Based on previously published evidence, in January 2022 the World Heart Federation (WHF) issued a policy brief stating that alcohol consumption of any amount, even as little as one glass of wine a day, leads to greater risk of developing cardiovascular diseases such as heart failure and stroke.

Study design

The primary source of the evidence discussed in the policy brief comes from a 2018 article published in The Lancet, “Alcohol Use and Burden for 195 Countries and Territories, 1990-2016: A Systematic Analysis for the Global Burden of Disease Study 2016.” The meta-analysis was a review of 694 data sources measuring 23 health outcomes, including ischemic heart disease, ischemic and hemorrhagic stroke, cancer, and diabetes.

Outcomes

According to The Lancet article, even small amounts of alcohol lead to increased risk of developing heart disease and cancer, and higher mortality rates. The correlation is dose dependent; therefore, the increase in risk correlates with the amount of alcohol consumed.

Limitations

The evidence prior to the study published in The Lancet suggested that some amount of alcohol had protective properties toward ischemic heart disease and diabetes. According to this study, those data were unreliable and had biases. Both The Lancet article and the 2022 WHF policy brief contradict decades of popular belief that alcohol prolongs life and decreases cardiovascular risks. The WHF policy brief notes that no randomized controlled trials have confirmed the benefits of alcohol. One limitation of the meta-analysis is that it may in fact underreport the health risks of alcohol use.

Clinical significance

Most patients trust their doctors, and frequently we have the ability to influence their health decisions. When patients who smoke tobacco have thyroid eye-related disease (TED) or age-related macular degeneration (AMD), they often stop smoking when we educate them about the risks and provide encouragement for quitting. When we instruct opioid-naïve patients to avoid opiates because studies have shown that their risk of addiction is increased, they again frequently adhere to our advice. Similarly, when we tell patients with diabetes that decreasing their glycated hemoglobin (HbA1c) levels from 8.0% to  7.0% reduces the risk of diabetic retinopathy by at least 50%, they often listen and try to improve their HbA1c. Researchers have known for a long time that alcohol consumption increases many health problems such as cancer and cardiovascular disease, exacerbates social burdens such as mental illness and interpersonal violence, and even hurts innocent bystanders such as victims in motor vehicle collisions. Because alcohol intake increases cardiovascular disease, one could also assume it is detrimental to the eyes by worsening diabetic retinopathy or retinal vessel disease. If the conversation arises, ophthalmologists should plan to educate patients that despite popular belief, no amount of alcohol is safe, and this is especially true in patients with chronic diseases.

--Damien M Luviano, MD