Q. I'm 72 years old, with high blood pressure and high cholesterol. I take HydroDiuril and Lipitor. I feel fine, but I want to know if I can drink red wine while I'm taking these medications or should I be concerned about combining statins and alcohol?
A. It sounds like you are on a good combination of medications, with a thiazide diuretic (HydroDiuril) for hypertension and a statin drug (Lipitor) to lower your cholesterol. Even with these medications, of course, you should eat right, stay lean, exercise regularly, shun tobacco, and keep your stress under control. You should also be sure your medications are bringing your blood pressure and cholesterol down to the levels your doctor has set as a goal.
Low-dose alcohol also may slightly reduce the risk of heart attacks and certain strokes. That means no more than one to two drinks a day, counting five ounces of wine, 12 ounces of beer, and 1.5 ounces of liquor as one drink. Although red wine has theoretical advantages for the heart, studies suggest that all forms of alcohol are equally protective as long as the dose is right.
But alcohol can have side effects, usually due to drinking too much or at the wrong time (before driving, for example). Alcohol can also interact with medications, particularly tranquilizers and sleeping pills. And because high doses of alcohol can damage the liver, your question about statins is a good one since about 2% of people who take these drugs develop chemical evidence of liver inflammation. Fortunately, the inflammation is usually mild; it resolves when statins are stopped, but many doctors believe it's safe to continue statin therapy even if mild liver test abnormalities develop.
Does low-dose alcohol increase the likelihood that a statin will cause liver inflammation? A 2006 Harvard study evaluated the question in 1,244 men who had undergone coronary artery bypass surgery. The men were randomly assigned to take low- or high-dose lovastatin (Mevacor — the first statin drug). Among the 345 men on high doses, there was no effect of alcohol on the risk of liver inflammation, even in the men who averaged more than two drinks a day.
Statins are medications. Alcohol is not. Despite this difference, they share an important proviso: each should be used responsibly. And if you do that, you can have your wine and your statin, too.
— Harvey B. Simon, M.D.
Former Editor, Harvard Men's Health Watch