Page 1 of 4 Critical review

Effects of ethanol on the heart and blood vessels Biomedical A Nikaj 1, B Cakani1, A Shkoza2, E Ranxha3, G Vyshka3*

Abstract Introduction the most important theories through Introduction A very much controversial considering historically important Alcohol consumption and its component, ethanol has been at the position papers, with the aim of lending influences over human health have centre of large studies and perspective in such a largely debated been at the centre of medical contradictory medical opinions ever medical issue, namely the health discussions for centuries. An since. Actually, its pharmacological problems related with the consumption important part of the daily menu, value is restricted mainly to topical of alcohol, vis-à-vis any benefits of its ethanol has had in the not so remote usage as the most widely used skin use. past a variety of uses in medicine and disinfectant, being a very effective 1 Discussion pharmacology, although very few of antimicrobial . Apart from being an them resisted the proof of time. Its important solvent for different The Dilemma of Stimulant or gastronomical consumption should be preparations, alcohol usage as Depressant moderate, and moderate drinking is antiperspirant for hyperhydrosis is One of the most particular dilemmas of presumed to have a protective role another survival of very numerous the medical community related to against hypertension and coronary different therapeutic values attributed alcohol and its use was due to the fact heart disease. We have revised several to this preparation, not longer than that initially it was surprisingly papers that raise doubts, with all pros half a century from now. Some considered as a stimulant. and cons of its consumption, starting neurosurgeons still rely on alcoholic In 1928, in the presidential address, from the historical sources to the most gasserian injection from refractory Gunn enumerated several stimulants updated opinions. The classification of trigeminal neuralgia, a relatively old acting on the heart. Alcohol was on the abstainers, light, moderate and heavy method2. On the other hand, very few same list with strychnine, adrenaline, drinkers should as well be kept in conditions warrant the use of ethanol pituitrin and camphor7. Such an idea mind when dealing with patients that through the intravenous route, with about alcohol (obviously ethanol) being

pretend consuming alcohol in ‘social methanol and ethylene glycol a stimulant tempted several dosis’, since restriction seems by far a intoxications having such a treatment professionals, albeit culture, more than better option rather than uncontrolled probably as an ultima ratio; and as a medicine, has sustained its aphrodisiac use. Physiological influences of tocolytic, or even as an obstetrical properties8.

ethanol over the heart, vessels, central analgesic, that actually might be It took in fact some decennia to clarify preparation, read approvedandthe final manuscript.

3,4,5 incontestably that alcohol is a nervous system and autonomous classified as obsolete options . t nervous system are mentioned as well Of course, old debates are definitely depressant, not only of the nervous in the present paper. forgotten and some strange clinical system, but for the cardiovascular Conclusion applications have been forever activity in general. In a highly Alcohol is part of the menu for more dismissed. The immediate availability sophisticated paper of the time, than five millennia, and refraining of alcohol, the ease of its use, and lack Conway concluded that ethyl alcohol totally from its consumption seems of other options could explain (ethanol) is a myocardial depressant9. illogical and unachievable. However, historical treatments that have been Since different body systems might

awareness should be raised that its abandoned, among which are those in have individual reactive properties, we Conflict interests: of Nonedeclared. role as a risk factor for vascular psychiatry that probably can better cannot assume conclusions to be diseases seems by far to overrun the illustrate how alcohol was surrounded universal. In fact, when discussing presumed protection offered from a from strange beliefs, ideas, and about the nervous system it seems that moderate use of alcoholic beverages. medical opinions of a certain but ethanol might have a biphasic effect, certainly not too short period of time6. and lower doses can be considered Obviously, the effects of alcohol (as stimulating10. *Corresponding author ethanol) on the heart and blood The initial dilemmas were Email: [email protected] vessels have as well been the object to summarized in 1955 by Eliaser and 1 Doctoral School, Faculty of Medical and continuous scrutiny. Therefore and Giansiracusa11. The authors made a Technical Sciences, University of Medicine in clear distinction in between “moderate logically, we cannot of course expect Tirana, Albania. 2 alcohol intake” and “excessive intake”. Biomedical and Experimental Department, uniformity of opinions and Faculty of Medicine, University of Medicine in conclusions, even with regards to While tracing back the advice to use

All authors contributed All to conception design,and manuscrip All authors All abide by the Association Medical for Ethics (AME) ethical of rules disclosure. Tirana, Albania. alcohol as a vasodilator for coronary CompetingNone interests: declared. 3 alcohol effects on the cardiovascular Service of Neurology, University Hospital system. Trying to confront these artery disease since 1772 from Centre “Mother Theresa”, Tirana, Albania. different positions, we have reviewed Heberden, however, these authors’

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Critical review

opinion is part of the very large dissent about alleged beneficial effects of alcohol on the heart11,12. Actually, there seems little space to justify counselling of patients for taking a drink during acute chest pain; positive effects (if any) are merely psychological. Chest pain was not the only setting where strong beliefs and presumptions have exposed naïve albeit not teetotal patients to alcohol consumption. Illusions about an antiarrhythmic action of alcohol were meanwhile striving to find an experimental basis13.

