One Drink Can Do to Your Heart After 65

I have had the opportunity to train and learn under some of the most gifted doctors specializing in treating heart disease, including one in particular who was an exceptional athlete and wanted to prove that an age difference was not enough to beat him.

One day while we were working together, he told me he was out biking and was passed by a competitive cyclist 20 years younger. It took my colleague 13 to 15 miles to catch this young rider and pass him, to prove his point.

Yet age does change our hearts, and new research I’ll discuss here shows, in particular, how our aging hearts react to alcohol.

Each day, regardless of what we do, our hearts get older. We can modify the impact of aging by careful lifestyle choices, but we can’t prevent it completely. I recently sent a 90-year-old patient for a surgery. I told the surgeon that she was very active, fit, and healthy, and because of this I felt she would do well in the surgery. Despite being 90 years old, I said, she looks much younger.
The surgeon responded, “She is still 90 on the inside.”

When we age, everyone can see the outward changes. However, many changes occur on the inside. Some of these changes relate to how we break down, metabolize, and process food, alcohol, drugs, and supplements.

For this reason, drug-related side effects are more common in the elderly. Also, elderly patients are much more likely to experience drug-to-drug interactions when using multiple medications. Drugs that were once beneficial can cause significant side effects, or become hazardous, just because the person taking them is aging.

Alcohol and Your Heart

Alcohol has both potential beneficial and harmful properties for your body. I will focus on the heart and vascular system-related effects.

Excessive alcohol use can be directly toxic to your heart. As a heart toxin, alcohol can injure the heart muscle and, research shows, lead to severe weakening and congestive heart failure in alcoholics.

Unfortunately, as a physician who treats cardiac diseases, I commonly see alcohol-related heart failure. Fortunately, most people do not use alcohol excessively.

However, even mild-to-moderate alcohol use in susceptible people can increase blood pressure and risk of atrial fibrillation. Because women are more susceptible to the risks of alcohol use, mild-to-moderate drinking for females is only up to two drinks daily, compared to three drinks for men.

With mild-to-moderate alcohol use there are potential heart-health benefits. When used in small quantities, studies on alcohol use show, it can improve healthy cholesterol levels, reduce risk of coronary artery disease, and lower risk of heart failure for some.

Unfortunately, the line between benefit and risk with alcohol is narrow and remains controversial.

Alcohol Use as We Age

Just like many drugs, alcohol is metabolized through a number of pathways in our bodies. We lose only about 8 percent that is not metabolized through our breath, urine, or sweat. Three enzymes within our bodies do most of the work to break down alcohol (alcohol dehydrogenase, cytochrome P450 CYP2E1, catalase). With age, we often produce less of some of these enzymes.

Also, many drugs and other food sources can compete for these enzymes and further reduce the quantity of enzymes available to break down the alcohol. As a consequence, the line between heart-disease risk and benefit changes with age.

A recent study helps define what may be a healthy level of alcohol consumption in the elderly. The study included 4,466 people older than 65 who were studied for more than 10 years. Alcohol use was divided into four categories:

1.Nondrinkers

2.No more than 7 drinks per week

3.7 to 14 drinks per week

4.More than 14 drinks per week

The authors found a number of significant findings in this group of people over 65:

1.More alcohol use was associated with an increase in the size of the heart cavity while the heart relaxes (diastole) and contracts (systole), in both sexes. Like all muscles, our heart works best when the muscle fibers are not overly stretched. Increasing heart cavity size puts tension on the muscle fibers and they become less efficient.

2.Increasing alcohol intake in men was linked to an increased heart mass (thickened heart). Thickened skeletal or outward muscles are okay, but you don’t want a thickened heart muscle. This is because the heart has to actively relax. A thick heart muscle takes more time to relax, and if the heart rate gets too fast, symptoms of shortness of breath and heart failure can develop.

3.Increasing alcohol use in women was associated with lower heart function. The ejection fraction of the heart is the amount of blood the heart pumps out, divided by the amount it receives. Ejection fractions in women who had more alcohol, compared to those who did not drink alcohol at all or used less, were significantly lower.

4.In both sexes, increasing alcohol consumption was linked to a larger upper heart chamber (left atrium). A larger left atrium is an important cause of atrial fibrillation.

5.Only in the group who had 14 drinks or more per week was an increase in blood pressure noted.
Across both sexes, these adverse heart findings increased as weekly alcohol use increased. As previous studies also found, women were more susceptible than men across all the drinking levels. 

Unfortunately, in this elderly group, no level of alcohol use was linked to a lowered risk of coronary artery disease.

Reasons to Lower Alcohol Use

This study shows that any level of alcohol consumption in the elderly can increase risk of upper and lower heart chamber enlargement. These structural changes to the heart can raise the risk of atrial fibrillation and heart failure.

Women are particularly susceptible to these changes, but the authors also saw adverse changes in men who consumed more than one drink per day.

These study results make it very hard to provide a healthy level of alcohol use in people over 65 years of age, in particular, for women. At a minimum, if you want to lower your risk of atrial fibrillation, heart failure, and high blood pressure, try to limit your alcohol use to less than seven drinks a week.

This is particularly important for women as they age.

T. Jared Bunch, MD is a native of Logan, Utah, and directs heart rhythm research at the Intermountain Medical Center Heart Institute. You can follow @TJaredBunch on Twitter. Dr. Bunch is also a frequent guest on The Dr. John Day Show, available on iTunes.

Source: Goncalves A, Jhund P, Claggett B, Shah AM, Konety S, Butler K, Kitzman DW, Rosamond W, Fuchs FD, Solomon SD. Relationship Between Alcohol Consumption and Cardiac Structure and Function in the Elderly
The Atherosclerosis Risk in Communities Study. Circ Cardiovasc Imaging. 2015;8:e002846. DOI: 10.1161/CIRCIMAGING.114.002846.