Heart Attack and Alcohol

What is a heart attack?

Heart attacks (HAs) occur when the major blood vessels that supply the heart muscle get clogged from the build-up of plaque and blood clots. The reduced blood flow to the heart that these obstructions cause is dangerous because the delivery of oxygen and vital nutrients for normal cardiac cell function is blocked. If the heart doesn’t get these essential materials, its  muscle cells will tire and die. Reduced heart cell function inhibits the contractile capacity of the heart and the blood cannot reach all areas of the body efficiently.

Symptoms of a heart attack

HA symptoms vary across patients, they most commonly cause heavy and tight chest pain,1 often compared to an indigestion-like burning. HA pain can manifest in the arms (usually going down the left arm), the jaw, the neck and back and the upper abdomen. Other symptoms can include feeling lightheaded or dizzy, excess sweating, trouble breathing and nausea. 

Frequent alcohol intake increases the risk of a heart attack

Many cardiovascular disease (CVD) prevention guides will recommend cutting down your alcohol intake. There is a strong relationship between heavy alcohol consumption and increased HA risk. Globally alcohol consumption is a burden on health with excessive drinking being one of the three leading preventable causes of death.2 In a study it was found that drinking heavily (over six units a day) doubles the incidence of a fatal HA.3 Alcohol affects many areas of the body’s physiology but how does it impact the heart?

For each of the next headings explain how

Chronic dehydration and high blood pressure

Drinking alcohol increases patient blood pressure. Heightened blood pressure is deleterious as it puts strain on the heart and vessels transporting blood, resulting in their damage. Injury to these areas results in blockages because blood clots and plaques will form over wound sites. Arterial blockages cause HAs because heart cells are starved of blood carrying the oxygen and energy they need for efficient action. Alcohol consumption increases blood pressure via changing the body’s hydration status. Alcohol is a diuretic, causing the rapid removal of fluids from your blood via renal system action. Therefore, regular alcohol abuse promotes a chronically dehydrated state. Dehydration is a risk factor for CVD because reduced fluids mean that a person’s blood volume is low.4 The heart has to pump faster and blood vessels must narrow to compensate for the reduced volume so each organ receives enough blood despite this. Elevating heart rate and vasoconstriction increase blood pressure causing stress to the heart, intensifying HA chances.

Thinning of the heart muscle wall

Excessive alcohol consumption can cause alcoholic cardiomyopathy. This is a cause of heart failure where the contractile capacity of the heart is reduced. The heart’s main role in the body is to act as a reliable muscular pump and continuously move blood to different areas of the body, this proper function is interrupted upon cardiomyopathy onset. This reduced pumping power appears in the thinning of the heart muscle walls, especially of the ventricles.5 Alcohol can exert this cardiotoxic effect by reducing the function of mitochondria6 (a cell’s energy powerhouse). This means that the heart muscle will have an energy deficit causing reduced contractile strength of the muscle wall. The reduced mitochondrial function will cause cell death and the thinning of the heart muscle wall. Furthermore, the heart pumps by the transfer of electrical signals across heart wall cells. This function is reduced due to the alterations alcohol enacts on cell membranes and ion transporters.7 The reduced strength of the heart that alcohol directly causes means that it will have to pump more to compensate for this, putting it at risk of more damage.

Hardening of the arteries

Damage to blood vessel walls will cause hard atherosclerotic plaques to form over the injury site increasing the rigidity of the vessel meaning that it will respond poorly, by further injury, to changes in blood pressure and strain. Blockages in the form of atherosclerotic plaques are dangerous because they narrow the diameter of the blood vessel causing increased blood pressure (furthering cardiovascular injury) and reduced nutrient delivery to the heart resulting in a HA. Alcohol abuse can cause hardening of the arteries because alcohol increases the production of free radicals,8 which are unstable components that act to cause cellular damage and death. If this damage occurs in endothelial cells (cells lining each blood vessel), the reactions that cause arterial hardening will be triggered. 

