops at 98 grams for both men and women. The rest of Europe goes higher.

Heart and brain, how I love you! I like my brain and don’t want to pickle it. I think I’ll choose heart and brain over alcohol, long term over short term, health over escapism.

Have a great week!




I took the photograph. It reminds me of neurons in the brain.

9 thoughts on “Heart and brain and alcohol, 2018

  1. Shelley says:

    On average, on a busy day in your clinic, how many healthy people do you see compared to sick patients? How many physicals do you give them a clean bill of health, no prescriptions, or say, “Heck, you’re doing everything right, don’t come back until you need to see me for something?” Or do those people stay away from the clinics (an undetermined amount of people like your 500,000 figure above) because they don’t need to see the doctor? I tend to believe that stats measured are only from the people physicians see in the clinics, hospitals, treatment centers, not the ones they don’t (obviously) so they are skewed. As a person who sees people (on a daily basis) who have dementia, not all of them drank alcohol, used drugs, or smoked, many have, but it isn’t the only determining factor for getting dementia. Having said all that rambling from a non-physician perspective, I do agree, it is a huge risk factor and taken in moderation, if at all, is best. Thank you for sharing your stats and thoughts.

    • drkottaway says:

      Another doc in town said men don’t need physicals. I said heck yeah they do you are so wrong. A physical to me is about HEALTH. Do you have the top ten causes of death in the US memorized? I do. A physical is about PREVENTION. 78% of my patients are over 50, 48% are over 65, I take care of people from age zero to 104 (my record so far… or theirs) and do you think I’d like to talk to more of the young “healthy”? What do you think of as “young”? In my clinic it is under 40. And my clinic actually reflects the demographics that our country is headed for…..

    • drkottaway says:

      Also the CDC collects information about the general population…. this is not from “clinics, hospitals and treatment centers”. It interests me to watch “young” people down two 9% pints at our local brewery…. though I won’t be their doctor dealing with the consequences…..

      • Shelley says:

        They’ve never talked to me, I hang up on them if they call – hate telemarketers…! All funning aside, you’re obviously passionate about your chosen life path, that’s a good thing in a physician :-)! Thanks for listening to my comments.

        • drkottaway says:

          …ah. What did you think the CDC was selling?

          • Shelley says:

            …phone calls soliciting info from strangers (CDC, because they’ve never seen me or have info on me that I’ve directly provided to them via the phone, so I assume they make it up) are just like telemarketers. I’m weird and make strange connections in an effort to be funny! ;-)

  2. Shelley says:

    There are many marathoners who love to drink and they run to stay healthy. What are your thoughts on exercise being able to combat alcohol consumption’s effect on the heart?

    • drkottaway says:

      Thoughts vs evidence. I would like to see a study with 500,000 people but then I suspect there are not that many marathoners…. My thoughts are that I have patients in their 90s and my first male patient who is 100. They don’t drink alcohol.

    • drkottaway says:

      Also in residency at OHSU in Portland, early 1990s, I looked around at the adult patients we had in our tertiary care center. 90% or more were there because of tobacco, alcohol or drugs.

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