MedicaidSeptember 1, 2022
Alcohol use disorders linked to chronic diseases
A number of chronic diseases, including heart disease, cancer, and type 2 diabetes, are linked to alcohol use disorders (AUD).
Heart disease:1
Low alcohol consumption is associated with a reduced risk for cardiovascular disease (CVD), but higher amounts and binge drinking lead to a higher risk of CVD. Binge drinking and chronic heavy alcohol consumption is associated with a higher risk of hypertension. Alcohol leads to buildup of plaque in the arteries, disruptions in arterial function, oxidative stress throughout the body, and imbalances in hormones that control blood pressure regulation.
Heavy alcohol use is also associated with increased risk for coronary heart disease, stroke, peripheral arterial disease, and cardiomyopathy. It is suspected that the increase in blood pressure from heavy alcohol use plays a part in these increased risks. Alcohol also appears to contribute to arthrosclerosis and chronic inflammation, which follow the pathophysiologic process behind most CVD.
See Piano, 2017 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513687/) for a more
thorough examination of the increased risk of CVD from excess alcohol use; mechanisms of action; biomarkers; and considerations of genetic, socioeconomic, and racial factors.
Cancer:
An estimated 3.5% of cancer deaths in the United States are alcohol related. Alcohol is a known human carcinogen.2 When consumed, ethanol breaks down into acetaldehyde, which is carcinogenic.
Alcohol consumption is linked to seven types of cancers.3 It raises the risk for cancer of the month, larynx, throat, and esophagus. Drinking and smoking together significantly increases this risk. Alcohol helps the harmful chemicals in tobacco to better infiltrate the cells and cause disease. Alcohol can also limit the cells’ ability to repair DNA damage from the chemicals in tobacco.
Regular, heavy alcohol use damages the liver and causes inflammation and scarring. This increases the risk of liver cancer. In addition, alcohol can raise estrogen levels, which is associated with a higher risk of breast cancer. Moderate drinkers have up to a one and a half times increased risk of ectal cancer. While the risk is increased for men and women, the evidence of this link is stronger in men.
Type 2 diabetes:
Chronic use of alcohol is considered to be a potential risk factor for the development of type 2 diabetes mellitus (T2D).4 Like heart disease, low alcohol consumption decreases the risk of T2D, but chronic heavy alcohol use increases the risk. Alcohol disrupts glucose homeostasis in the body and is associated with insulin resistance.
In addition, alcohol affects excess caloric intake, pancreatitis, and impaired liver function. This affects blood glucose levels and causes hypoglycemia. Alcohol alters the brain’s ability to produce hunger hormones and increases food-seeking behaviors. Dysregulation of these hormones (specifically ghrelin and leptin) plays a part in T2D.
Heavy alcohol use can worsen symptoms in patients with TD2 and cause hyper-and hypoglycemia.5 Alcohol-induced hypoglycemia can lead to serious neurological complications in T2D patients, which may or may not be reversible. It can also cause life-threatening ketoacidosis and worsen diabetic neuropathy and retinopathy. Alcohol has serious interactions with some T2D medications including Chlorpropamide, Metformin, and Troglitazone.
If you need assistance connecting your patients to chronic disease or AUD treatment, please contact Anthem Blue Cross call centers at 800-407-4627 (outside L.A. County) or 888-285-7801 (inside L.A. County). For L.A. Care only: 888-285-7801.
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