Many studies have shown that alcohol consumption, even at heavy levels, can protect against cardiovascular disease (CVD). But is the link that simple? France has the lowest death rate from CVD in Europe. Why does a similar level of alcohol consumption in eastern Europe have harmful cardiovascular effects?

Researchers from the London School of Hygiene and Tropical Medicine examine this paradox through a systematic review of research on the relationship between heart disease and heavy drinking.

Existing studies consistently show that alcohol has a cardioprotective effect even at high levels of consumption. However, most record the amount drunk each week or month and do not look at the pattern of drinking. Recent evidence from eastern Europe challenges the conventional wisdom, showing a link between heart disease and heavy drinking. The effects of different patterns of drinking may explain this apparent contradiction. Cultural differences between countries influence how alcohol is consumed. In Mediterranean countries, alcohol is typically consumed as wine with meals, whereas in eastern Europe people are more likely to drink spirits in 'binges'.

Key findings from the study include:

• Sudden cardiac death in Moscow increases significantly at weekends, especially among young and early middle-aged men. A similar peak is seen for deaths more obviously related to alcohol.
• The physiological effects of binge drinking are quite different from those seen with regular moderate and heavy drinking.
• In societies where binge drinking is common, removal of alcohol is associated with a fall in cardiovascular death rates.
• Problem or binge drinkers have a two to six times increased risk of sudden death.
• Alcohol has less of a cardioprotective effect for people with a low folate intake.

Policy-makers seeking to promote 'sensible drinking' need to present clearly the message that, while regular moderate drinking may be good for your heart, the same total weekly amount drunk irregularly may have the opposite effect.

Other policy recommendations include:

• investigating the importance of drinking pattern for other alcohol-related health problems
• using caution when advising that even moderate drinking is beneficial for coronary heart disease in regions, such as central and eastern Europe and the former Soviet Union, where diets are traditionally low in folate
• ensuring that messages reach those on the margins of society who are most likely to drink in binges
• recognising the increasing frequency of binge drinking among women in some societies.

Source(s):
‘The relation between alcohol and cardiovascular disease in Eastern Europe: explaining the paradox’, Journal Epidemiology Community Health 54: 328-332, by A. Britton and M. McKee, 2000

Funded by: UK Department for International Development

id21 Research Highlight: 08 May 2002

Further Information:
Martin McKee
ECOHOST
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
UK

Tel: +44 (0)20 7927 8636
Fax: +44 (0)20 7580 8183
Contact the contributor: martin.mckee@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

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