Effects of alcohol consumption on cardiovascular system

Light to moderate alcohol consumption – up to one drink per day for a woman and 1-2 glasses per day for a man – would be expected to reduce mortality, risk of coronary heart disease, diabetes or stroke prevalence. Is alcohol good or bad for your health and how much should you drink?

 American researchers who publish an article on this subject in Mayo Clinic Proceedings confirm that cardiovascular benefits are observed with a light to moderate consumption of alcohol, ideally of red wine taken before or during the evening meal. But the most important thing in their research is dose of alcohol that people consume and serious toxic effect in an exposed individual. The overconsumption of alcohol is in fact is linked to serious pathologies: cirrhosis, stroke, cancers of the colon/rectum, breast, larynx and liver. Alcohol also increases violence and the risk of traffic accidents.

Regarding general mortality, a meta-analysis involving 1,2 million people found that small amounts of alcohol to moderate alcohol consumption was associated with decreased mortality: the maximum protection was raised with half to one drink per day for women and 1 to 2 glasses a day for men. But 2.5 glasses a day for women and 4 a day for men increased the risk of death.

The benefits do NOT outweigh the risks

alcohol consumption impact on cardiovascular health

Chronic consumption of alcohol in large amounts can lead to a condition called alcoholic cardiomyopathy. Consume a lot of alcohol (four to five drinks a day for several years) leads to weakening of the heart muscle.  This weakening becomes even more important when a person consumes alcohol in excessive amounts.  Excessive consumption of alcohol (on the same occasion, four or more drinks for women, and five or more drinks for men) and heavy alcohol consumption can increase blood pressure and the risk of developing arrhythmias (irregular heartbeat), such as atrial fibrillation. Such alcohol consumption can increase the risk of death, whether or not the person has heart disease. People who survive a heart attack and report excessive alcohol use are twice as likely to die of any condition, including heart disease, as those who do not consume alcohol excessively. There is no doubt that excessive alcohol consumption, even once a week, puts you at higher risk for heart disease or stroke.  We tend to minimize this point, but if you are trying to lose weight healthily, reducing your alcohol intake can save you a lot of calories. Light and non-alcoholic beers are a better choice than standard beers when it comes to caloric and alcohol content.

Summary and conclusions

If you do not consume alcohol, you do not deprive yourself of any benefit and it is not recommended that you change your good habits. The risk of cancer, liver disease, pancreatitis, accidents, suicide and exposure to violence are also important negative effects of alcohol. 

There are better ways to reduce the risk associated with heart disease, such as exercising, eating a balanced diet, and quitting smoking and alcohol at the same time. All of these methods offer benefits without the added risks associated with alcohol consumption. However, consuming a small amount of alcohol from time to time is not necessarily detrimental to your health, ergo, moderation is the solution.  As there are some exceptions, it is important to talk to your doctor and pharmacist about your use of alcohol. Some people should avoid taking it to avoid aggravating their condition. Mixing alcohol and certain medications can also cause dangerous side effects that can be fatal.

Modifying alcohol consumption

Limit your alcohol consumption in the following ways:  two drinks a day most days, for a maximum of 10 per week for women and three drinks a day most days, for a maximum of 15 per week for men.  Consumption is:  341 ml or 1 bottle of beer at normal alcohol level (5%), 142 ml or 5 oz of wine (12% alcohol) 43 ml or 1½ oz of spirits (40% alcohol content). Chronic consumption of alcohol can raise blood pressure and contribute to the development of heart disease and stroke.  If you drink alcohol, avoid taking more than:  two drinks a day for up to 10 drinks a week for women  and three drinks per day for up to 15 drinks per week for men

Take care of your health and safety. If you are worried about the effects of alcohol on your health, consult your doctor or pharmacist.

Effects of nicotine on cardiovascular system

It is clearly established that tobacco and nicotine has increased mortality and cardiovascular events (CV), however, the price of smoking is often neglected. Behavioral interventions and stop assisting treatments are effective and do not increase the risk of CV events when used over a specified period. E-cigarettes (or vaporettes) contain potentially cardiotoxic substances but lower concentrations than those of cigarettes. The CV effect of vaping is difficult today to evaluate and depends on the type of device used and its mode of consumption. Consumers have been advised to quit using sprays and it is recommended that they be discontinued as soon as they are stabilized.

nicotine structure

Smoking is one of the major cardiovascular (CV) risk factors. Despite the fact that the link between smoking and cardiovascular disease (CVD) has been known for more than 60 years, 1 tobacco still kills nearly 5 million people every year according to WHO. According to estimates by the Federal Statistical Office, 9,500 deaths in Switzerland in 2012 are attributable to diseases caused by tobacco, which represents 1 out of 7.3 deaths CVD accounts for 39% of the causes of tobacco-related deaths (15 % of ischemic heart disease, 24% of other CVD). Despite this, the prevalence of smoking remains high even among people with a CV event. Smoking cessation is one of the recommendations for primary and secondary prevention.  In this article, we will consider the CV effects of smoking, the CV benefits of stopping as well as the effectiveness and possible risks of some cessation aid treatments.

