We often hear different statements about what cardiomyopathy patients (or heart patients in general) should or shouldn't do, eat or drink. This becomes more important this time of year, when it's colder, we gather with our loved ones and share big, cheerful meals. It's a big topic, and for many of these questions, science doesn't have simple answers - at least not yet. However, there are some answers, and we'll try to dispel some myths by giving you simple, helpful advice on three things that many people love (and others avoid altogether): wine, chocolate, coffee, and how to deal with the oncoming cold.
Prof. Thomas Lüscher is a well-known cardiologist working between London and Zurich. He was editor of theEuropean Heart Journal for over 10 years. He and his collaborators have been analyzing this topic (1) by examining over 3200 published research articles on the effects of wine, chocolate, and coffee on the heart. Their conclusions are about the heart in general and are not specific to patients with cardiomyopathy, but they are valid and applicable to the somewhat peculiar hearts of our patients. Let's discuss them one by one…
ALCOHOL
It is well known that drinking alcohol is not good for the heart. It tends to increase blood pressure. It increases the likelihood of palpitations and arrhythmias, especially atrial fibrillation. It promotes weight gain. And so on and so forth…
A few years ago, an influential study (2)seemed to show that up to 4 or 5 glasses of hard liquor a week had a small protective effect against stroke and heart attack. More careful studies (3), who controlled for genetic factors, concluded that there is no protective effect and that excessive use of alcoholic beverages may increase the risk of atrial fibrillation and heart failure. In addition, the so-called vasodilatory effect of this substance, or the relaxation of the arteries of the body with consequent demand for greater work by the heart, may be particularly harmful in patients with hypertrophic cardiomyopathy, unfortunately significantly favoring the obstruction of the exit of blood from the left ventricle. Furthermore, alcohol has a depressive effect on the contractile force of the heart and this may accentuate the already reduced function of the left ventricle in patients with dilated cardiomyopathy. Lüscher's conclusion is therefore: "Wine is truly a joy, but at most neutral if consumed in moderation and in particular situations, such as hypertrophic cardiomyopathy, while it should be consumed in very small doses (one-two glasses a day), provided that you also regularly drink at least 1 litres of water a day, to allow for good hydration.." Also to be avoided is the massive use of wine or spirits occasionally, for example at the weekend (called "binge drinking"), a rare habit in Italy among adults, but frequent among adolescents.
CHOCOLATE
Research shows that dark and bitter chocolate have a protective effect on the cardiovascular system. It is important to note that other types of chocolate – especially milk chocolate – do not have this effect. In addition, milk chocolate contains a lot of calories due to its high fat and sugar content. Here too, colleague Lüscher summarizes: “Chocolate is a joy for our cardiovascular system, if consumed in its dark and bitter form. Let us remember that if consumed in large quantities it contributes to weight gain and the accumulation of fat in our arteries.”
COFFEE
Coffee contains stimulants, which is why it is often said that heart patients should avoid it. However, research does not generally support this claim. Regular coffee drinkers have a very reduced response to stimulants. Those who consume up to four cups a day have a reduced risk of heart failure compared to the general population. In addition, coffee has a protective effect against type II diabetes and against mortality from many causes (excluding cancer). Here too, Lüscher calls for moderation, reminding us: "Coffee wakes us up, but less so if we drink it regularly, and at a dosage of up to four cups a day it could even be protective. Those who overdo it, then, can experience its deleterious effects, namely palpitations and insomnia."
THE COLD
Cold, windy, and wet weather can take heat away from your body. When it’s cold, blood vessels in your skin, fingers, and feet narrow, so you lose less heat. This narrowing (called “vasoconstriction”) causes your blood pressure and heart rate to rise, making your heart work harder to pump blood around your body. This is a normal response to cold. However, the extra effort can be more difficult for people with heart disease, especially during exercise.
So what to do? Don't go out during the winter? Of course you can and should continue to go out when it's cold, but it's important to dress appropriately and try to stay dry. Wearing multiple layers of clothing, as well as a hat, gloves and scarf, and being prepared, such as bringing a raincoat and umbrella, will help you manage the cold and bad weather. Also, if you have serious heart or respiratory problems, cold air can make it harder to breathe. It's best to avoid exercising outdoors on particularly cold days. There are many activities and exercises you can do indoors to improve your mood and keep your heart healthy. Some practical and common sense tips could be (4):
- Keep the room where you spend most of your time at a temperature of at least 18°C.
- Dress in layers with socks, sweaters, and blankets. Wear several thin layers rather than one thick layer; this will trap heat and keep you warmer. A hot water bottle or electric blanket can help keep you warm at night.
- During extreme cold or when going out, dressing in layers and wearing a hat, scarf and gloves can help keep your body warm.
- Remember to move around indoors too to warm up and boost your immune system.
- Eat warm meals and drink healthy beverages to give your body the energy it needs to stay warm. Homemade vegetable soup can be healthy and filling.
FINAL TIPS
Of course, if your doctor advises you to avoid coffee or dark and bitter chocolate, you need to follow his/her advice because these are general recommendations, very different from the personalized treatment that doctors propose. If you don't like them (or don't like the way we react to them), avoid them! But there is no evidence that heart patients in general should avoid them and they could even be beneficial. That glass of wine? There is no evidence that it is protective and we know that alcohol can cause us problems. It is up to each of us to choose, to understand based on our own pathology, but if we decide to drink, it is essential not to overdo it and to hydrate well! In other words, all patients with cardiomyopathy can and should spend the holidays in total serenity, fully enjoying every moment, let's just remember to follow a few rules and above all to respect the 'right measure'.
To learn more about the topic, you can consult the scientific articles cited:
- Lüscher, T. F. 2001. Wine, chocolate, and coffee: forbidden joys? European Heart Journal 42: 4520-4522.
- Leong, D. P., A. Smyth, K. K. Teo, M. McKee, S. Rangarajan, P. Pais, L. Liu, S. S. Anand, and S. Yusuf. 2014. Patterns of alcohol consumption and myocardial infarction risk: observations from 52 countries in the INTERHEART case-control study. Circulation130:390–398.
- Millwood, I. Y., R. G. Walters, X. W. Mei, Y. Guo, L. Yang, Z. Bian, D. A. Bennett, Y. Chen, C. . Dong, R. Hu, G. Zhou, B. Yu, W. Jia, S. Parish, R. Clarke, G. Davey Smith, R. Collins, M. V. Holmes, L. Li, R. Peto, and Z. Chen . 2019. Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500000 men and women in China. Lancet 393: 1831–1842.
- https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/cold-weather-and-cardiovascular-disease

*Niccolò Maurizi, author of the new AICARM News column, is currently head of the Cardiomyopathy clinic at the CHUV in Lausanne. Previously, he worked as a researcher at the University of Florence. In 2015 he co-founded D-Heart, a startup that has created a device capable of autonomously recording the ECG from the patient and transmitting it with their smartphone. He is the author and co-author of almost 100 scientific articles focused on topics related to HCM (management of sudden cardiac arrest, pregnancy in HCM, smart devices in clinical practice, etc.).