Acute inhibitory effect of alcohol on fibrinolysis

Background In contrast to a reduced risk of coronary heart disease (CHD) wi th light to moderate alcohol consumption, heavy alcohol intake and binge dr inking are associated with increased cardiovascular mortality. Alcohol has an acute and profound effect on fibrinolysis that may be relevant to the pa thogenesis of CHD. Materials and methods The short-term effects of a low (two glasses, 250 mL, 20 g ethanol) and a high (six glasses, 750 mL, 60 g ethanol) intake of red wine were studied in male volunteers and compared to the intake of mineral water. To find a threshold for inhibition of fibrinolysis and to study a b inge effect, a second experiment was performed comparing the intake of four (500 mL, 40 g ethanol) and eight (1000 mL, 80 g ethanol) glasses of red wi ne with mineral water. Plasminogen activator inhibitor-1 (PAI-1), tissue-ty pe plasminogen activator (t-PA), plasmin-antiplasmin (PAP) complexes and cl ot lysis time were measured. Results In contrast to the circadian rhythm with an enhanced fibrinolysis i n the evening that was found in the mineral water group, an intake above fo ur glasses of wine inhibited fibrinolysis significantly. After the intake o f two glasses no significant disturbance of the circadian rhythm was observ ed. Five hours after the consumption of six glasses of wine, a dramatic inc rease occurred of PAI-1 antigen (77 +/- 42 mug L-1 vs. -5 +/- 10 mug L-1 in the mineral water controls; P< 0.001) and PAI-1 activity (27 +/- 15 U mL(- 1) vs. -2 +/- 3 U mL(-1) in mineral water controls; P < 0.001). Despite a r ise in t-PA antigen, t-PA activity dropped (- 0.5 +/- 0.2 U mL(-1) vs. - 0. 1 +/- 0.2 in controls; P < 0.001) as did PAP complexes (- 103 +/- 55 <mu>g L-1 vs. - 26 +/- 57 mug L-1 in controls; P < 0.01). After the consumption o f eight glasses of wine, the clot lysis assay indicated continued inhibitio n of fibrinolysis the following morning. Conclusions Drinking a large amount of alcohol in the evening results in an acute inhibition of fibrinolysis, persisting the following morning. This m ay predispose to accelerated atherosclerosis and set the stage for thrombot ic coronary events, explaining the higher cardiovascular mortality risk in binge drinkers.