The Heart & Health & Beer

I can’t tell you how sick I am of the unscrupulous tactics of prohibitionists; the way they bend the truth to suit their agenda, the way they play so fast and loose with the truth and the way they demonize those of us in the alcohol industry. I find their hypocrisy more than a little unsettling, especially when they claim to be “watchdogs,” keeping the alcohol industry honest, while being so dishonest in the process. Why they continue to receive positive press is bewildering to me. Here’s the latest example of this, from one of the most egregious of the bunch, Alcohol Justice. Here’s what they’ve recently added to their daily tweetings.

Oh, Alcohol Justice, how do I hate thee, let me count the ways.

1. Alcohol no benefit to the heart, even light use: You probably won’t be too surprised to learn that clicking on the subsequent link takes you to a story that says roughly the same thing, but that the study’s conclusion requires a great leap from one conclusion to another, with no obvious causation or relation of one to the other, as you’ll see below. AJ happily picks up on bad and sloppy reporting, and an apparently agenda promoting press release without ever noticing that the basis for all of it does not support the headline.
2. Refutes bogus industry claims: Okay, this one really pisses me off. The claims about how moderate alcohol consumption can benefit heart health are not “industry claims,” but comes from numerous scientific studies, and dismissing them all as “bogus” with a wave of the hand over one so-called study, even if right on point, is so mindbogglingly disingenuous and dishonest to make them utterly fundamentalist prohibitionist wingnuts with absolutely no regard for honesty or truth whatsoever.

Unfortunately they’re lead down this rabbit hole partly by one media outlet, a press release by one of the universities involved in the study and even a weird, untrue statement by one of the researchers.

So let’s start with the news media report. Alcohol does not benefit the heart, claims new study is on the website Medical News Today, which in the past has also used misleading headlines and twisted analysis of studies to misrepresent the results. The article is written by a Catharine Paddock, who apparently has a PhD and despite writing numerous times about medical and health topics, has a background as a “technical writer in the computer and electronics industry.” She also “enjoys keeping fit, yoga, reading, [and] walking,” so she’s obviously qualified to write about complex medical studies. But to be fair, she pretty much uncritically reports and reworks the press release on the study. Despite Medical New Today helpfully providing links to both the press release and the original study, she appears not to have read or looked at the study itself, otherwise she might have noticed that the two don’t really agree.

Next, let’s look at the “news release” from Penn Medicine, titled New Study Shows Drinking Alcohol, Even Light-to-Moderate Amounts, Provides No Heart Health Benefit, subtitled “Results Call into Question Previous Studies Suggesting One Drink Per Day May Promote Cardiovascular Health,” so it’s obvious that’s where the mischaracterizations begin. Curiously, they don’t even provide a link to the study that’s the subject of their news release. But given that they’re pushing this study to toot their own horn, to promote the work of their own Perelman School of Medicine at the University of Pennsylvania, it’s not too surprising that they’d oversell its accomplishments. It’s slightly more surprising that the mainstream news media would not critically question it, but it’s still troubling and more than a little annoying given that most people expect that a news story has been vetted and checked for accuracy. But more often what happens is overworked journalists simply rework a press release into a story and often don’t bother investigating its veracity or interview anyone with a contrary opinion or even someone simply outside or not involved in the organization who put out the press release itself.

But let’s go first to the study itself, titled simply Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. Here’s the abstract:

Objective To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease.

Design Mendelian randomisation meta-analysis of 56 epidemiological studies.

Participants 261 991 individuals of European descent, including 20 259 coronary heart disease cases and 10 164 stroke events. Data were available on ADH1B rs1229984 variant, alcohol phenotypes, and cardiovascular biomarkers.

Main outcome measures Odds ratio for coronary heart disease and stroke associated with the ADH1B variant in all individuals and by categories of alcohol consumption.