What are the health effects of cigarette smoking?

 Smoking has 5 main adverse effects on your cardiovascular system: 

  • Cigarettes significally reduces the concetration of oxygen in the blood, causing shortness of breath and impaired functioning of your muscles.
  •  It hurts your arteries, which lose their ability to expand normally. It also causes spasms (sudden narrowing of the caliber of the artery) that potentially can be fatal.
  • It can cause blood clotting and promotes, among other things, the formation of clots and thus the potential release of an infarct, a phlebitis or a stroke (stroke). 
  • It causes inflammation of the blood vessels, a phenomenon that also promotes the formation of clots and atherosclerosis.
  • It lowers the level of good cholesterol, which is an additional risk factor for your cardiovascular system in the long term. In fact, the good cholesterol or HDL-cholesterol acts as a “scavenger of the arteries” by cleaning the plaque that forms there. 

Smoking also has an indirect effect: the relative loss of taste and smell associated with tobacco promotes smoker’s attraction to more tasty foods, usually much richer in saturated (bad) fats and more salty. However, a diet high in salt and saturated fat further increases the risk of developing cardiovascular disease.

The pathophysiology of cigarette smoking and cardiovascular disease

Nicotine is naturally occurring liquid alkaloid. An alkaloid is an organic compound made out of carbon, hydrogen, nitrogen and sometimes oxygen, and it can have potent effects on human body. Nicotine is a major addictive ingredient found in all tobacco products. Nicotine primarily binds to nicotinic cholinergic receptors in the brain and acts as a sympathomimetic substance. As a result, it stimulates the release of catecholamines (epinephrine, norepinephrine), which lead to an increase in heart rate, blood pressure and myocardial contractility, which in turn increases myocardial work  and oxygen requirements. Nicotine has a toxic effect on the endothelium and, acting also on alpha-adrenergic receptors, causes vasoconstriction. This leads to a decrease in arterial, coronary and cerebral flows. The harmful effects of nicotine are mainly due to long-term consumption and affect the overall health of the body.

As nicotine narrows the blood vessels and also lower the temperature of the skin (it also leads to increased sweating). The increased blood pressure permanently increases the risk of clot formation. Indirectly, nicotine also promotes the development of arteriosclerosis. Thus, there are numerous gases and substances (for example nitrogen monoxide) in tobacco smoke, which are deposited in the vessels and harden them. This reduces the oxygen supply to the vessels and leads to loss of function. In the further course it can come to a complete stop of the blood supply of individual body regions, which can cause sometimes the death of body parts. As arteriosclerosis also affects the heart, it increases the risk of heart attack. A lack of blood flow in the brain increases the risk of stroke and has a negative effect on the health of the brain. Overall, the cardiovascular system also suffers from red blood cells taking up carbon monoxide instead of oxygen. Thus, there is a shortage of oxygen throughout the body, which among other things accelerates cell death.

The chemical process of burning tobacco creates high levels of harmful chemicals, CO is one among them. It binds to hemoglobin more easily than oxygen, thus decreasing the oxygenation of different organs resulting in moderate hypoxemia that can lead to ischemic events. Erythrocyte production is stimulated by hypoxemia, causing hyperviscosity that contributes to hypercoagulability.  The smoke contains a considerable number of oxidizing gases. These lead to inflammation, endothelial dysfunction and lipid oxidation, which contributes to the pathogenesis of CVD. Oxidizing gases also participate in platelet activation and thermogenesis and increase coagulability. Other components of the smoke, such as heavy metals and polycyclic aromatic hydrocarbons, destroy endothelial cells and contribute to the progression of atherosclerosis.

Nicotine substitutuion

The cardiovascular effects of cigarettes are well known and preventable. They are caused by nicotine, CO, heavy metals on the other side nicotine substitutes contain low dose nicotine and are relatively safe to use even in people with CV risk. Precautions are required during a severe acute cardiac event, but even in these situations, the use of nicotine replacement therapy remains preferable to smoking. Data on the efficacy and safety of varenicline in CVs are favorable. With respect to vaping, the exposure to nicotine and other compounds in the vapor differs with respect to the type and generation of the device and its use. It is therefore extremely difficult to generalize the results of the studies. In addition to nicotine, other substances in the liquid may have a CV effect. The CV toxicity of the vapote nevertheless seems to be lower compared to cigarettes but medium and long term data on the CV safety of the current devices are necessary. In the meantime, it is recommended that people who have quit smoking by vaporettes stop using them as soon as the cessation of smoking is consolidated and that they feel confident enough not to relapse.

