Alcohol is probably not good for your heart, even in moderate amounts. Older studies suggested that light drinkers had fewer heart attacks than non-drinkers, but newer analyses indicate that much of that apparent benefit came from how the studies were designed, not from the alcohol.
What is well established points the other way. Drinking raises blood pressure, makes atrial fibrillation more likely to return, and is linked to more strokes and heart failure as the amount goes up. If you do not drink, heart health is not a reason to start.
Key takeaways
- The belief that moderate drinking protects the heart rests on observational studies with known weaknesses.
- When researchers correct for those weaknesses, light drinkers no longer appear to live longer than lifelong non-drinkers.
- Stroke, heart failure and deaths from high blood pressure all rise steadily with the amount people drink.
- Cutting back lowers blood pressure in heavier drinkers and reduced atrial fibrillation episodes in a randomized trial.
- American Heart Association guidance is not to start drinking, and to limit intake if you do drink.
Where the "moderate drinking is protective" idea came from
For decades, studies that tracked large groups of people found a J-shaped curve. Light and moderate drinkers had fewer heart attacks than people who did not drink at all, and heavy drinkers had the most problems.
The finding itself was real. Even in recent data, higher alcohol intake is associated with a slightly lower rate of heart attack. The question is what explains it.
Why newer analyses doubt it
Two problems have become clear.
The first is who ends up in the "non-drinker" group. It often includes people who quit because of illness, medication or a past drinking problem. Comparing drinkers with that group makes drinking look better than it is.
A 2023 meta-analysis of 107 cohort studies, covering more than 4.8 million people, corrected for this and for other study-quality issues. After those adjustments, low-volume drinkers did not have a significantly lower risk of death than people who had never been drinkers.1 Risk of death was significantly higher from about 45 grams of alcohol a day, and it rose at lower levels in women than in men.
The second problem is lifestyle. In an analysis of 371,463 UK Biobank participants, light to moderate drinkers also had healthier habits in general, and adjusting for those habits weakened the apparent heart benefit. The same study used genetic methods, which are less affected by lifestyle differences. Those results suggested that alcohol at every level was associated with higher cardiovascular risk: a small increase with light drinking and a much steeper one with heavier drinking.2
Genetic studies rest on their own assumptions. Taken together, though, these analyses give little support to the idea that alcohol protects the heart.
What large studies show by amount
A combined analysis of 599,912 current drinkers in 83 studies looked at risk by weekly intake. The lowest risk of death from any cause was at about 100 grams of alcohol a week or less.3
A "drink" is defined differently from country to country. Several of the studies in this article counted a standard drink as about 12 grams of pure alcohol, which makes 100 grams roughly eight drinks a week.
Above that level, the same analysis estimated shorter life expectancy at age 40:
| Weekly alcohol | Life expectancy at 40, compared with up to 100 g a week |
|---|---|
| More than 100 g, up to 200 g | About 6 months shorter |
| More than 200 g, up to 350 g | About 1 to 2 years shorter |
| More than 350 g | About 4 to 5 years shorter |
The pattern differed by condition. Higher intake was associated with a higher risk of stroke, heart failure, fatal high blood pressure disease and fatal aortic aneurysm, with no clear safe threshold.3 Heart attack was the exception, with a slightly lower risk at higher intake.
These are observational estimates in people who already drank, so they describe associations in groups, not a guarantee for any one person.
Alcohol and blood pressure
Here the evidence comes from trials, which is firmer ground. A meta-analysis of 36 trials with 2,865 participants found that cutting back lowered blood pressure in people who drank more than two drinks a day. The effect was largest in the heaviest drinkers. Among people having six or more drinks a day, cutting intake by about half lowered systolic pressure by 5.5 mm Hg and diastolic pressure by about 4 mm Hg.4
In people who drank two or fewer drinks a day, reducing further did not produce a significant change in blood pressure.
Alcohol and atrial fibrillation
Atrial fibrillation, or AFib, is an irregular heart rhythm that raises the risk of stroke. Heavier drinking has long been associated with it.
A randomized trial in Australia tested what happens when people stop. It enrolled 140 adults with AFib who drank ten or more drinks a week and assigned half to abstain. Over six months, AFib returned in 53% of the abstinence group and 73% of the group that kept drinking.5 The abstinence group also spent less time in AFib overall.
The trial was small and included only regular drinkers who already had AFib, so it does not show what an occasional drink does. If you notice palpitations after drinking, tell your clinician.
What the guidance says
The American Heart Association's 2021 dietary guidance puts it in one line: if you do not drink alcohol, do not start, and if you choose to drink, limit your intake.6
That advice sits within a wider eating pattern, covered in our guide to the best diet for heart health. If you take prescription medicines, ask your prescriber how alcohol fits with them. If cutting back is hard, say so. Stopping suddenly after heavy daily drinking can be dangerous without medical support.
Where to go from here
If you drink regularly and wonder what it has meant for your heart, the useful step is to look at what can be measured. Our guide on how to read a lipid panel is a good place to start, along with the PREVENT risk calculator, which includes blood pressure.
Excessive alcohol use is one of the risk factors that Cardio Res-Q, the heart-disease prevention program at YoungerMeMD, screens for. You can answer the three quick questions in the screener on the program page to see whether a closer evaluation makes sense for you.
Are You a Candidate for Cardio Res-Q?
Three quick questions about the risk factors we screen for. Your answers stay between you and the clinic.
Frequently asked questions
Is red wine good for your heart?
There is no good trial evidence that red wine, or any alcoholic drink, protects the heart. The large studies described above looked at total alcohol and found that the apparent benefit of light drinking shrinks or disappears once study weaknesses are corrected.
Is there a safe amount of alcohol for the heart?
The research does not identify an amount that is proven safe. In one large analysis the lowest risk of death was at about 100 grams a week or less, and genetic analyses suggest only a small increase in cardiovascular risk with light drinking. Less is lower risk than more.
I have atrial fibrillation. Should I stop drinking?
That is a decision to make with your cardiologist, but there is trial evidence to bring to the conversation. In regular drinkers with AFib, abstaining reduced how often the rhythm problem came back over six months.
Related reading
This article is for general education and is not medical advice. Decisions about testing and medication should be made with your clinician. If you have chest pain or other symptoms of a heart attack, call 911.
