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ALCOHOL, CARDIOVASCULAR DISEASE and CANCER

Abstract:  A modest daily amount of alcohol in drinks of liquor, wine, or beer can reduce the risk of coronary heart disease. But alcohol also increases risk of cancer and some other health factors.  Most people can obtain an advantage of about 300 Well-Days of life with just one regular and continuing drink of alcohol per day.  But this risk reverses with use of more alcohol, and amounts much in excess of two drinks per day can significantly diminish Well-Days of life.  Those having an elevated risk of cancer should not consume alcohol. Life Ahead will compute a likely effect of any amount of alcohol consumption for individuals of widely varying basic risk.

Alcohol long has been regarded as a major threat to health.  Yet a fascinating finding of research – long opposed but now finally acknowledged by researchers – is that a small daily consumption of alcohol usually can provide a quite significant benefit to health.  Dozens of studies now confirm this, with a majority confirming that carefully monitored consumption can lower the risk of heart disease up to near 50% for many but not all people. 

The Life Ahead Analysis:  The review used for Life Ahead included results from various statistical regressions of data from 8 studies and several meta-analyses found in Medline for heart disease, and from 50 studies and 8 meta-analyses relating alcohol to various cancers.   Because the effects of alcohol on major disease are well recognized and are not now controversial, the extensive set of data used in the Life Ahead analyses is not included following.

The relationship between alcohol and heart disease is so-called “J” shaped, as showing reduced risk for a modest consumption that reverses toward much higher risk at high consumption.  Some studies indicate equal benefits up to and beyond 2 drinks per day for heart disease. But individual population studies do not have the resolving power to identify an optimum consumption of alcohol for minimum risk.  Thus results of multiple studies or meta analyses are needed for useful analysis.  Even with use of the extensive data found the exact optimum alcohol for minimum cardiovascular risk is difficult to determine accurately. But this optimum for coronary disease probably is at or modestly below 2 drinks per day or 14 per week. 

The risks of alcohol on individual causes of cancer are below the margin of error of some population studies, and thus also require analysis of multiple studies for useful significance and conclusion.  Risks from cancer do not follow the "J" shape but proceed steadily higher as higher amounts of alcohol are consumed.  Thus the overall optimum amount use of alcohol considering both heart disease and cancer is lower than that estimated only for use of alcohol on heart disease.   The research data used on 66 comparisons of cancer reviewed show significantly increased risk with increasing alcohol intake for breast, colon, female area, lung, prostate, and all other cancers. The effects of alcohol on the various cancer types tend to be similar, and do not deny the hypothesis that alcohol affects all forms of cancer similarly.  But because lung and prostate cancer appear somewhat less affected by alcohol than do the other cancers, Life Ahead assigns just two levels of cancer risk for alcohol intake, one to lung and prostate cancer, and the other to all other cancers.

The table following provides the result of a Life Ahead Analysis of effects of alcohol consumption on an average non-smoking population of men of age 50.  Risks of disease per year are those computed to age 60.  Column 2 shows that risks of heart disease decrease from 8.2% for non-drinkers to a minimum of 5% at about 10 drinks per week.  This risk of heart disease then reverses to higher values as alcohol consumption moves higher.  At 21 drinks per week or 3 per day risk exceeds that for the non-drinkers.  Although most research was for men, risks for women appear similar to those for men.

Risks of cancer are higher in amount than those for coronary heart disease for this average man.  The 3rd column in the table following shows that these risks  proceed steadily upward as alcohol use is increased.  Life Ahead provides by its lifecycle approach what may now be a unique method for computing how the results of combined risks such as these are likely to extend to produce Well-Days of overall healthy life.  Computed total Well-Days of life from the program reach an optimum of 9140 at just 7 drinks per week or 1 per day.  Any gain for use of alcohol is erased at 2 drinks per day.  And consumption of 4 to 6 drinks per day produces expected losses of from 4 to 7 years of Well-Days of life.