Retinopathy

Retinopathy refers to any damage to the retina of the eyes, which may cause vision impairment. Retinopathy often refers to a retinal vascular disease, or the damage to the vessels of the retina caused by abnormal blood flow. Retinopathy can be broadly categorized into proliferative and non-proliferative types. By examining the retina, the light-sensitive layer at the back of the eyes, a doctor can detect early signs of complications of diabetes or high blood pressure, as well as other diseases (such as sickle cell disease, anemia, lupus).

Types of the damage that can occur in the retina are hypertensive retinopathy, a complication of high blood pressure (hypertension), and diabetic retinopathy, a complication of long-term diabetes. Hypertensive retinopathy can lead to blockage of retinal arteries or veins, which in turn may eventually result in the loss of vision. Smoking and diabetes increase the risk of developing hypertensive retinopathy. Diabetic retinopathy is a deterioration of the blood vessels in the retina that usually affects both eyes. Diabetes is the most common cause of retinopathy in the U.S. Diabetic retinopathy is the leading cause of blindness in working-aged people. Almost all people with diabetes show signs of retinal damage after about 20 years of living with the condition. Retinopathy can also be seen in premature newborns.

retinopathy

Causes of retinopathy

Retinopathy is usually a sign of another medical condition. Although several medical conditions (sickle cell disease, lupus) can cause retinopathy, the most common causes are diabetes and hypertension.

Diabetic retinopathy is one of the most common complications of diabetes. Diabetes causes high blood sugar levels, which can damage blood vessels around the retina, that then leak protein and fats, forming deposits. The damaged blood vessels are also not as efficient at carrying oxygen to the retina. Diabetic retinopathy can be proliferative (growing abnormal blood vessels in the retina) or non-proliferative (not growing). Non-proliferative retinopathy is much more common and may not require treatment. In the advanced stage, called proliferative retinopathy, new blood vessels grow, when the existing vessels close off. However, they are weak and often burst, causing bleeding, which can cause scarring and damage vision. Regular eye examinations are important to check for progression of retinopathy from non-proliferative to proliferative stages. Diabetic retinopathy usually affects both eyes.

Hypertensive retinopathy is a complication of high blood pressure that usually takes many years to develop. High blood pressure damages the blood vessel walls, causing them to thicken and narrow, which then reduces the blood supply available to the retina, leading to retinal damage. Visual changes sometimes develop because of advanced retinopathy and may be a sign of undiagnosed or poorly controlled hypertension.

Signs and symptoms

Many people often do not have symptoms until there is irreversible damage. Symptoms are usually not painful and can include:

•    Spots or dark strings floating in your vision (floaters)

•    Blurred vision

•    Fluctuating vision

•    Impaired color vision

•    Eye pain and redness that does not resolve

•    Decreased peripheral vision

•    Changes in color perception

•    Headaches

The earliest sign of diabetic retinopathy that can be detected is the formation of microaneurysms. A more advanced form of diabetic retinopathy, called proliferative diabetic retinopathy, may lead to scars that decrease vision. In proliferative retinopathy, new blood vessels grow over the retina, these blood vessels may swell and burst, causing bleeding and damage to the eye.

Diagnosis and treatment

Retinopathy is diagnosed by an ophthalmologist during a comprehensive dilated eye exam that usually includes: visual acuity testing, tonometry, pupil dilation and optical coherence tomography (OCT). If severe diabetic retinopathy is suspected, a fluorescein angiogram may be used to look for damage or leakage in blood vessels. In the case of hypertensive retinopathy, an ophthalmologist will look for tiny cholesterol plaques as well as narrowing and thickening of the blood vessels.

The key to treating retinopathy is managing the underlying causes behind this condition. Controlling blood sugar levels in diabetes is critical in delaying the progression of diabetic retinopathy. Keeping blood pressure under control will help prevent hypertensive retinopathy. Regular exercise, proper diet, supplements and other lifestyle changes such as quitting smoking will reduce the risk of developing retinopathy. Once retinopathy is detected, early treatment is essential to prevent blindness.

Today, many retinal problems are treated with lasers. Evidence shows that laser therapy is generally safe and improves visual symptoms. If a blood vessel has already leaked and scarring has occurred, your doctor may advise you to have a vitrectomy, which involves removing a part of the vitreous humour along with the scar tissue. Treatment for hypertensive retinopathy includes medications to control blood pressure, laser treatment, and medications injected into the eye (corticosteroids).