Does Drinking Alcohol Affect Your Risk for Heart Disease?

a photo of someone drinking a glass of wine overlaid of a graphic of a heartbeat
a photo of someone drinking a glass of wine overlaid of a graphic of a heartbeat

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Whether it's a round of after-work pints with friends or a glass of wine in the evening, alcohol can be an enjoyable way to unwind from a stressful day. Considering that alcohol has been a staple across cultures for centuries and 63% of U.S. adults aged 18 and older drink alcohol (according to a recent Gallup poll), it's unlikely that alcohol will go away anytime soon. While drinking alcohol in moderation can offer some health benefits, consuming too much can affect your risk for heart disease—the No. 1 cause of death worldwide. But how much alcohol is safe? Here we dive into the research to weigh the pros and cons of drinking alcohol and see how it can impact your heart health.

How Alcohol Is Digested

When you drink alcohol, it isn't digested like other foods and beverages. Alcohol is metabolized by several pathways in your body, the most common involving two enzymes—alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). "Alcohol is mostly absorbed in the small intestine, where it's then transported to the liver and metabolized by ADH and ALDH," says Jared Selter, M.D., a cardiology specialist with the Hartford HealthCare Heart and Vascular Institute at St. Vincent's Medical Center. "These enzymes evolved to metabolize alcohols and other compounds which occur naturally in various foods. Alcohol gets broken down into a dangerous compound called acetaldehyde, then into acetate, which is broken down further into water and carbon dioxide."

Once alcohol is absorbed in the small intestine, it's rapidly absorbed into your bloodstream and distributed throughout your body, including your brain, kidneys, lungs and liver. "Your liver is the organ responsible for breaking down foods, metabolizing drugs and detoxifying toxins like alcohol," explains Florence Comite, M.D., founder of the Comite Center for Precision Medicine & Health. "Alcohol contains ethanol, which is turned into acetaldehyde (a poison) in your liver. Your liver then detoxifies acetaldehyde into acetic acid."

How Much Alcohol Is Safe?

While we here at EatingWell believe all food can have a place in a healthy diet—including alcohol—recent research suggests that no level of alcohol consumption is considered safe. A large cohort study published in JAMA Network Open in March 2022 (that included 371,463 participants) found an association between habitual alcohol consumption and increased cardiovascular risk, including heart disease, hypertension and coronary artery disease. In addition, the researchers noted that reducing or eliminating alcohol consumption benefits cardiovascular health.

"The World Health Organization has listed ethanol as a Class I carcinogen, similar to asbestos, radiation exposure and tobacco," says Selter. "Low-level consumption may not dramatically increase an individual's risk over their lifetime, but there's no level of alcohol consumption that's been shown not to cause some degree of damage."

Limit Your Alcohol Consumption to This Amount

Let's be real: People are still going to drink alcohol regardless of what the science and experts say—and there is research on both sides of the alcohol debate making it challenging to draw one definitive conclusion. So how much alcohol should you be drinking? The Dietary Guidelines for Americans recommends you drink alcohol in moderation by limiting your intake to two drinks or less per day for men or one drink or less a day for women. A "standard drink" is defined as:

  • 12 ounces of beer (5% alcohol content)

  • 8 ounces of malt liquor (7% alcohol content)

  • 5 ounces of wine (12% alcohol content)

  • 1.5 ounces of distilled spirits or liquor like gin, rum, vodka and whiskey (40% alcohol content)

The Pros

Alcohol can help improve blood sugar control.

If you want to lower your risk of developing type 2 diabetes, drinking wine with your meals may help. "Some studies have found that moderate alcohol consumption benefits glucose metabolism," says Comite. For example, research presented at an American Heart Association conference in 2022 found that moderate consumption of wine with meals (no more than 14 grams per day for women (around 1 glass) and 28 grams for men (around 2 glasses) was associated with a lower risk of type 2 diabetes. These findings are noteworthy since people with diabetes are twice as likely to have heart disease or a stroke.

Alcohol may boost heart health.

Some research has suggested that low to moderate alcohol consumption can have heart health benefits by improving cholesterol and blood pressure levels while reducing heart attack risk, according to a 2018 review published in Molecules.

"Much has been made of the potential heart benefits of drinking red wine due to its antioxidants, especially a polyphenol called resveratrol. However, the studies on resveratrol are mixed," says Comite. "Some show it reduces LDL cholesterol and inflammation while others show no benefits."

The Cons

Alcohol may spike liver disease risk.

"Alcohol consumption increases the risk of liver disease, including hepatocellular carcinoma and cirrhosis (liver failure)," cautions Selter. "Also, the risk of these liver conditions increases if [someone] has hepatitis B or C." According to a 2020 meta-review published in The American Journal of Gastroenterology, one drink per day showed an elevated risk for liver cirrhosis in women. In addition, drinking five or more drinks daily was associated with a significantly increased risk for all adults they studied.

Alcohol can increase risk for diabetes.

Since many alcoholic beverages are high in sugars (e.g., mixed drinks, wine, beer), regularly consuming excessive amounts of alcohol can increase the risk of developing type 2 diabetes. That's because high sugar intake from alcohol can lead to insulin resistance. Additionally, alcohol may lower testosterone levels, which are associated with higher diabetes risk in women.

Alcohol may elevate cancer risk.

"Any amount of alcohol can pose a health risk," cautions Comite. "Even light drinking (one drink or less daily) can raise the risk of esophageal cancer and other cancers." In addition, the National Cancer Institute states that the more alcohol you drink, the more your risk of developing alcohol-related cancers increases over time. Cancers associated with regular alcohol consumption include head and neck, breast, colorectal, esophageal and liver.

Frequently Asked Questions

1. What are signs that you are drinking too much alcohol?

The Centers for Disease Control and Prevention defines heavy drinking as eight or more drinks per week for women or 15 or more per week for men. "Signs you're drinking too much include consuming more alcohol to achieve the same physical effect, drinking more frequently, drinking to the point of blacking out, drinking alone and missing events or responsibilities to drink," says Selter. Other signs include alcohol cravings, alcohol negatively affecting your relationships and an inability to quit drinking despite wanting to.

2. Can you drink alcohol if you have heart disease?

Depending on the extent of your heart disease, low to moderate alcohol consumption may be acceptable. However, speak with your doctor or cardiologist and follow their advice. "In general, we advise against regular alcohol consumption in patients who suffer from heart disease," says Selter. "Also, alcohol might not be safe to use with the medications required to treat heart disease."

3. How does alcohol affect your heart health?

Drinking more than the recommended amounts of alcohol regularly can negatively affect your heart health and lead to several health problems, including cardiomyopathy (weakening of the heart muscle), irregular heartbeat, high blood pressure and increased stroke risk.

4. Can you reverse alcohol damage?

If your alcohol-related health conditions are detected early on, it's possible to reverse the damage done. For example, high blood pressure related to excessive alcohol consumption may improve once alcohol consumption has stopped. However, other conditions like cancer or cardiomyopathy can be treated but not reversed by abstaining from alcohol.

The Bottom Line

Drinking alcohol is deeply ingrained in our social fabric. While enjoying the occasional adult beverage can be a fun and enjoyable way to relax and socialize, the latest research suggests that any amount of alcohol may be bad for your health. If you choose to drink alcohol responsibly, limit your intake to one or two drinks per day for optimal heart health.