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1 Alcohol Unit Hospital Clinic University of Barcelona. Catalunya (Spain).

Cardiovascular diseases are the main cause of mortality and morbidity in developed countries. The clinical evidence of alcohol harmful effects for cardiovascular health was already suggested in old Greece by Hippocrates. Along history, the harmful and beneficial effects of alcohol have coexisted.
Alcohol has a dual effect on the cardiovascular system. Alcohol harmful cardiovascular effects have recently been clarified either in acute binge drinking as well as in chronic high-dose cumulated consumption (more than 40g/day for men and more than 20 g/day for women, with lifetime consumption longer than 10 years).
In these circumstances, alcohol may induce hypertension, arrhythmias, increases LDL-cholesterol and the incidence of diabetes mellitus, induces widespread arterial damage in coronary, brain, and peripheral limb arteries, as well as impairs the global and cardiovascular mortality. In addition, alcohol induces dose-dependent chronic dilated cardiomyopathy, leading to heart failure, arrhythmias and increased mortality rates.
The pathogenic mechanisms responsible for the harmful effects of alcohol on heart and cardiovascular system are diverse, and some of them act synchronic and synergistically. Alcohol may also sensitize to the damaging effect of other toxic substances (tobacco, cocaine).
High- dose alcohol induces inflammation, oxidative damage, disturbs metabolic and energetic cell pathways, produce interference in membrane receptors and intracellular transients. All these factors lead to cardiomyocyte apoptosis and cell loss.
In addition to the direct damage, ethanol disturbs the repair potential of cardiomyocytes decreasing the regeneration rate, and cell adaptation and repair mechanisms. In presence of high-dose alcohol cardiac and vascular plasticity impairs.
The cardiovascular effect of alcohol may be modulated by nutritional factors as well as in presence of vitamin deficiencies and behavioural factors. Nutrition may modify the oxidative and inflammatory mechanisms of alcohol- induced cardiovascular damage.
Genetic polymorphisms and racial factors may increase the personal susceptibility to alcohol-induced cardiovascular damage. In addition, women and adolescent are more susceptible to the alcohol-.induced damage on the heart and cardiovascular system compared to men.
Considering all these evidences, reductions in alcohol consumption should provide overall health benefits. The overall balance of beneficial and detrimental effects of alcohol should be considered when making individual and population-wide recommendations. Caution to recommend alcohol intake to abstainers seems mandatory.