Results Carriers of the A-allele of ADH1B rs1229984 consumed 17.2% fewer units of alcohol per week (95% confidence interval 15.6% to 18.9%), had a lower prevalence of binge drinking (odds ratio 0.78 (95% CI 0.73 to 0.84)), and had higher abstention (odds ratio 1.27 (1.21 to 1.34)) than non-carriers. Rs1229984 A-allele carriers had lower systolic blood pressure (−0.88 (−1.19 to −0.56) mm Hg), interleukin-6 levels (−5.2% (−7.8 to −2.4%)), waist circumference (−0.3 (−0.6 to −0.1) cm), and body mass index (−0.17 (−0.24 to −0.10) kg/m2). Rs1229984 A-allele carriers had lower odds of coronary heart disease (odds ratio 0.90 (0.84 to 0.96)). The protective association of the ADH1B rs1229984 A-allele variant remained the same across all categories of alcohol consumption (P=0.83 for heterogeneity). Although no association of rs1229984 was identified with the combined subtypes of stroke, carriers of the A-allele had lower odds of ischaemic stroke (odds ratio 0.83 (0.72 to 0.95)).

Conclusions Individuals with a genetic variant associated with non-drinking and lower alcohol consumption had a more favourable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant. This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.

So in this case, after all the scary headlines and statements like “[t]he latest findings call into question previous studies which suggest that consuming light-to-moderate amounts of alcohol (0.6-0.8 fluid ounces/day) may have a protective effect on cardiovascular health” they finally get to the truth, of sorts, well after many people probably stopped reading. Here it is: “Researchers found that individuals who carry a specific gene which typically leads to lower alcohol consumption over time have, on average, superior cardiovascular health records. Specifically, the results show that individuals who consume 17 percent less alcohol per week have on average a 10 percent reduced risk of coronary heart disease, lower blood pressure and a lower Body Mass Index.” That’s right, the conclusion is about people with a specific gene.

In the study’s abstract conclusion, they go from stating that those people who have the specific genetic variant drink less and also had “a reduced risk of coronary heart disease than those without the genetic variant” to a conclusion that therefore “reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.” But that makes no sense whatsoever.

But perhaps more annoying is a comment by one of the researchers at Penn, Co-lead author Michael Holmes, who essentially dismisses every study before his own as worthless as he arrogantly mansplains that those were all observational studies, just mere “observations,” unlike his study. His tone is clearer when you watch the video, but essentially it’s this, from the media report:

He explains how for some time, observational studies have suggested only heavy drinking is bad for the heart, and that light drinking might even provide some benefit, and this has led some people to believe moderate consumption is good for their health, even lowering their risk of heart disease.

And from the press release:

“These new results are critically important to our understanding of how alcohol affects heart disease. Contrary to what earlier reports have shown, it now appears that any exposure to alcohol has a negative impact upon heart health,” says co-lead author Michael Holmes, MD, PhD, research assistant professor in the department of Transplant Surgery at the Perelman School of Medicine at the University of Pennsylvania. “For some time, observational studies have suggested that only heavy drinking was detrimental to cardiovascular health, and that light consumption may actually be beneficial. This has led some people to drink moderately based on the belief that it would lower their risk of heart disease. However, what we’re seeing with this new study, which uses an investigative approach similar to a randomized clinical trial, is that reduced consumption of alcohol, even for light-to-moderate drinkers, may lead to improved cardiovascular health.”

In addition, his statement that people have been taking up drinking alcohol because previous studies showed a positive association between moderate drinking and heart health is utterly obnoxious. I’ve read a lot of these studies and every single one is overly careful to make sure nobody should ever take their study’s conclusion as a catalyst to start drinking. Between that and the incessant chorus in our society about the dangers of drinking or the idea that drinking’s a sin, this statement, I think, tells us more about his own personal issues with alcohol than any objective reality.

But despite the dismissive tone, waving aside every other study on this topic, suggesting this one study somehow supersedes and replaces them all, there have been perhaps hundreds, or more, studies around the world on the association between alcohol consumption and heart health. I have a hard time accepting that every one of them was “observational” or that they’re all now meaningless now that he’s done this one.

