Heavy Drinking May Contribute to CHD Risk in Young Women

Women who drink more than eight alcoholic beverages per week are at an increased risk of developing coronary heart disease (CHD), research suggests.

While both men and women in the study had increased risks of CHD with elevated alcohol consumption levels, the relationship was far more pronounced for women, said lead author Jamal S. Rana, MD, PhD (The Permanente Medical Group, Oakland, CA).

Women “consistently have higher risk, anytime they are consuming more than one drink on average per day,” Rana said in a web briefing prior to presentation of the study at the American College of Cardiology (ACC) 2024 Scientific Session.

To TCTMD, he noted that a recent statement from the World Health Organization suggested that no amount of alcohol is safe for human health. “I’m not saying that, [but for those] who already have hypertension or diabetes, I would say to avoid or minimize alcohol as much as they can,” he added.

Commenting for TCTMD, Sean Heffron, MD (NYU Langone Health, New York, NY), said the study is limited by its nonrandomized design as well as unmeasured confounders.

“That being said, I already do counsel patients that more than minimal amounts of alcohol are detrimental to health in general and likely to heart health,” he said. “For better or for worse, even in moderation, [alcohol] may not necessarily be a good thing for some of us, and even in minimal amounts it is a toxin.”

Those decisions that you make when you're younger can definitely have impacts when you're older. Sean Heffron

Rana noted that not only does alcohol raise blood pressure and lead to metabolic changes associated with inflammation and obesity, it also has been shown to be metabolized differently in women than men.

“At a public health level, I think we should start considering alcohol use as a vital sign,” akin to smoking and other unhealthy behaviors, he said in the web briefing.

Binge Drinkers at Highest Risk

For the study, 432,265 study participants (mean age 43.5 years; 44% female) with no prior history of CHD or stroke self-reported their drinking habits during primary-care office visits. Consumption of alcohol was classified as low (one to two drinks per week for men and women), moderate (three to 14 drinks per week for men; three to seven per week for women) and high (≥ 15 drinks per week for men; ≥ 8 per week for women). Heavy episodic drinking or binge drinking was classified at having ≥ 5 drinks in a single day in the last three months for men and ≥ 4 drinks in a single day in the last three months for women.

Over the 4-year follow-up period, 3,108 new cases of CHD were diagnosed among participants. After adjustment for a variety of factors including age, sex, race, ethnicity, body mass index, physical activity, smoking, hypertension, diabetes, and hyperlipidemia, women and men with high versus moderate alcohol consumption levels had a 45% and 15% increased risk of CHD, respectively.

Among binge drinkers, women had a 68% increased risk of CHD compared with women who were moderate drinkers, while men had a 33% increased risk.

Rana said the contemporary data also suggest that there has been an increase in the prevalence of women drinking large amounts of alcohol. He further pointed out that the study participants were fairly young, and that many may not be aware that drinking is a risk factor to worry about.

Heffron echoed that thinking.

“Atherosclerotic heart disease is a chronic disease that builds up over time and its foundation starts generally when we're young. Younger people tend to feel invincible and like nothing can hurt them, but even those decisions that you make when you're younger can definitely have impacts when you're older [because] you are laying that groundwork,” he said. “So, the younger that we can be when we adopt heart-healthy habits, the [more likely] it is that they will persist as we get older and help us avoid the early initiation of long-term chronic disease.”