Alcohol and cardiovascular disease in the geriatric population

Abstract

There has been little focus on the effects of alcohol on the elderly. Although the cardiovascular benefits of moderate alcohol consumption could be of the greatest benefit in this group, so might be the detrimental effects of abuse. In this article, we review available data on the effects of alcohol consumption on cardiovascular disease, cardiomyopathy, arrhythmias, hypertension, and vascular function in older adults. Alcohol consumption has increased in the US population age 65 years and older in the last decade, as has monthly heavy episodic drinking in older alcohol consumers. Studies of alcohol consumption in older subjects suggest that consumption in moderation does not increase the risk of heart failure, hypertension, or atrial arrhythmias, and may in fact improve vascular function and reduce cardiovascular disease events. As in younger subjects, heavy consumption, or abuse of alcohol, negates any potential protective cardiovascular effects, increasing the incidence of heart failure and hypertension. Although alcohol consumed in moderation does not appear harmful in the elderly population, heavier consumption exacerbates hypertension and increases the incidence of heart failure.

Keywords: alcohol abuse; atherosclerotic cardiovascular disease; elderly; older adults.

Figure 1

Relative risk functions (95% CI) describing the dose–response relationship between alcohol intake and risk of CHD. Analyses were adjusted for year of baseline questionnaire, education, smoking, BMI, physical activity, total energy intake, polyunsaturated fat, monounsaturated fat, saturated fat, fiber, and cholesterol intake. The fitted model (SE) is reported. The 99th percentile of cases was 64 g/d in women and 90 g/d in men. The highest alcohol intake in observed cases was 90 g/d in women and 215 g/d in men. Reprinted with permission from Hvidtfeldt et al.8 Abbreviations: BMI, body mass index; CHD, coronary heart disease; CI, confidence interval; HR, hazard ratio; InRR, natural log of relative risk; SE, standard error.

Figure 2

Beneficial effects of light‐to‐moderate alcohol consumption. Reprinted with permission from Movva and Figueredo.12 Abbreviations: HDL‐C, high‐density lipoprotein cholesterol; LDL, low‐density lipoprotein; LDL‐C, low‐density lipoprotein cholesterol.

Figure 3

Incidence rates of CHD according to age and alcohol intake. Analyses were adjusted for year of baseline questionnaire, education, smoking, BMI, physical activity, total energy intake, polyunsaturated fat, monounsaturated fat, saturated fat, fiber, and cholesterol intake. Reprinted with permission from Hvidtfeldt et al.8 Abbreviations: BMI, body mass index; CHD, coronary heart disease.

Figure 4

Rate of incident CHF by alcohol consumption category. Reprinted with permission from Bryson et al.21 Abbreviations: CHF, congestive heart failure.

Figure 5

Kaplan‐Meier estimates of survival free of AF among the Cardiovascular Health Study participants according to baseline alcohol consumption. Reprinted with permission from Mukamal et al.30 Abbreviations: AF, atrial fibrillation.