Cardiovascular disease is the number one cause of death in U.S., but moderate drinking can reduce risks 40-60% [Journal, Alcoholism, 2004] and the benefits of alcohol on the heart has been known since 1904 [Journal of the AMA, 1904].

The Director of the National Institute on Alcohol Abuse and Alcoholism wrote that “Numerous well-designed studies have concluded that moderate drinking is associated with improved cardiovascular health” and a Nutrition Committee of the American Heart Association reported that “the lowest mortality occurs in those who consume one or two drinks per day.” On top of that, the World Health Organization Technical Committee on Cardiovascular Disease asserted that the relationship between moderate alcohol consumption and reduced death from heart disease could no longer be doubted. [AIM Digest (Supplement), June 1997].

And here’s just a sample of previous studies, taken from Alcohol Problems and Solutions. And none of them are bogus industry claims, either.

Heart Health

Medical research has demonstrated a strong relationship between moderate alcohol consumption and reduction in cardiovascular disease in general and coronary artery disease in particular. [Moore, R., and Pearson, T. Moderate alcohol consumption and coronary artery disease. Medicine, 1986, 65 (4), 242-267.]

The National Institute on Alcohol Abuse and Alcoholism found that moderate drinking is beneficial to heart health, resulting in a sharp decrease in heart disease risk (40%-60%). [Highlights of the NIAAA position paper on moderate alcohol consumption. Press release from the journal, Alcoholism: Clinical & Experimental Research, June 14, 2004; Berman, Jessica. Moderate alcohol consumption benefits heart, U.S. government says. Voice of America News, June 16, 2004.] This is important because cardiovascular disease is the number one cause of death in the United States and heart disease kills about one million Americans each and every year. [American Heart Association web site.]

The Director of the National Institute on Alcohol Abuse and Alcoholism wrote that “Numerous well-designed studies have concluded that moderate drinking is associated with improved cardiovascular health,” and the Nutrition Committee of the American Heart Association reported that “The lowest mortality occurs in those who consume one or two drinks per day.” [Pearson, T.A. (for the American Heart Association). Alcohol and heart disease. Circulation, 1996, 94, 3023-3025.] A World Health Organization Technical Committee on Cardiovascular Disease asserted that the relationship between moderate alcohol consumption and reduced death from heart disease can no longer be doubted. [Wilkie, S. Global overview of drinking recommendations and guidelines. AIM Digest (Supplement), June, 1997, 2-4, 4.]

• Researchers studied volunteers in seven European countries and found that people who have a daily drink of beer, wine or distilled spirits (whiskey, rum, tequila, etc.) have significantly better arterial elasticity, a strong indicator of of heart health and cardiovascular health, than nondrinkers. Moderate drinkers also had significantly better pulse rates than those of abstainers from alcohol.
• A study of 1,795 subjects found that “the risk of extensive coronary calcification was 50% lower in individuals who consumed one to two alcoholic drinks per day than in nondrinkers.” [Vliegenthart, R., et al. Alcohol consumption and coronary calcification in a general population. Archives of Internal Medicine, 2004 (November 22), 164, 2355-2360.]
• Research demonstrates that moderate alcohol consumption is associated with better endothelial function, which contributes to better heart health and lowers risk of atherosclerosis and cardiovascular disease. [Suzuki, K., et al. Moderate alcohol consumption is associated with better endothelial function: a cross sectional study. BMC Cardiovasc. Discord., 2009, 9, 8.]
• A study of over 3,000 men and women found that those who never drank alcohol were at a greater risk of having high levels of CRP and IL-6 (excellent predictors of heart attack) than were those who consumed alcoholic beverages in moderation. [Price, J.H. Light drinking lowers bad proteins. The Washington Times, February 11, 2004.]

Moderate Drinkers are Less Likely to Suffer Coronary Heart Disease and Heart Attacks (Acute Myocardial Infarctions) than are Abstainers or Heavy Drinkers.

