Cardiovascular Journal of Africa: Vol 32 No 5 (SEPTEMBER/OCTOBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 5, September/October 2021 AFRICA 247 American College of Cardiology 2021: Moderate drinkers have 20% lower heart risk than teetotallers Moderate drinking, possibly by dampening stress-related neurological signals, is associated with a significantly lower risk of dying from cardiovascular disease (CVD) when compared with abstainers or excessive drinkers, according to research at the American College of Cardiology’s 70th Annual Scientific Session, reports MedicalBrief . Three other studies, into exercise, having a spouse with CVD, and the effect of psychological distress, further highlighted the damaging role of stress in major heart events. First study The study, based on the healthcare records of more than 53 000 people, is the first to show that drinking moderately, defined as no more than one alcoholic drink for women and two for men per day, may be heart protective, said Dr Kenechukwu Mezue, a fellow in nuclear cardiology at Massachusetts General Hospital and the study’s lead author. Findings should spur the search for new therapies, such as exercise or yoga, which help lower stress and impact on the heart without the drawbacks of alcohol. ‘We found that stress-related activity in the brain was higher in non-drinkers when compared with people who drank moderately, while people who drank excessively (more than 14 drinks per week) had the highest level of stress- related brain activity,’ said Mezue. ‘The thought is that moderate amounts of alcohol may have effects on the brain that can help you relax, reduce stress levels and, perhaps through these mechanisms, lower the incidence of CVD.’ ‘While the current study suggests that moderate alcohol intake beneficially impacts on the brain–heart connection, alcohol has several important side effects, including an increased risk of cancer, liver damage and dependence, so other interventions with better side-effect profiles that beneficially impact on brain–heart pathways are needed,’ Mezue said. For the alcohol study, data were obtained from the Mass General Brigham Biobank health care survey of 53 064 participants, of whom 59.9% were women and the average age was 57.2 years. Alcohol intake was based on self-report and was classified as low (< one drink/week), moderate (one to 14 drinks/week) or high (> 14 drinks/week). Major adverse cardiovascular events, including heart attack, stroke or related hospitalisations, were determined using diagnostic (ICD) codes. Of the patients included, 752 underwent 18 F-fluorodeoxyglucose positron emission tomography, or PET imaging, which is often used as part of cancer screening but can also show areas in the brain that have increased activity. The scans allowed researchers to objectively measure activity in regions of the brain known to be associated with stress. Researchers assessed stress-related brain activity by measuring the activity of the amygdala (the part of the brain associated with fear and stress) and dividing it by activity in the frontal cortex (the part of the brain involved in executive functions). They then grouped patients based on the extent of brain stress activity. Of the 53 064 participants, 7 905 (15%) experienced a major adverse cardiovascular event: 17% in the low alcohol- intake group and 13% in the moderate alcohol-intake group. People who reported moderate alcohol intake were found to have a 20% lower chance of having a major event compared to low alcohol intake (in adjusted analysis), and also had lower stress-related brain activity. This remained significant, even after controlling for demographic variables, cardiovascular risk factors, socio-economic variables and psychological factors. ‘Previous studies by our group and others have shown a robust association between heightened amygdala activity and a higher risk of major adverse cardiovascular outcomes, such as heart attack, stroke or death. In the current study, path analyses showed that the link between moderate alcohol intake and lowered cardiovascular event risk was significantly mediated though reductions in amygdalr activity,’ Mezue said. The study is limited due to the self-reporting of alcohol intake based on the average consumption of drinks per week. The data are also from a single centre, and each participant in the imaging sub-study received only a single brain scan. 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