How Harmful Alcohol Consumption Impacts People with Heart Disease: Evidence from the PROSA Project

Alcohol consumption is a common behavior in the general population and, in some contexts, is still associated with the idea of potential cardiovascular benefits when consumed in moderation. However, recent scientific evidence shows that harmful alcohol use represents an important risk factor in people with heart disease. A Brazilian study published in 2025, conducted within the framework of the PROSA Project (Health and Alcohol Project), analyzed the relationship between lifestyle patterns and harmful alcohol consumption in patients with heart disease, bringing relevant findings for clinical practice and public health.

Harmful alcohol consumption is associated with increased morbidity and mortality, especially among individuals with cardiovascular diseases. Although light to moderate drinking has historically been described as potentially protective in some populations, this relationship does not hold when considering patterns of abusive alcohol intake, particularly in patients with established heart disease.

The PROSA Project study, published in the Arquivos Brasileiros de Cardiologia, evaluated more than 4,000 individuals¹, including patients with heart disease and volunteers without cardiopathy, using standardized instruments to measure both alcohol consumption and lifestyle behaviors. Harmful consumption was identified using the AUDIT-C test, while lifestyle was assessed through a specific score that considered factors such as smoking, physical inactivity, excess weight, anxiety, and depression.

The results showed that patients with heart disease and lifestyle behaviors classified as fair or unhealthy were more likely to engage in harmful alcohol consumption, even after adjusting for age and sex. In addition, the study demonstrated that improvements in lifestyle over time were associated with a significant reduction in abusive alcohol consumption, reinforcing the dynamic and potentially modifiable nature of this behavior.

Another relevant finding was the higher prevalence of abusive consumption among men and younger individuals, whereas prevalence was lower in older age groups. These data suggest that behavioral and psychosocial factors play a central role in alcohol consumption patterns among cardiac patients, more so than isolated clinical aspects of heart disease.

The study also highlights that abusive alcohol consumption in patients with heart disease may worsen preexisting conditions, increase the risk of arrhythmias, heart failure, and other cardiovascular events, as well as compromise treatment adherence and quality of life. Therefore, systematic lifestyle assessment emerges as an important tool to identify individuals at higher risk and to guide preventive interventions.

In conclusion, the evidence indicates that harmful alcohol consumption in people with heart disease is strongly associated with unfavorable lifestyle behaviors. Rather than being an isolated factor, alcohol is part of a broader set of habits that, when unhealthy, significantly increase cardiovascular health risks. Early identification of these behaviors and the promotion of lifestyle changes may effectively contribute to reducing abusive alcohol consumption and improving clinical outcomes in patients with heart disease.

References:

1. Martinelli-Filho M, Spaggiari CV, Baroni RV, Gomes CIG, Hueb TO, Martins SAM, et al. Consumo abusivo de álcool em cardiopatas: análise de risco pelo comportamento de estilo de vida – Projeto PROSA (Projeto Saúde e Álcool). Arquivos Brasileiros de Cardiologia. 2025;122(10):e20240744. doi:10.36660/abc.20240744