ALCOHOL AND OLDER POPULATIONS - More about health effects of alcohol

Coronary heart disease

Coronary heart disease is the leading cause of death in older people, and the coronary health benefits of a moderate alcohol consumption found in several large population studies highlight the considerable difficulty in balancing the apparent risks and benefits of alcohol use and the greater sensitivity of older adults to the physiological effects of alcohol (see more).

Although we do not advocate that anyone take up moderate drinking alcohol for health reasons, The UK Government guidelines explain that middle aged or elderly non-drinkers or infrequent drinkers and especially those at risk for heart disease ‘may wish to consider the possibility that light drinking may be of benefit to their overall health and life expectancy'.

Hypertension

Hypertension is associated with a doubled risk for cardiovascular disease and may account for 30% of events associated with cardiovascular disease. The risk relationship between alcohol consumption and hypertension may best be described as a threshold effect : little increase in risk is found up to about 20-30g of alcohol per day, beyond which blood pressure increases markedly. At a drinking level of 30g or more a day (two US and Canadian drinks and three UK drinks), a net harm is seen in epidemiological studies.

Heart Failure

Heart Failure (HF) is one of the leading causes of hospitalization of the elderly. In the New Haven EPESE cohort study of 2235 elderly persons (mean age 73.7 years) consumption of about 1.5 to 2 drinks per day was associated with a significantly reduced risk of HF:compared with non-drinkers. (Abramson JL et al. Moderate alcohol consumption and risk of heart failure among older persons. JAMA 2001;285:1971-77.) A meta-analysis of data from 6 studies suggest that infrequent and light-to-moderate drinking is associated with a lower risk of heart failure. (Padilla H et al. Alcohol consumption and risk of heart failure. A meta-analysis. The Physician and Sports medicine 2010;38:84-89.) However, long-term heavy alcohol consumption has been associated with worsening cardiac function, and chronic alcoholism is one of the most important causes of dilated cardiomyopathy. (Rubin E et al. Alcoholic cardiomyopathy. Alcohol Clin Exp Res 1994;18:111-4).

Alcohol use and successful aging

Among 13,894 women in the Nurses’ Health Study, investigators prospectively examined alcohol use assessed at midlife in relation to ‘successful ageing’, which was defined as survival to age 70 years, not having a major chronic disease (such as coronary disease, cancer, stroke, diabetes), and having no major cognitive impairment, physical impairment, or mental health problems. Only 11% of the women met these criteria. The results indicate that moderate drinkers, especially those consuming wine and drinking regularly, were more likely to exhibit successful ageing. For average amount consumed, the largest benefit (an increase of 28%) was among women who reported 15.1 30 g of alcohol per day (an average of just over 1 to 2 drinks per day), when compared with non-drinkers. The frequency of drinking was especially important: in comparison with non-drinkers, women who drank only on 1 to 2 days per week had little increase in their risk of successful ageing, but those drinking on at least 5 days per week had almost a 50% greater chance of successful ageing. (Sun Q et al. Alcohol consumption at midlife and successful ageing in women: A prospective cohort analysis in the Nurses’ Health Study. PLoS Med 8(9): e1001090. doi:10.1371/journal.pmed.1001090).

Alcohol and dementia

As well as the ‘heart-healthy’ benefits of moderate drinking to older people, research is also finding that moderate alcohol consumption may reduce the risk of dementia and Alzheimer’s disease. Heavy alcohol consumption will, however, cause neural damage and memory loss. The benefit of moderate alcohol for cognition has been shown in both men and women, although the amount and pattern of drinking is very different between the two sexes). A recent meta-analysis of 143 papers describing the relative drinking of alcohol and cognition found that moderate drinking seems to reduce the risk of dementia and cognitive decline in older subjects. (Neuropsychiatric Disease and Treatment 2011;7:465-84.) Heavy alcohol use has a significant and negative effect on everyday cognitive performance, and the presence of cognitive and neuropsychological deficits have been observed in heavy drinkers. (Ling T et al. Effects of alcohol on subjective ratings of prospective and everyday memory deficits. Alcohol Clin Exp Res 2003:27:970-74.). Long-term abuse of alcohol is associated with alcohol dementia. (Wernicke-Korsakoffs Syndrome). Alcoholic beverage consumption may exacerbate cognitive impairment and dementias due to other causes, and recognition of heavy alcohol consumption in cognitively impaired patients is important, as chronic alcohol toxicity represents one cause of potentially reversible dementia.

Alcohol use and bone strength

Abuse of alcohol is considered to be an important risk factor for fractures and osteoporosis.However, evidence is showing that moderate intake of alcoholic beverages is linked to higher bone mineral density. (Jugdaohsingh MA et al. Moderate alcohol consumption and increased bone mineral density: potential ethanol and non-ethanol mechanisms. Proceedings of the Nutrition Society 2006;65:1-20.)