Last Call? Moderate Alcohol's Health Benefits Look Increasingly Doubtful

When holiday shoppers recently went to their local liquor stores in search of some liquid spirit, many were instead greeted by the sight of increasingly barren shelves.

Although partly a result of global supply chain issues, this was also yet more evidence of the rising demand for alcohol among adults during these difficult COVID years. It's a trend that has led to concerns of an echo pandemic of alcohol-related morbidity, which has begun to play out in the form of rising rates of gastrointestinal and liver disease, hospital admissions for alcoholic hepatitis, and alcohol-related incidents of domestic violence.

Those who imbibe alcohol in low-to-moderate levels may not see themselves reflected in such stories of drinking's hefty tolls. They're instead following established health guidance that a little bit of alcohol now and then actually has robust health benefits. Yet the last couple of years have seen a notable fraying of this idea, as emerging data calls into question whether alcohol in moderation should really continue to be just what the doctor ordered.

Behind the Curve: Alcohol's Diminishing Cardioprotective Value

Perhaps the most resonant argument for the benefits of light-to-moderate alcohol consumption—usually defined as between 1 to 2 drinks a day—has been its proposed cardioprotective value. In this way, alcohol differs from tobacco, which is unsafe at any level. Alcohol's proposed cardioprotective effects are often represented as a J-shaped curve, with moderate drinking occupying the sweet spot between teetotaling and heavy/binge drinking when it comes to reduced mortality.

In reality, this association is more likely "a statistical artifact" largely derived from low-quality observational studies, according to Christopher Labos, MD, CM, MSc, an epidemiologist and cardiologist at the Queen Elizabeth Health Complex in Montreal, Canada.

"When you look at studies that correct for things like reverse causation, or the fact that some people who drink zero alcohol are former drinkers who used to drink alcohol, then you realize that the protective benefit of alcohol is either minimal or nonexistent and that alcohol does more harm than good to our society," said Labos, who detailed the reasons underpinning alcohol's unearned cardioprotective reputation in a 2020 Medscape commentary.

This statistical limitation was on display in July when BMC Medicine published results from meta-analyses suggesting that current drinkers need not stop consuming small amounts of alcohol for the secondary prevention of cardiovascular disease (CVD). The study's own investigators noted that it likely overestimated the reduced risk of CVD by including former heavy drinkers as nondrinkers.