Protecting the heart may not protect the public health

Editor—Britton raises the profile of what will continue to be an informed debate over the role of alcohol in protecting the heart from vascular disease.¹ However, the picture is not complete and, as she points out, the media could take a rather skewed view of the benefits of drinking.

In older people the harmful effects of alcohol may manifest themselves in ways other than cardiac events. For example, 50% of older people with alcohol misuse present to secondary care services with falls.² The cardioprotective message is also clouded by the lack of any clear evidence that alcohol is beneficial to older people's health in general.

The prevalence of alcohol misuse in older people has risen steeply in the UK over the past 20 years, by 50% in men and by 100% in women. Coupled with a projected rise in over 65s of 50% between 2001 and 2031, there is a risk of a greater public health burden in years to come.

There may be alternatives to reducing cardiovascular risk other than the use of a psychoactive drug with the potential for adverse non-cardiac effects. Furthermore, for the public health, the “prevention paradox” suggests that older people drinking at moderate levels may pose the greatest public health burden.³ The media, government, and drinks industry would do well to consider the bigger picture of alcohol related burden in people approaching their 60s before potentially misinforming the public of the benefits of alcohol.