Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2000 May;54(5):328–332. doi: 10.1136/jech.54.5.328

The relation between alcohol and cardiovascular disease in Eastern Europe: explaining the paradox

A Britton 1, M McKee 1
PMCID: PMC1731674  PMID: 10814651

Abstract

BACKGROUND—Recent evidence from Eastern Europe of a positive association between alcohol and cardiovascular disease has challenged the prevailing view that drinking is cardioprotective. Consuming amounts of alcohol comparable to those consumed in France has been linked to detrimental cardiovascular effects. One possibility is that this could be related to the particular consequences of binge drinking, which is common in Russia.
METHODS—A systematic review of literature on the relation between cardiovascular disease and heavy drinking and irregular (binge) drinking.
RESULTS—Most existing reviews of the relation between alcohol and cardiovascular disease have examined the amount drunk per week or month and have not looked at the pattern of drinking. These have consistently shown that alcohol has a cardioprotective effect, even at high levels of consumption. In contrast, studies that have looked at pattern of drinking, either directly, or indirectly, using indicators such as frequency of hangovers or reports of the consequences of drunkenness, have consistently found an invcreased risk of cardiovascular death, particularly sudden death. A separate review of the physiological basis for a difference between regular heavy drinking and heavy binge drinking demonstrates that the two types of drinking have quite different effects.
CONCLUSION—An association between binge drinking and cardiovascular death meets the standard criteria for causality. It is important that future studies of alcohol related harm examine the pattern of drinking as well as the amount drunk.


