THE COMPLEXITY OF ALCOHOL
ALCOHOL AND THE HEART - AN ENIGMATIC
ASSOCIATION
AUTHOR M. Saleem Seyal, MD, FACC, FACP
“It has long been recognized that the problems with alcohol relate not
to the use of a bad thing, but to the abuse of a good thing.” Abraham
Lincoln (1)
T
he origin of the word “alcohol’ is from
the Arabic language and originally
referred to a method of manufactur-
ing makeup, like kohl, for darkening
eyelashes. Chemical analyses recently
confirmed that the earliest alcoholic
beverage yet found in the world was
a mixed fermented drink of rice, honey and
hawthorn fruit and/or grape. The residues of
the beverage, dated circa 7,000–6,600 BCE, were recovered from
early pottery from Jiahu, a Neolithic village in the Yellow River Valley
in China. This beverage currently predates the earliest evidence of
grape wine from the Middle East by more than 500 years.
Alcohol is ubiquitous and the most commonly utilized addic-
tive chemical substance in the United States. Many studies have
suggested that moderate alcohol consumption may have salutary
effects in preventing myocardial infarctions (MIs) and congestive
heart failure (CHF). On the other hand, low to moderate use of
alcohol have been associated with the ever-increasing problem of
AF (atrial fibrillation) (2). Alcohol abuse is a serious health issue
that affects 10 to 15 million Americans and is associated with hepatic
cirrhosis, domestic violence, cardiomyopathy, accidents, suicide and
some cancers (2). Alcohol consumption is therefore the proverbial
double- edged sword when used in different doses and patterns.
DEFINITION OF ALCOHOL USE DISORDER (AUD)
The Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5, 2013), integrated alcohol abuse and alcohol depen-
dence into the all-encompassing category of Alcohol Use Disorder
(AUD) with two to three of the 11 criteria labeled as mild, four to
five symptoms constitute moderate AUD and presence of six or
more symptoms connote severe AUD. The criteria or symptoms
are listed as follows:
1) Alcohol use in larger quantities and for longer duration than
intended.
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LOUISVILLE MEDICINE
2) Persistent desire or unsuccessful efforts to control the quantity
and use of alcohol.
3) Excessive use of time consumed in procuring and using alcohol
or recovering from its effects.
4) Craving or strong desire to use alcohol.
5) Uncontrollable and recurrent use resulting in a failure to fulfill
job and home obligations.
6) Persistent use despite recurring social or interpersonal problems
attributed to alcohol use.
7) Abandonment or reduction of social, occupational and recre-
ational activities due to alcohol use.
8) Recurrent alcohol use in situations in which it is physically
hazardous.
9) Continued alcohol use despite known physical and psychologic
issues caused or exacerbated by alcohol.
10) Tolerance is defined either by need for increasing the quantity
of alcohol to get the desired effect or a markedly diminishing
effect with continued use of the same quantity of alcohol.
11) Withdrawal is either by the presence of typical symptoms or
use of sedatives to combat or prevent withdrawal symptoms.
DEFINITION OF LIGHT, MODERATE AND HEAVY DRINKING
Alcohol Consumption has been defined as light (less than seven
standard drinks per week); moderate (seven to 21 standard drinks
per week) and heavy (greater than 21 standard drinks per week).
One standard drink is approximately 12 grams of alcohol. This is
5 oz. of wine, 24 proof or 12% ABV (alcohol by volume), 12 oz.
of beer at 10 proof or 5% ABV, or 1.5 oz. of distilled spirit, 80-100
proof or 40-50% ABV. Fortified wines have distilled spirits added
to them and hence they have much higher alcohol content with a
large spectrum and include sherry, port, vermouth and marsala.
Unhealthy alcohol consumption can take many forms including
binge-drinking, at-risk drinking and alcohol use disorder (AUD) as
described above. Although not universally agreed upon by health
care providers, if someone wishes to drink alcohol, the limit for men
is two drinks per day and, for women, one drink per day.
Acute alcohol intoxication can occur after heavy episodic alcohol
use and results in high blood ethanol levels which can cause central