Gordon Fox • July 31, 2022
Can HCM Patients Use Alcohol, Chocolate, & Coffee?
Bitter, dark chocolate has a protective effect!

We hear many different claims about what HCM patients (or heart patients in general) should or shouldn’t eat and drink. This is a big topic, and for much of it, the science doesn’t have simple answers – at least not yet. But it turns out that there are some answers for three things that many people like (and many people won’t touch): wine, chocolate, and coffee.

Dr. Thomas Lüscher is a highly respected cardiologist in London and Zurich. He was editor of the European Heart Journal for over 10 years. He and his coworkers reviewed this topic ( Lüscher 2021 ) by reading over 3200 published research papers on the effects of wine, chocolate, and coffee on the heart. Their conclusions are for hearts in general and not specific to HCM, but their conclusions are sound and apply to HCM hearts as well.

Alcohol

It’s well known that alcohol isn’t good for hearts. It tends to increase blood pressure. It makes palpitations more likely. It promotes weight gain. And so on. A few years ago, an influential study  ( Leong et al. 2014 ) seemed to show that up to 4 or 5 drinks per week had a small protective effect in terms of stroke and heart attack. More careful studies ( Millwood et al. 2019 ) that controlled for genetic factors concluded that there is no protective effect.  Lüscher’s conclusion: “wine is truly a joy, but at best neutral when consumed in moderation.”

Chocolate

Research shows that dark, bitter chocolate does have a protective effect on the cardiovascular system. Importantly, other chocolates – especially milk chocolate – don’t have that effect. And milk chocolate comes with plenty of fat and sugar.  Lüscher’s conclusion: “Chocolate is a joy for our CV system, if consumed in dark, bitter form.”

Coffee

Coffee contains stimulants, so we sometimes hear people insist that it must be avoided by heart patients. The research doesn’t support this in general. People who drink coffee regularly have a much smaller response to the stimulant. Those who drink 4 cups per day or fewer have a reduced risk of heart failure. Coffee also has a protective effect against Type II diabetes and against mortality from many causes (other than cancer).  Lüscher’s conclusion: “It wakes us up, less so if you drink it regularly, and at that dose of up to 4 cups a day, might even be protective.”

Parting advice

Of course, if your doctor recommends avoiding coffee or dark, bitter chocolate, you should. If you don’t like them (or don’t like the way you react to them), by all means, avoid them! But there is no evidence that heart patients generally should avoid them, and they may even be good for you. That glass of wine?  There isn’t any evidence that it’s protective, and we know that alcohol can cause us problems. It’s your choice, but if you do have some, don’t have much!

Literature cited

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. Circulation 130: 390–398.

Lüscher, T. F. 2001. Wine, chocolate, and coffee: forbidden joys? European Heart Journal 42: 4520-4522.

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.

HCMA Blog

April 30, 2025
Medical Management means using medicines and other non-invasive therapies to relieve symptoms. It's exciting that new treatments for HCM are being studied and that the FDA approved Camzyos in 2022! HCM can cause various symptoms depending on how stiff the heart is, how much scarring (fibrosis) there is, and whether there is obstruction. Some people have no noticeable symptoms. Common symptoms are chest pain/pressure, shortness of breath, lightheadedness, fatigue, palpitations, and brain fog. Syncope (fainting) is dramatic but not as common as the other symptoms. Medications are the first-line treatment for symptoms of HCM. If patients can't take one class of medication, they can try a medication from a different class. Here are some medications used to treat HCM and what they're for: Beta Blockers - make your heart beat slower and relax better. They allow the heart to fill more completely between beats. They can lower blood pressure and relieve symptoms. Calcium Channel Blockers - used to lower blood pressure and slow the heart rate. May reduce symptoms from obstruction in HCM. Myosin Inhibitors - cause the heart to beat with less force. They may reduce obstruction and septal thickness in some patients. Camzyos (mavacamten) is the first of this class of medication. For more information, click HERE . Antiarrhythmics - help to restore normal rhythm in the heart. Blood Thinners - anticoagulants and anti-platelets make it harder for blood to clot. They are prescribed to reduce the risk of stroke. This risk is higher in patients with afib, aflutter, and artificial heart valves. Diuretics , or "water pills," help the kidneys get rid of extra water and salt, reducing swelling in the body. Sodium Channel Blockers - may reduce gradient in obstructive HCM and can treat chest pain. Some also act as antiarrhythmics. Antibiotics - treat or prevent bacterial infections. In HCM, they may be given before dental work to prevent infective endocarditis. To learn more and see the side effects of these medications, click HERE .
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