• A National Institute on Alcohol Abuse and Alcoholism review of research studies from at least 20 countries around the world demonstrate a 20- to 40-percent lower coronary heart disease (CHD) incidence among drinkers compared to nondrinkers. It asserts that “The totality of evidence on moderate alcohol and CHD supports a judgment of a cause-effect relationship… there are cardioprotective benefits associated with responsible, moderate alcohol intake.” [Hennekens, C. H. Alcohol and Risk of Coronary Events. In: National Institute on Alcohol Abuse and Alcoholism. Alcohol and the Cardiovascular System. Washington, DC: U.S. Department of Health and Human Services, 1996.]
• Harvard researchers have identified the moderate consumption of alcohol as a proven way to reduce coronary heart disease risk.[Manson, J. E., et al. The primary prevention of myocardial infarction. The New England Journal of Medicine, 1992, 326(21), 1406-1416.]
• A study of 18,455 males from the Physicians Health Study revealed that those originally consuming one drink per week or less who increased their consumption up to to six drinks per week had a 29% reduction in CVD risk compared to those who did not increase their consumption. Men originally consuming 1-6 drinks per week who increased their consumption moderately had an additional 15% decrease in CVD risk. [Sesso, H.D., et al. Seven -year changes in alcohol consumption and subsequent risk of cardiovascular disease in men. Archives of Internal Medicine, 2001, 160, 2505-2612.]
• The Harvard Health Professionals Follow-Up Study of over 44,000 men found moderate alcohol consumption to be associated with a 37% reduction in coronary disease. [Rimm, E., et al. Prospective study of alcohol consumption and risk of coronary disease in men. The Lancet. 1991, 338, 464-468.]
• A British study of women found moderate consumption of alcohol to be associated with lower levels of cardiovascular risk factors. [Razay, G., et al. Alcohol consumption and its relation to cardiovascular risk factors in British women. British Medical Journal, 1992, 304, 80-83.]
• A study of over 5,000 women with type 2 diabetes mellitus found that coronary heart disease rates “were significantly lower in women who reported moderate alcohol intake than in those who reported drinking no alcohol.” Women who drank more than 5 grams (about one-third glass) a day reduced their risk of CHD (fatal or nonfatal) by more than half. [Solomon, C. G., et al. Moderate alcohol consumption and risk of coronary heart disease among women with type 2 diabetes mellitus. Circulation, 2000, 102, 494-499.]
• In a study of nearly 88,000 men, researchers found that drinking reduced risk of coronary heart disease risk among both diabetics and non-diabetics. Weekly consumption of alcohol reduced CHD risk by one-third (33%) while daily consumption reduced the risk by over half (58%) among diabetics. For non-diabetics, weekly consumption reduced CHD risk by 18% while daily consumption reduced the risk by 39%. [Ajani, U. A., et al. Alcohol consumption and risk of coronary heart disease by diabetic status. Circulation, 2000, 102, 500.]
• Light to moderate consumption of alcohol appears to reduce the risk of coronary heart disease by as much as 80% among individuals with older-onset diabetes, according to a study published in the Journal of the American Medical Association. [Valmidrid, C. T., et al. Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus. Journal of the American Medical Association, 1999, 282(3), 239-246.]
• The Honolulu Heart Study found a 49% reduction in coronary heart disease among men who drank alcohol in moderation. [Blackwelder, W. C., et al. Alcohol and mortality. The Honolulu Heart Study. American Journal of Medicine, 1980, 68(2), 164-169.]
• Harvard researchers concluded about coronary heart disease that “Consumption of one or two drinks of beer, wine, or liquor per day has corresponded to a reduction in risk of approximately 20-40%.” [Manson, J. E., et al. Prevention of Myocardial Infarction. New York: Oxford University Press, 1996.]
• At a scientific conference, researchers from Korea, Italy, Germany, Poland, the Netherlands, and the United States reported finding striking reductions in death among moderate drinkers, with heart disease and total mortality rates about one half or less compared to non-drinkers. [Trevisan, M., et al. Drinking pattern and mortality: a longitudinal study; Gaziano, J. M., et al. A prospective cohort study of moderate alcohol consumption and sudden death in the Physicians’ Health Study; Keil, U., et al. The relation of alcohol to coronary heart disease and total mortality in a beer drinking population in Southern Germany; Waskiewicz, A., et al. Alcohol consumption and l l-year total and CVD mortality among men in Pol-MONICA study; Grobbee, D. E., et al. Alcohol and cardiovascular risk in the elderly. All presented at the 4th International Conference on Preventive Cardiology, Montreal, Canada, June 29-July 3, 1997, and published in Abstracts from the 4th International Conference on Preventive Cardiology. The Canadian Journal of Cardiology, June, 1997, volume 13, Supplement B.]
• After over 6,000 participants in the Framingham Heart Study were followed for a period of six to ten years, researchers found that “when consumed in moderation, alcohol appears to protect against congestive heart failure.” [Walsh, C. R., et al. Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study. Annals of Internal Medicine, 2002, 136(3), 181-191.]
• The American Heart Association, based on the research evidence, concludes that the “Consumption of one or two drinks per day is associated with a [CHD] reduction in risk of approximately 30% to 50%.” [Pearson, Thomas A. (for the American Heart Association). Alcohol and heart disease. Circulation, 1996, 94, 3023-3025.]
• After reviewing the research, Dr. David Whitten reported that “The studies that have been done show pretty clearly that the chances of suffering cardiac death are dramatically reduced by drinking” one or two drinks a day and asserted that “We don’t have any drugs that are as good as alcohol.” [Whitten, D. Wine Institute Seminar. San Francisco, CA: 1987. Quoted in Ford, G. The French Paradox and Drinking for Health. San Francisco, CA: Wine Appreciation Guild, 1993. Pp. 26-27.]
• Based on the medical evidence, noted investigator Dr. Curtis Ellison asserted that “abstinence from alcohol is a major risk factor for coronary heart disease.” [Vin, sante & societe. AIM, 1995, 4(2), 7-10, p. 9.]