Since medical casuistics started to register irrefutable cases of cardiomyopathy due to alcohol abuse, opinions started to shift14. It became very clear that alcohol abuse caused left ventricle dysfunction, with deterioration of kinetic properties, Figure 1: A thrombosed myocardial arteriole in the centre of the figure. Note the fatty and substantial decrease of the tissue changes, with vacuoles in the periphery of the histological specimen. ejection fraction among others14,15. The role of thiamine deficiency considered as exaggerated. Authors intracellular calcium activity, together

(thiamine-deficient hearts, Beri-Beri agree that there is little consensus, with oxidative stress and endothelial heart disease) was widely tested, both although detailed stratification of the dysfunction have all been accused21. in clinical and in experimental consistency of alcohol consumption is The epidemiological data might be even studies16,17. The importance of the available; Dawson (quoted from more ominous when countries with

nutritional status, and of other Dufour) proposed the following high rates of alcohol consumption are concomitant factors that generally definitions: evaluated; instead of morbidity, are accompany chronic alcohol abuse, was a. Abstainer; consuming less than 12 mentioned casual links with already emphasized in pioneering drinks during the past year, mortality22.

works11 (Figure 1). b. Light drinker; consuming 1 to 13 Alcohol-induced cardiovascular

preparation,read and approved the final manuscript.

drinks per month; should have a multigenic aetiology, t Alcohol: A Major Risk Factor c. Moderate drinker; consuming 4 to which makes it difficult to ponder the There is little space to doubt about 14 drinks per week; individual risks with the quantity ethanol as an independent risk factor d. Heavy drinker; an individual consumed. Cardiomyopathy is one of for cardiovascular disease. Several consuming more than 2 drinks daily19. the occurrences that fall within this studies, papers and opinions hold category23. Probably due to this ethanol responsible for influencing, The difficulty of defining what is a multiplicity of aetiological factors, not causing or predisposing to at least ‘standard drink’ has been well all heavy drinkers will develop 24 three major cardiovascular encountered, and arbitrarily cardiomyopathy . Conflict interests: of Nonedeclared. occurrences, namely hypertension, surpassed through considering a Unfortunately, alcohol abuse can cardiomyopathy and coronary heart standard drink as having 12 grams of cause a cardiomyopathy indistin- disease. alcohol, equivalent to 350 millilitres of guishable from other types of dilated If alcohol consumption is ‘modest’, beer, and 150 millilitres of wine19. non-ischemic cardiomyopathy, with however, causal links with Experimental designs have tried to most heavy-drinkers remaining hypertension are difficult to prove. In pick up correlations between chronic asymptomatic in the first stages of the fact, no increase in the incidence of alcohol consumption, stress and disease25. hypertension was seen when men hypertension20. The mechanisms Apart from hypertension and consumed 19-24 ounces of alcohol through which ethanol produces cardiomyopathy, ethanol has been [approx. 560 to 710 millilitres of pure hypertension might be somehow imputed somewhere as a protective ethanol] monthly18. Hereby a elusive, but an enhancement of the factor (when consumed ‘moderately’)

methodological issue is raised, of what sympathetic system activity, the for coronary heart disease, and

All authors All contributed to conception and design, manuscrip authors All abide by the Association Medical for Ethics (AME) ethical of rules disclosure. should be considered ‘modest’ alcohol stimulation of renin-angiotensin- elsewhere as a risk factor (obviously for CompetingNone interests: declared. consumption, and what should be aldosterone system, an increase of heavy drinkers). In fact, thorough

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Critical review

analysis has found that consumption cardiovascular system, and at the References of up to two drinks per day promote same time different and colourful 1. McDonnell G, Russell AD. Antiseptics molecular changes that reduce the biochemical mechanisms of its and disinfectants: activity, action, and risk of heart disease, at the same time action30,31,32. resistance. Clin Microbiol Rev. 1999; as increasing levels of other molecules In fact, wine has been the most 12(1):147-79. that unfortunately, will do the endorsed and appraised from all 2. Ecker A, Perl T. Alcoholic injection of contrary26. While we think all these fermented beverages. The so-called the gasserian ganglion for tic changes and dilemmas are related “French paradox” more than douloureux. N Y State Dent J. 1967; with chronic alcohol consumption, promoting the indisputable quality of 33(3):149-58. here we might still be wrong: even Grand Crus de France, suggested that 3. Wedge MK, Natarajan S, Johanson C, short-term alcohol consumption the polyphenolic content of red wine Patel R, Kanji S. The safety of ethanol might be deleterious, with obvious could be responsible for the infusions for the treatment of methanol cardiac implications27. advantages of moderate consumption or ethylene glycol intoxication: an of this sort of wine, when compared observational study. CJEM. 2012; What About Protection? with other products27. The heart was 14(5):283-9. Prohibitionism and complete alcohol not the only organ that presumably 4. Souney PF, Kaul AF, Osathanondh R.

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All authors All contributed to conception and design, manuscrip authors All abide by the Association Medical for Ethics (AME) ethical of rules disclosure. studies have advocated the protective moderate use. Ventricular function in noncardiacs CompetingNone interests: declared. role of moderate ethanol use in the

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Critical review

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All authors All contributed to conception and design, manuscrip authors All abide by the Association Medical for Ethics (AME) ethical of rules disclosure. Balak W, Pietrzak J, Sinkiewicz W. CompetingNone interests: declared. Short-term alcohol consumption may

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FOR CITATION PURPOSES: Nikaj A, Cakani B, Shkoza A, Ranxha E, Vyshka G. Effects of ethanol on the heart and blood vessels. OA Alcohol 2014 Apr 18;2(1):7.