• Ichiro WakabayashiEmail author


Alcohol drinking is a general modifiable risk factor for various diseases including cardiovascular disease. A J-shaped relationship is known to exist between alcohol intake and risk of cardiovascular disease as well as between alcohol intake and total mortality. Risks of ischemic arterial diseases, such as coronary artery disease, ischemic stroke, and peripheral arterial disease, are lower in light-to-moderate drinkers (not more than one drink per day for women and not more than two drinks per day for men) than in abstainers. Beneficial effects of alcohol drinking on the risks of ischemic arterial diseases are mainly explained by the actions of alcohol on cholesterol metabolism and the blood coagulation-fibrinolysis system. Light-to-moderate alcohol consumption has also been shown to be associated with decrease in production of proinflammatory cytokines and increase in insulin sensitivity. Additional benefits for cardiovascular protection are expected in polyphenols, contained in red wine, which exert cardiovascular protective actions represented by antioxidative action. On the other hand, heavy drinking and binge drinking increase the risks of hemorrhagic types of stroke, such as cerebral hemorrhage and subarachnoid hemorrhage; cardiomyopathy; and cardiac arrhythmia, particularly atrial fibrillation. The association between alcohol and hemorrhagic stroke is speculated to be due to alcohol-induced hypertension in combination with impaired blood coagulation-fibrinolysis balance. Drinking alcohol beverages, particularly beer, causes increase in blood uric acid level, an independent risk factor for cardiovascular disease. A variety of molecular pathophysiological mechanisms, e.g., oxidative stress, protein phosphorylation, and alterations in Ca2+ homeostasis and gene expression, explained in this chapter are involved in the beneficial and detrimental effects of alcohol on cardiovascular disease and its risk factors. Furthermore, the relationships between alcohol intake and cardiovascular risk may be modified by individual genetic backgrounds represented by polymorphisms of alcohol-metabolizing enzymes. Although light-to-moderate drinking is associated with reduced risk of cardiovascular disease, the use of alcohol as a strategy for cardiovascular protection is not recommended for abstainers because of the lack of randomized outcome data and the future possibility of alcohol abuse.


Alcohol Arrhythmia Cardiomyopathy Cholesterol Coagulation-fibrinolysis balance Hypertension Inflammation Insulin sensitivity Polyphenol Uric acid 


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© Springer-Verlag Wien 2013

Authors and Affiliations

  1. 1.Department of Environmental and Preventive MedicineHyogo College of MedicineNishinomiyaJapan

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