Is that evening glass of wine really good for your heart?

By Hugo Francisco de SouzaReviewed by Susha Cheriyedath, M.Sc.Jun 10 2025

Think a daily drink is good for your heart? This major review challenges old beliefs and urges proven lifestyle choices over alcohol for protecting cardiovascular health.

Review: Alcohol Use and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Image Credit: Lomb / Shutterstock

In a recent review in the journal Circulation, researchers collate and discuss the results of numerous publications representing decades of alcohol research to elucidate the substance’s impact on cardiovascular health. Review findings confirm the harmful effects of heavier alcohol consumption (≥3 drinks daily) across all measures of cardiovascular disease metrics.

More cautiously, this review further challenges long-held beliefs associated with low-to-moderate alcohol consumption (1-2 drinks daily), highlighting that previously hypothesized cardiovascular benefits may stem from methodological inconsistencies and sampling/analysis biases (lifestyle and socioeconomic). Consequently, this review cautions against alcohol consumption for cardiovascular health, urging consumers to curb their alcohol intake and clarifying that the cardiovascular risk of light drinking remains uncertain.

Background

Alcohol remains one of the world’s most popular psychoactive substances, with an estimated 2.3 billion consumers and an average of 5.5 liters of per capita intake annually. Despite decades of research investigating the effects of alcohol consumption on cardiovascular diseases (CVDs), observed associations remain complex and controversial, resulting in numerous inconsistencies in public health recommendations and myths regarding the substance’s perceived dose-dependent benefits.

While some older observational studies suggested that low-to-moderate alcohol intake (1-2 drinks daily) may mitigate consumers’ risk of certain CVDs, such as coronary heart disease (CHD), recent investigations using modern methodologies (Mendelian randomizations [MR] and individual-scale meta-analyses) challenge these hypotheses, finding weak or no evidence for the substance’s benefits on CVD outcomes irrespective of consumption dosage.

In contrast, the negative impacts of heavier alcohol consumption (≥3 drinks daily) across all aspects of cardiovascular health are well established. Binge drinking and alcohol dependence have been significantly associated with increased myocardial infarction (MI), hypertension, heart failure (HF), stroke, and cardiac arrhythmia risk.

In today’s world of increasing alcohol use (particularly following the recent COVID-19 pandemic) and exacerbating CVD-associated morbidity and mortality, a review of the facts, myths, and recommendations surrounding alcohol consumption is essential. This information will enable policymakers, clinicians, and consumers to make informed decisions and implement interventions to prevent adverse cardiovascular disease (CVD) outcomes and enhance global public health.

About the study

This review aims to address knowledge gaps on the associations between alcohol consumption and cardiovascular disease (CVD) outcomes by synthesizing findings from numerous prior publications, including large cohort studies, meta-analyses, and mechanistic research, on the topic. It further discusses the proceedings of an expert panel on cardiovascular outcomes tied to alcohol consumption, focusing on hypertension, heart muscle disease, arrhythmias, atherosclerosis, and stroke.

The review evaluated previous research, emphasizing the importance of study design, hypothesis testing, and adequate confounding variables (age, sex, socioeconomic status, physical activity level, and diet) adjustments. Observational studies were critically evaluated for potential selection bias and “sick quitter” effects. Pathophysiology studies were assessed for mechanistic plausibility, i.e., the impacts of dose-dependent alcohol consumption on participants’ blood pressure, lipid profiles, myocardial structure, electrical conduction, and vascular function.

Special attention was paid to study outcomes, particularly key endpoints such as CVD events, subclinical markers, and mortality. All evaluations were carried out against the contextual backdrop of the World Health Organization (WHO) and other public health association guidelines. Notably, the study underscores that, given the current uncertainty in alcohol-CVD association research, factual patient education may be challenging.

Consequently, it highlights the current knowledge gap and proposes future directions while emphasizing that the evidence for harm from heavy drinking is clear, significant uncertainty remains regarding low-level consumption.

Study findings

The present review elucidates several critical takeaways:

1. Low-to-moderate alcohol consumption has uncertain benefits to cardiovascular health. While traditional observational studies suggested that 1-2 glasses of alcohol daily may confer cardiovascular protection, promoting a popular narrative, these studies were often prone to extensive selection bias and other methodological issues. Controlling for lifestyle and socioeconomic variables significantly weakens or appears to negate these previously observed benefits, suggesting that any protective association, if present, is likely weak and may not be causal.

2. In contrast, the paper notes a clear link between alcohol and higher blood pressure, with research suggesting that even low levels of alcohol consumption can substantially exacerbate hypertension risk. The link between low-to-moderate alcohol consumption and arrhythmia, specifically atrial fibrillation, remains conflicting, though heavier consumption clearly increases the risk.

3. An overwhelming body of robust literature highlights the significant CVD-associated demerits of heavy/binge drinking, emphasizing that higher alcohol consumption exacerbates CVD-associated risks across all tested diseases. The review confirms that both binge drinking and long-term heavy consumption are linked to higher rates of myocardial infarction and stroke. Crucially, the paper also notes that for moderate drinkers, engaging in episodes of heavy or binge drinking negates any potential cardiovascular protection.

Conclusions

The present review concludes that while the harms of heavy drinking are certain, the true cardiovascular impact of low-to-moderate consumption remains unclear. Consequently, the AHA advises against initiating alcohol use for the express purpose of cardiovascular protection. The statement reinforces that individuals should focus on proven heart-healthy behaviors (healthy diets, exercise, and smoking cessation) to optimize cardiovascular health and overall well-being, as the potential benefits of alcohol are not firmly established and may not outweigh its risks.