The Moderate Consumption of Alcohol Increases the Survivability of Heart Attacks

• Drinking alcohol in moderation throughout the year before a heart attack or acute myocardial infarction (AMI) has been found to reduce the risk of dying afterward. Moderate drinkers had the lowest mortality rate, reducing their risk by 32%, compared to abstainers. The health benefits were virtually identical for beer, distilled spirits, and wine. [Mulcamel, K.J., et al. Alcohol consumption after myocardial infarction. Journal of the American Medical Association, 2001, 285(15), 1965-1970; Alcohol and AMI: Benefits from beer, wine, and liquor. American Journal of Nursing, 2001, 101(8), 18.]
• Men who consume two to four drinks of alcohol after a heart attack are less likely to experience a second heart attack than are abstainers, according to a study of 353 male heart attack survivors. Researchers found that men who consumed an average of two drinks of alcohol per day were 59% less likely than non-drinkers to have another heart attack. Those who drank an average of four drinks per day experienced a risk reduction of 52% compared to abstainers. [de Lorgeril, M., et al. Wine drinking and risks of cardiovascular complications after recent acute myocardial infarction. Circulation: Journal of the American Heart Association, 2002, 106, 1465-1469.]
• Research at the University of Missouri-Columbia found that drinking alcohol (beer, wine, or distilled spirits) in moderation reduced the damage to effected tissue following a heart attack. [Dayton C, DC Gute, P Carter, and RJ Korthuis. Antecedent ethanol prevents postischemic P-selectin expression in murine small intestine. Microcirculation, 2004, 11, 709-718.]
• A study for a five year period of over 85,000 men who had suffered previous heart attacks found that “moderate alcohol intake was associated with a significant decrease in total mortality” compared to nondrinkers. [Gaziano, J., et al. Potential mortality benefits for drinkers with previous heart attacks. The Lancet, 1998, 352, M 1882-1885.]