Liver issues

When thinking about the organ that alcohol mainly affects, I’m sure the liver came to mind. The liver has many roles including filtering toxins and controlling blood sugar and cholesterol levels. Whilst the liver is resilient, and able to regenerate, chronic excess alcohol consumption results in serious and permanent damage.9 What does this reduced functionality mean for the heart? Liver damage is associated with changes in cholesterol levels, of which there are two main types, low-density lipoprotein (LDL, “harmful cholesterol”) and high-density lipoprotein (HDL, “beneficial cholesterol”). A dysfunctional liver due to alcohol abuse will cause the rise of LDL and fall of HDL levels in the blood.10 LDL is harmful because the plaques that block arteries are primarily made of LDL. Therefore, raised circulating LDL increases the likelihood of cardiovascular blockages by LDL-based atherosclerotic plaque formation. Increased blockages in the cardiovascular system will block the heart’s blood supply causing irreparable damage.

If you’re worried about your or your loved one’s alcohol intake

If you are worried about your drinking habits or those of a loved one, visit your GP. They are an effective point of call who can inform you about the treatments and services available. There are also many charities dedicated to tackling alcohol abuse such as Alcohol Change UK. They offer great resources and support for those going through a time of alcohol-related difficulty.

When to contact a doctor

If you feel like your relationship with alcohol is unhealthy, seek medical support. HAs are serious medical emergencies so upon experiencing the previously stated symptoms, medical attention should be sought immediately.


This article was written with the intention of underlining the severity and strength of the relationship between alcohol abuse and the heart, a relationship unknown and overlooked by many. It is important to be aware of the intricacies of CVDs as they are the leading cause of death worldwide.11 Additionally, increased consciousness of alcohol’s negative implications is important because it is interwoven into British culture. This article however was not meant to frighten, the alcohol-HA relationship is only observed when drinking in excess so like most things, in moderation, maintaining a healthy lifestyle, you should be fine.


  1. https://www.nhs.uk/conditions/heart-attack/
  2. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. The lancet. 2006 May 27;367(9524):1747-57.
  3. Malyutina S, Bobak M, Kurilovitch S, Gafarov V, Simonova G, Nikitin Y, Marmot M. Relation between heavy and binge drinking and all-cause and cardiovascular mortality in Novosibirsk, Russia: a prospective cohort study. The Lancet. 2002 Nov 9;360(9344):1448-54.
  4. Dintenfass L. The cause of death: blood hyperviscosity?. Journal of the Royal Society of Medicine. 1987 Aug;80(8):536.
  5. Djoussé L, Gaziano JM. Alcohol consumption and heart failure: a systematic review. Current atherosclerosis reports. 2008 Apr;10(2):117-20.
  6. Beckemeier ME, Bora PS. Fatty acid ethyl esters: potentially toxic products of myocardial ethanol metabolism. Journal of molecular and cellular cardiology. 1998 Nov 1;30(11):2487-94.
  7. Waldenström A. Alcohol and congestive heart failure. Alcoholism: Clinical and Experimental Research. 1998 May;22:315s-7s.
  8. Skotzko CE, Vrinceanu A, Krueger L, Freudenberger R. Alcohol use and congestive heart failure: incidence, importance, and approaches to improved history taking. Heart failure reviews. 2009 Mar;14(1):51-5...
  9. https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/alcohol-related-liver-disease#:~:text=Drinking%20a%20large%20amount%20of,drinking%20at%20a%20harmful%20level.
  10. Ismaiel A, Dumitraşcu DL. Cardiovascular risk in fatty liver disease: the liver-heart axis—literature review. Frontiers in Medicine. 2019 Sep 13;6:202.
  11. Mc Namara K, Alzubaidi H, Jackson JK. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved?. Integrated pharmacy research & practice. 2019;8:1.

Frankie Perrett

MSc Molecular Medicine and BSc Biological Sciences – University of East Anglia, Norwich

Frankie works in an NHS Hospital Pathology laboratory so has acquired excellent insight into many different diseases and their mechanisms of action.

Frankie’s Master’s course focused on key areas of biomedicine, centring around patient-first learning. In her degree, she specialised in Lung adenocarcinoma and its mechanisms of cell communication.

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