Is alcohol good or bad for the Heart?

Is alcohol good or bad for the heart?
I am asked this question many a time in my practice. I usually answer without committing myself. I will reply that in very small amounts it may not be harmful.
I am aware that many studies from the West have shown that mild to moderate intake of alcohol,especially Red wines are somewhat protective to the heart. At the same time I know that many who ask this question are alcoholics who just want a positive response from the doctor to continue to indulge in  spirits.

A recent study in Indian males disapproves the theory that alcohol in mild to moderate doses has a protective effect on Heart. In a large retrospective survey based study [being the first of it kind in India looking at this question] conducted in 10 centers showed that alcohol consumption even in low amounts increased coronary artery disease risk. Heart attacks were more seen in those who are regular drinkers, occassional drinkers and even ex-drinkers when compared to life long abstainers.


Why Indian male drinkers are more prone to heart disease than Western drinking population?

The reasons are not clear and even lack of protective effect has to be proved with large prospective randomised controlled  studies. But some theories are postulated.
1. Indians are more prone to binge drinking than Caucasian population.Binge drinking can cause Heart attack. In the above study around 55% were binge drinkers.
2. Indians tend to drink more stronger spirits that Caucasians. We drink more whiskey and Rum than wine and beer.
3. There may be genetic/racial difference in effect of alcohol on human body. African American drinkers  also do not have that much protective effect on Heart as Caucasians.

So in conclusion let me state that the so called protective effect of alcohol on Heart is under a big question mark especially for  Indians.
So please do not drink to live.