Resources


  1. Sadhu JS, Novak E, Mukamal KJ, et al. Association of Alcohol Consumption After Development of Heart Failure With Survival Among Older Adults in the Cardiovascular Health Study. JAMA Netw Open. 2018;1(8):e186383. doi:10.1001/jamanetworkopen.2018.6383



Transcript

Dr. Frank Domino:

Tim, a 68-year-old male comes in today, following his recent diagnosis with heart failure. He's accompanied by his wife, he's had a variety of tests and has seen the cardiologist, but he still has a few questions. He's begun cardiac rehab and feels that that's working out well and he enjoys going. He has never smoked, but he does like to have a cocktail at night. Mary asks if this is okay, she keeps telling me I need to stop drinking says Tim, is that correct? How safe is alcohol in heart failure?

Hi, this is Frank Domino, Professor in the Department of Family Medicine and Community Health at the University of Massachusetts Medical School. Joining me today to discuss heart failure and alcohol consumption is Dr. Susan Feeney, Assistant Professor and Coordinator of the Family Nurse Practitioner Track at the University of Massachusetts Medical School's Graduate School of Nursing. Thanks for coming today, Susan.

Susan Feeney:

Hi, Frank.

Dr. Domino:

So I guess my initial answer to Mary's and Tim's concern is, well, gee, probably not. What is the best evidence that we have about alcohol consumption and heart failure?

Susan Feeney:

Well, there is actually quite a bit. Well first of all we know that excessive alcohol, so people who are excessive, or alcoholic, that can be associated with cardiomyopathy, but that's not the majority of people. And we do know that moderate alcohol intake, less than seven drinks per week has been associate with a decreased risk of incident heart failure. So it does seem, people who drink moderately, seem to have a less risk of developing heart failure. And that, we know that, again, excessive alcohol intake, can be associated with an increased hazard-of heart failure, so there seems to be a sweet spot here of how much alcohol someone can drink that might actually be beneficial in either preventing heart failure.

When people who already have heart failure, who have what we call prevalent heart failure, that light to moderate alcohol intake, which is described as seven or less drinks per week, that has been associated with lower mortality and improved perceived and objective measures of health outcomes. The data seems to be pointing towards this sweet spot, if you will, that perhaps moderate alcohol intake might be beneficial, but there wasn't a lot of knowledge on people who are newly diagnosed or incident heart failure.

So a recent study that was in Open JAMA was a re-examination of data from the cardiovascular health study, which was a prospective cohort study done of about 6000 folks, both black and white, from four areas in the United States. And they looked at incident heart failure and alcohol intake, to see if it had any effect on survival. And what they found was that when they looked at people who drank, and they looked at people... And then they measured that amount, was it less than seven, was it greater than seven, was it greater than 14? Were they abstainers? Meaning they've never drank, or were they former drinkers? What they found is that folks who drank moderately, seven or less drinks per week, that there was an increased rate of survival, that they had a... It was a significant increase in survival over abstainers. Folks that drank, 7-14 drinks have real minor increase in survival. But it did appear that there was a benefit, a survival benefit for those folks who were drinking at the time of diagnosis and it helped them survive longer.

Dr. Domino:

Okay. From what you're saying, we know that mild to moderate alcohol intake can prevent heart failure, but if you've got new onset heart failure, compared to abstaining having seven or less drinks per week, can actually improve survival and outcomes.

Susan Feeney:

Correct. Yeah.

Dr. Domino:

That's really interesting. Now, were there any risks identified with this alcohol intake?

Susan Feeney:

Not that they could see, that it seemed to have... There wasn't any increased risk of events, they really spoke more about the survival, and they did adjust obviously for comorbidities and other concerns. So they adjusted for A-fib and things like that, but across the board, they saw this pretty significant increase in survival rates.

Dr. Domino:

Wow. This sounds like it's something we can safely recommend. How about if you've had heart failure for a while? Is there any data there that can help give us direction?

Susan Feeney:

Yeah, the previous data, this study didn't look at that specifically because there has some been some research that folks who have prevalent heart failure will benefit or will have an increase... Decrease in mortality rather, and increased health outcomes, by the same amount of light to moderate alcohol intake. So that, again, described as seven or less drinks per week. And I think it's important to remind people what a drink is, because I have a friend who used to take care of... Worked in a home for retired Jesuit priests and one of the priests said, dear I only have one glass a day. And then he realized that he just kept refilling his glass. So it's important to know what the amounts are. So an alcoholic beverage is a 12 ounce beer, a six-ounce glass of wine or one shot of 1.5, usually 80% proof of alcohol.

Dr. Domino:

Alright. So what about abstainers? So maybe for religious reasons or for family issues in general, I've never had alcohol, now I've developed heart failure. Should they start drinking?

Susan Feeney:

Well, the authors of the study were very clear saying that this really... We should look at this as, that folks who have incident heart failure don't need to stop drinking, they can continue at a moderate pace, but not to use this to tell abstainers that they should start drinking. But I think what we can say to our folks who are abstainers, they go to a family wedding, if they wanna have a glass of wine with dinner occasionally, that they don't have to be afraid of that.

Dr. Domino:

I think that sounds very, very reasonable and reassuring. I think when we start many medications now, patients often will ask or are certainly worried about, "Hey, can I have a drink with this?" And I'm sure people with heart failure are scared to death. So that's very reassuring, that if you've never drank but you feel like having a drink, it's not gonna complicate your heart.

Susan Feeney:

Correct. And I think that there's so many restrictions we put on people, and there's so many lifestyle changes with folks for heart failure, that this is actually kind of some good news that they can either continue what they were doing or can have a drink occasionally, and not have a negative impact on their disease process.

Dr. Domino:

Alright. Any final thoughts on what we should be telling Tim and Mary today?

Susan Feeney:

Well, I think what we can say to him is, "Hey the good news is, Tim. According to the guidelines and recent findings, you're drinking seven or less drinks a week. You can continue what you're doing, as long as you maintain exercise, and a healthy diet, you don't need to make that change.

Dr. Domino:

I think that's a great way to frame it to say, this is going to be safe as long as you adhere to most of the lifestyle things that we've asked you to do, including the cardiac rehab. And keep it moderate, don't let it get excessive and it becomes a problem, to let us know.

Susan Feeney:

And that seems to be that when you read through all the data on preventing heart failure or people who've had a heart failure, incident heart failure is moderate, everything in moderation.

Dr. Domino:

Everything in moderation.

Susan Feeney:

And it really does seem to... And it's interesting the reasons they think it might help is that it can lower HDL and help with inflammation, and that kind of thing.

Dr. Domino:

Susan, thanks so much I appreciate you telling us about this interesting paper.

Susan Feeney:

My pleasure.

Dr. Domino:

Practice pointer, for your patients 65 and older with newly diagnosed heart failure, it appears moderate alcohol consumption, less than seven drinks per week, can be beneficial in improving life expectancy. Join us next time when we talk about patients who have high risk sexual activity and your ability to help them prevent HIV transmission.