Alcohol Abstainers Who Begin Drinking Reduce Their Risk of Cardiovascular Disease

• During a ten year study of 7,697 non-drinkers, investigators found that 6% began consuming alcohol in moderation. After four years of follow-up, new moderate drinkers had a 38% lower chance of developing cardiovascular disease than did those who continued abstaining. Even after adjusting for physical activity, Body Mass Index (BMI), demographic and cardiac risk factors, this difference persisted.
    
  This study is important because it provides additional strong evidence that the reduced risk of cardiovascular disease among moderate drinkers is a result of the alcohol itself rather than any differences in lifestyle, genetics, or other factors. [King, Dana E., Mainous, III, Arch G. and Geesey, Mark E. Adopting moderate alcohol consumption in middle-age: Subsequent cardiovascular events. American Journal of Medicine, 2008 (March), 121(3).]
• A study of men with high blood pressure found that those who averaged one to six drinks per week has a 39% lower risk of death from cardiovascular causes than were abstainers. Those who averaged more (one or two drinks each day) were 44% less likely to experience such death. [Malinski, M.K., Sesso, H.D., Lopez-Jimenez, F., Buring, J.E., and Gaziano, M. Alcohol consumption and cardiovascular disease mortality in hypertensive men. Archives of Internal Medicine, 2004, 164(6), 623.]
• Frequent Drinkers Enjoy Greater Heart-Health Benefits than Those Who Drink Less Often
  In a study of nearly 88,000 men, researchers found reductions in coronary heart disease risk with increasing frequency of drinking alcohol for both diabetics and non-diabetics. Weekly consumption of alcohol reduced CHD risk by one-third (33%) while daily consumption reduced the risk by over half (58%) among diabetics. For non-diabetics, weekly consumption reduced CHD risk by 18% while daily consumption reduced the risk by 39%. [Anani, U. A., et al. Alcohol consumption and risk of coronary heart disease by diabetes status. Circulation, 2000, 102, 500-505.]

And that’s just a sample, obviously. While this new study is interesting, and I’m looking forward to learning more about the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B), it’s seems more than a little premature to throw out everything that’s come before it. But back to ADH1B. How many people have that gene variant. How can people know if they have it? Although curiously, it’s mentioned in passing that people with the gene variant are also slightly more likely to smoke. Doesn’t it seem at least as likely that the while the gene variant may have a positive effect on heart health, that not having ADH1B isn’t automatically a negative, but the norm? Without knowing the percentage of the population that has this gene variant, it seems odd to me that the conclusion is that the rest of us are somehow negatively impacted by not having what’s by definition a mutation. If having it is good for your heart, can it be synthesized?

Also, in their conclusions, they found that people with the ADH1B gene variant, in addition to drinking less, also “exhibited lower levels of blood pressure, inflammatory biomarkers, adiposity measures, and non-HDL cholesterol,” which could also be contributing to their heart health, couldn’t they? The most confounding conclusion, that simply because they used mendelian randomisation “that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health” I confess I don’t fully understand. Not being a scientist, and not having come across mendelian randomisation before, I don’t fully understand how it can provide results that are so certain, despite it apparently being prone to misleading conclusions from “linkage disequilibrium, genetic heterogeneity, pleiotropy, or population stratification” or any of the biases or problems that you’d have with any study. Almost every preliminary study, or whenever one is the first of its kind, the researchers are always careful not to make too much of their results. They always caution people from drawing too many conclusions and usually state that further research is necessary to confirm or invalidate their findings. That’s how the scientific method is supposed to work, I always thought. But in this instance, one study is being touted as the be all, end all in understanding the relationship between alcohol and your heart. That seems very strange to me. Maybe that’s my ignorance, but neither the press release nor the news report on the study has done anything to clear it up. Considering that those are aimed at the general public, that seems like a big failure. But it certainly makes it easier for Alcohol Justice to jump in and claim victory that alcohol is now completely bad for everyone, no exceptions, despite society having endured quite well since the dawn of time with alcohol playing a fairly prominent role.