The risk of cancer will be appreciably higher for one that has a family risk of any kind of cancer.  And it can be still higher for those that have had any kind of cancer in the past. Thus it is unlikely that alcohol will be of any benefit for those having any elevated cancer risk, and its consumption in any amount by such persons probably will be unhealthy. Life Ahead will compute a most probable result for those having any combination of prior risks.

It is impossible to obtain the probable accuracy of Life Ahead in computing this risk from any individual or combination of studies without the global analysis of multiple study results on both heart disease and cancer used here. Individual studies have margins of error that are far too wide for a useful optimum value for alcohol intake to be obtained.

Optimum Use of Alcohol Can Differ for Some Individuals:  The above results for an average man of age 50 probably will be roughly valid for many middle-aged men and women.  But those that have much differing risks of heart disease and cancer can have differing optimums for alcohol consumption.  For example those with quite low risks of heart disease and high risks of cancer will find alcohol of less benefit;  those with high risks of heart disease and low risks of cancer may find 2 drinks per day closer to an optimum. A woman of average habits that had a sibling with any cancer at or before age 45 will not obtain any benefit for 1 drink per day, can lose nearly 2 years of Well-Days for 2 drinks per day.  Life Ahead will compute most likely risks for any consumption of alcohol for individuals having any combination of disease risks.

Smokers who also consume alcohol obtain a very high risk.  A reason for this becomes obvious from chemistry. Carcinogenic tars are water insoluble and thus can mostly pass through the human body.  But alcohol provides a mutual solvent for both tars and water, and this can bring the carcinogens in much closer contact with body tissue.  Thus smokers should avoid drinking alcohol during any time that they smoke.  Life Ahead assigns these higher risks of alcohol for smokers. Life Ahead also recognizes that high alcohol consumption also increases risks of accidents and other non-disease deaths.

How Does Alcohol Produce its Benefit?  As is well known, alcohol improves HDL cholesterol.  There has been much study of the possibility that this explains the benefit found  A meta study of 62 comparisons from 42 studies (Rimm, EB, BMJ, 1999, 319:1523) found that 30 grams/day or one daily drink of alcohol improved HDL by about 4 mg/dl.  Yet, this explains only a part of the risk reduction on cardiovascular disease for the first drink per day of alcohol.  Higher amounts of alcohol continue to improve HDL but then reverse to produce increased cardiovascular risk. Thus it is unlikely that the HDL association has biochemical significance.  Other factors much more important than HDL appear to be involved here both in alcohol's benefit and in its harm that are not now explained.  No confirmed mechanism by which alcohol increases risk of cancer was found in the Life Ahead review. But alcohol does provide a mutual solvent for some carcinogens and body fluids that could be harmful.

Life Ahead can forecast a risk for any amount of alcohol for any combination of other health risks for men or women of any age.  Simply compute a person’s risk, preferably with diet.  Then access the ‘Change Other Habits’ tab and enter any change in amount of alcohol desired.  The result will show the estimated gain or loss in Well Days and risks of included diseases to specified ages for any change in alcohol. This computation recognizes the combined effect of alcohol on both cardiovascular diseases and cancer and on other disease and non-disease risks.  The program provides for entry of usual drinks per day as a general entry option, and also provides for including the alcohol included in various drinks in a diet entry.  The general entry option operates only if a diet is not entered.  If a diet is entered, the alcohol in this specific diet replaces the general alcohol entry option. This method is required for a proper comparison of overall health effects of various diets.

Much research and media attention has focused on the relative merits of alcohol in red and white wines, beer, and liquor.  The results of this are so conflicting and of such high error margin that no attempt is now made in Life Ahead to include differences for drink types now. The balance of evidence suggests that a given amount of alcohol from various sources is near equivalent in effect.  If more convincing evidence can be provided that there are advantages for one or more alcohol types, this will be welcomed and the program will be expanded to reflect this.  Researchers identify alcohol use in grams.  Life Ahead uses for convenience 'drinks' identified as 28.4 grams of alcohol, 1.5 oz liquor,  one beer, or 4 ounces of wine.