By Gemma Chiva-Blanch and Lina Badimon
The relationship between alcohol consumption and CVD appears in general terms biphasic, being protective at low and moderate amounts and detrimental at high intakes, even when occasionally consumed. Although several authors defend that the harmful effects of alcohol, even at low amounts, outweigh their benefits, current evidence supports that low amounts of alcohol are safe and beneficial for the CV system.
As per evident ethical and logistical reasons, the main body of evidence relies on epidemiological studies of associative nature which carry several limitations such as the quantification of alcohol consumption. In the future, these studies should include reliable measurements of biological biomarkers of alcohol exposure such as urinary ethyl glucuronide which may better reflect short-term and habitual alcohol consumption than self-reported intake and should also include repeated measures
It is worth mentioning that, despite the cardioprotective effects derived from low/moderate alcohol consumption, these benefits may be weighed against the potential harms from an individual perspective and addressing serious issues such as the propensity to alcohol dependence and collateral social harms, genetic vulnerability, pregnancy or even the family history of cancer. On the other hand, heavy and binge alcohol consumption should be categorically discouraged without any exception or pretext. Along this line, national and international guidelines should be better implemented and updated.
Notwithstanding, alcohol consumption is increasing worldwide and consumed by about half of the population over 15 years of age. As no large randomized trials have been able to be performed at the moment, from a public health perspective, several questions remain open: (1) Which daily amount of alcohol consumption can be considered as safe and truly cardioprotective? (2) Which type of alcoholic beverage is really more beneficial? (3) Do the effects of alcohol vary according to the
region and socioeconomic status of the countries and because of genetic and ethnical traits? (4) Are the effects of alcohol consumption specific at dierent ages? (5) Do sex-specific differences in the pathophysiological effects of alcohol consumption disappear at a certain age? To summarize: to drink or not to drink? This question was launched in 2007 and remains unanswered 13 years after. This is of especial importance considering the fact that the majority of disease endpoints attributable to alcohol consumption are also associated with aging, and also considering that the main body of evidence relies in countries with the highest life expectancy. Meanwhile, as alcohol consumption is part of the lifestyle of several cultures, it would be wise to suggest low–moderate alcohol consumption among current drinkers and never recommending drinking in order to improve health outcomes.