Keywords: alcohol; cardiovascular disease

Full Text

The Full Text of this article is available as a PDF (113.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson P., Cremona A., Paton A., Turner C., Wallace P. The risk of alcohol. Addiction. 1993 Nov;88(11):1493–1508. doi: 10.1111/j.1360-0443.1993.tb03135.x. [DOI] [PubMed] [Google Scholar]
  2. Beaglehole R., Jackson R. Alcohol, cardiovascular diseases and all causes of death: a review of the epidemiological evidence. Drug Alcohol Rev. 1992;11(3):275–289. doi: 10.1080/09595239200185811. [DOI] [PubMed] [Google Scholar]
  3. Bellentani S., Saccoccio G., Costa G., Tiribelli C., Manenti F., Sodde M., Saveria Crocè L., Sasso F., Pozzato G., Cristianini G. Drinking habits as cofactors of risk for alcohol induced liver damage. The Dionysos Study Group. Gut. 1997 Dec;41(6):845–850. doi: 10.1136/gut.41.6.845. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bobak M., McKee M., Rose R., Marmot M. Alcohol consumption in a national sample of the Russian population. Addiction. 1999 Jun;94(6):857–866. doi: 10.1046/j.1360-0443.1999.9468579.x. [DOI] [PubMed] [Google Scholar]
  5. Broda G., Davis C. E., Pajak A., Williams O. D., Rywik S. L., Baczyńska E., Folsom A. R., Szklo M. Poland and United States Collaborative Study on Cardiovascular Epidemiology. A comparison of HDL cholesterol and its subfractions in populations covered by the United States Atherosclerosis Risk in Communities Study and the Pol-MONICA Project. Arterioscler Thromb Vasc Biol. 1996 Feb;16(2):339–349. doi: 10.1161/01.atv.16.2.339. [DOI] [PubMed] [Google Scholar]
  6. Chenet L., McKee M., Fulop N., Bojan F., Brand H., Hort A., Kalbarczyk P. Changing life expectancy in central Europe: is there a single reason? J Public Health Med. 1996 Sep;18(3):329–336. doi: 10.1093/oxfordjournals.pubmed.a024514. [DOI] [PubMed] [Google Scholar]
  7. Chenet L., McKee M., Leon D., Shkolnikov V., Vassin S. Alcohol and cardiovascular mortality in Moscow; new evidence of a causal association. J Epidemiol Community Health. 1998 Dec;52(12):772–774. doi: 10.1136/jech.52.12.772. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Deev A., Shestov D., Abernathy J., Kapustina A., Muhina N., Irving S. Association of alcohol consumption to morality in middle-aged U.S. and Russian men and women. Ann Epidemiol. 1998 Apr;8(3):147–153. doi: 10.1016/s1047-2797(98)00004-0. [DOI] [PubMed] [Google Scholar]
  9. Doll R. One for the heart. BMJ. 1997 Dec 20;315(7123):1664–1668. doi: 10.1136/bmj.315.7123.1664. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Dyer A. R., Stamler J., Paul O., Berkson D. M., Lepper M. H., McKean H., Shekelle R. B., Lindberg H. A., Garside D. Alcohol consumption, cardiovascular risk factors, and mortality in two Chicago epidemiologic studies. Circulation. 1977 Dec;56(6):1067–1074. doi: 10.1161/01.cir.56.6.1067. [DOI] [PubMed] [Google Scholar]
  11. Evans C., Chalmers J., Capewell S., Redpath A., Finlayson A., Boyd J., Pell J., McMurray J., Macintyre K., Graham L. "I don't like Mondays"-day of the week of coronary heart disease deaths in Scotland: study of routinely collected data. BMJ. 2000 Jan 22;320(7229):218–219. doi: 10.1136/bmj.320.7229.218. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. HILL A. B. THE ENVIRONMENT AND DISEASE: ASSOCIATION OR CAUSATION? Proc R Soc Med. 1965 May;58:295–300. [PMC free article] [PubMed] [Google Scholar]
  13. Holman C. D., English D. R., Milne E., Winter M. G. Meta-analysis of alcohol and all-cause mortality: a validation of NHMRC recommendations. Med J Aust. 1996 Feb 5;164(3):141–145. doi: 10.5694/j.1326-5377.1996.tb122011.x. [DOI] [PubMed] [Google Scholar]
  14. Kannel W. B. Alcohol and cardiovascular disease. Proc Nutr Soc. 1988 Jul;47(2):99–110. doi: 10.1079/pns19880018. [DOI] [PubMed] [Google Scholar]
  15. Kauhanen J., Kaplan G. A., Goldberg D. D., Cohen R. D., Lakka T. A., Salonen J. T. Frequent hangovers and cardiovascular mortality in middle-aged men. Epidemiology. 1997 May;8(3):310–314. doi: 10.1097/00001648-199705000-00014. [DOI] [PubMed] [Google Scholar]
  16. Klatsky A. L. Epidemiology of coronary heart disease--influence of alcohol. Alcohol Clin Exp Res. 1994 Feb;18(1):88–96. doi: 10.1111/j.1530-0277.1994.tb00886.x. [DOI] [PubMed] [Google Scholar]
  17. Kozarevic D., Demirovic J., Gordon T., Kaelber C. T., McGee D., Zukel W. J. Drinking habits and coronary heart disease: the Yugoslavia cardiovascular disease study. Am J Epidemiol. 1982 Nov;116(5):748–758. doi: 10.1093/oxfordjournals.aje.a113464. [DOI] [PubMed] [Google Scholar]
  18. Lee A. J., Crombie I. K., Smith W. C., Tunstall-Pedoe H. Alcohol consumption and unemployment among men: the Scottish Heart Health Study. Br J Addict. 1990 Sep;85(9):1165–1170. doi: 10.1111/j.1360-0443.1990.tb03441.x. [DOI] [PubMed] [Google Scholar]
  19. Leon D. A., Chenet L., Shkolnikov V. M., Zakharov S., Shapiro J., Rakhmanova G., Vassin S., McKee M. Huge variation in Russian mortality rates 1984-94: artefact, alcohol, or what? Lancet. 1997 Aug 9;350(9075):383–388. doi: 10.1016/S0140-6736(97)03360-6. [DOI] [PubMed] [Google Scholar]
  20. Lithell H., Aberg H., Selinus I., Hedstrand H. Alcohol intemperance and sudden death. Br Med J (Clin Res Ed) 1987 Jun 6;294(6585):1456–1458. doi: 10.1136/bmj.294.6585.1456. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Marmot M. G. Alcohol and coronary heart disease. Int J Epidemiol. 1984 Jun;13(2):160–167. doi: 10.1093/ije/13.2.160. [DOI] [PubMed] [Google Scholar]
  22. McElduff P., Dobson A. J. How much alcohol and how often? Population based case-control study of alcohol consumption and risk of a major coronary event. BMJ. 1997 Apr 19;314(7088):1159–1164. doi: 10.1136/bmj.314.7088.1159. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. McKee M., Britton A. The positive relationship between alcohol and heart disease in eastern Europe: potential physiological mechanisms. J R Soc Med. 1998 Aug;91(8):402–407. doi: 10.1177/014107689809100802. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. McKee M., Sanderson C., Chenet L., Vassin S., Shkolnikov V. Seasonal variation in mortality in Moscow. J Public Health Med. 1998 Sep;20(3):268–274. doi: 10.1093/oxfordjournals.pubmed.a024768. [DOI] [PubMed] [Google Scholar]
  25. Mercer P. W., Khavari K. A. Are women drinking more like men? An empirical examination of the convergence hypothesis. Alcohol Clin Exp Res. 1990 Jun;14(3):461–466. doi: 10.1111/j.1530-0277.1990.tb00504.x. [DOI] [PubMed] [Google Scholar]
  26. Moushmoush B., Abi-Mansour P. Alcohol and the heart. The long-term effects of alcohol on the cardiovascular system. Arch Intern Med. 1991 Jan;151(1):36–42. doi: 10.1001/archinte.151.1.36. [DOI] [PubMed] [Google Scholar]
  27. Poikolainen K. Alcohol and mortality: a review. J Clin Epidemiol. 1995 Apr;48(4):455–465. doi: 10.1016/0895-4356(94)00174-o. [DOI] [PubMed] [Google Scholar]
  28. Poikolainen K. Inebriation and mortality. Int J Epidemiol. 1983 Jun;12(2):151–155. doi: 10.1093/ije/12.2.151. [DOI] [PubMed] [Google Scholar]
  29. Rimm E. B., Willett W. C., Hu F. B., Sampson L., Colditz G. A., Manson J. E., Hennekens C., Stampfer M. J. Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women. JAMA. 1998 Feb 4;279(5):359–364. doi: 10.1001/jama.279.5.359. [DOI] [PubMed] [Google Scholar]
  30. Rosengren A., Wilhelmsen L., Pennert K., Berglund G., Elmfeldt D. Alcoholic intemperance, coronary heart disease and mortality in middle-aged Swedish men. Acta Med Scand. 1987;222(3):201–213. doi: 10.1111/j.0954-6820.1987.tb10661.x. [DOI] [PubMed] [Google Scholar]
  31. Rossow I., Amundsen A. Alcohol abuse and mortality: a 40-year prospective study of Norwegian conscripts. Soc Sci Med. 1997 Jan;44(2):261–267. doi: 10.1016/s0277-9536(96)00161-x. [DOI] [PubMed] [Google Scholar]
  32. Sexton P. T., Walsh J., Jamrozik K., Parsons R. Risk factors for sudden unexpected cardiac death in Tasmanian men. Aust N Z J Med. 1997 Feb;27(1):45–50. doi: 10.1111/j.1445-5994.1997.tb00913.x. [DOI] [PubMed] [Google Scholar]
  33. Shaper A. G., Wannamethee G., Walker M. Alcohol and mortality in British men: explaining the U-shaped curve. Lancet. 1988 Dec 3;2(8623):1267–1273. doi: 10.1016/s0140-6736(88)92890-5. [DOI] [PubMed] [Google Scholar]
  34. Shestov D. B., Deev A. D., Klimov A. N., Davis C. E., Tyroler H. A. Increased risk of coronary heart disease death in men with low total and low-density lipoprotein cholesterol in the Russian Lipid Research Clinics Prevalence Follow-up Study. Circulation. 1993 Sep;88(3):846–853. doi: 10.1161/01.cir.88.3.846. [DOI] [PubMed] [Google Scholar]
  35. Skog O. J. The collectivity of drinking cultures: a theory of the distribution of alcohol consumption. Br J Addict. 1985 Mar;80(1):83–99. doi: 10.1111/j.1360-0443.1985.tb05294.x. [DOI] [PubMed] [Google Scholar]
  36. St Leger A. S., Cochrane A. L., Moore F. Factors associated with cardiac mortality in developed countries with particular reference to the consumption of wine. Lancet. 1979 May 12;1(8124):1017–1020. doi: 10.1016/s0140-6736(79)92765-x. [DOI] [PubMed] [Google Scholar]
  37. Walberg P., McKee M., Shkolnikov V., Chenet L., Leon D. A. Economic change, crime, and mortality crisis in Russia: regional analysis. BMJ. 1998 Aug 1;317(7154):312–318. doi: 10.1136/bmj.317.7154.312. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Wannamethee G., Shaper A. G. Alcohol and sudden cardiac death. Br Heart J. 1992 Nov;68(5):443–448. doi: 10.1136/hrt.68.11.443. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES