2001 estimated that medium and high consumption of alcohol led to 75,754 deaths in the united states in 2001. low consumption of alcohol had some beneficial effects, so a net 59,180 deaths were attributed to alcohol. longevity in 2016, a meta-analysis of 87 studies investigating alcohol use and mortality risk was conducted. the studies analyzed had shown the largest mortality risk reduction in moderate drinkers, but these studies did not correct for confounding variables common with certain abstainers, such as previous alcoholism, and chronic health issues. after adjusting these studies for abstainer biases, no reduction in mortality risk was found for low-volume drinkers. however, there have been individual studies that show abstainers and heavy drinkers have an increased mortality of about 50% over moderate drinkers after adjustment for confounding factors in individuals above the age of 55. cardiovascular system main article: alcohol and cardiovascular disease alcohol has been found to have anticoagulant properties. thrombosis is lower among moderate drinkers than abstainers. a meta-analysis of randomized trials found that alcohol consumption in moderation decreases serum levels of fibrinogen, a protein that promotes clot formation, while it increases levels of tissue type plasminogen activator, an enzyme that helps dissolve clots. these changes were estimated to reduce coronary heart disease risk by about 24%. another meta-analysis in 2011 found favorable changes in hdl cholesterol, adiponectin, and fibrinogen associated with moderate alcohol consumption. a systematic review based on 16,351 participants showed j-shaped curve for the overall relationship between cardiovascular mortality and alcohol intake. maximal protective effect was shown with 5–10 g of alcohol consumption per day and the effect was significant up to 26 g/day alcohol consumption. serum levels of c-reactive protein (crp), a putative marker of inflammation and predictor of chd (coronary heart disease) risk, are lower in moderate drinkers than in those who abstain from alcohol, suggesting that alcohol consumption in moderation might have anti-inflammatory effects. data from one prospective study suggest that, among men with initially low alcohol consumption (</=1 drink per week), a subsequent moderate increase in alcohol consumption may lower their cvd risk. despite epidemiological evidence, many have cautioned against recommendations for the use of alcohol for health benefits. a physician from the world health organization labeled such alcohol promotion as "ridiculous and dangerous". one reviewer noted, "despite the wealth of observational data, it is not absolutely clear that alcohol reduces cardiovascular risk, because no randomized controlled trials have been performed. alcohol should never be recommended to patients to reduce cardiovascular risk as a substitute for the well-proven alternatives of appropriate diet, exercise, and drugs." it has been argued that the health benefits from alcohol are at best debatable and may have been exaggerated by the alcohol industry, with investigators holding that alcohol should be regarded as a recreational drug with potentially serious adverse effects on health and should not be promoted for cardio-protection. peripheral arterial disease a prospective study published in 1997 found "moderate alcohol consumption appears to decrease the risk of pad in apparently healthy men." in a large population-based study, moderate alcohol consumption was inversely associated with peripheral arterial disease in women but not in men. but when confounding by smoking was considered, the benefit extended to men. the study concluded "an inverse association between alcohol consumption and peripheral arterial disease was found in nonsmoking men and women." intermittent claudication a study found that moderate consumption of alcohol had a protective effect against intermittent claudication. the lowest risk was seen in men who drank 1 to 2 drinks per day and in women who drank half to 1 drink per day. heart attack and stroke drinking in moderation has been found to help those who have had a heart attack survive it. however, excessive alcohol consumption leads to an increased risk of heart failure. a review of the literature found that half a drink of alcohol offered the best level of protection. however, they noted that at present there have been no randomised trials to confirm the evidence which suggests a protective role of low doses of alcohol against heart attacks. there is an increased risk of hypertriglyceridemia, cardiomyopathy, hypertension, and stroke if three or more standard drinks of alcohol are taken per day. a systematic review reported that reducing alcohol intake lowers blood pressure in a dose-dependent manner in heavy drinkers. for people who drank two or fewer drinks per day, no difference was found. cardiomyopathy large amount of alcohol over the long term can lead to alcoholic cardiomyopathy. alcoholic cardiomyopathy presents in a manner clinically identical to idiopathic dilated cardiomyopathy, involving hypertrophy of the musculature of the heart that can lead to congestive heart failure. hematologic diseases alcoholics may have anemia from several causes; they may also develop thrombocytopenia from direct toxic effect on megakaryocytes, or from hypersplenism. atrial fibrillation alcohol consumption increases the risk of atrial fibrillation, a type of abnormal heart rhythm. this remains true even at moderate levels of consumption. nervous system results of the iscd 2010 study ranking the levels of damage caused by drugs, in the opinion of drug-harm experts. when harm to self and others is summed, alcohol was the most harmful of all drugs considered, scoring 72%. chronic heavy alcohol consumption impairs brain development, causes alcohol dementia, brain shrinkage, physical dependence, alcoholic polyneuropathy (also known as 'alcohol leg'), increases neuropsychiatric and cognitive disorders and causes distortion of the brain chemistry. at present, due to poor study design and methodology, the literature is inconclusive on whether moderate alcohol consumption increases the risk of dementia or decreases it. evidence for a protective effect of low to moderate alcohol consumption on age-related cognitive decline and dementia has been suggested by some research; however, other research has not found a protective effect of low to moderate alcohol consumption. some evidence suggests that low to moderate alcohol consumption may speed up brain volume loss. chronic consumption of alcohol may result in increased plasma levels of the toxic amino acid homocysteine; which may explain alcohol withdrawal seizures, alcohol-induced brain atrophy and alcohol-related cognitive disturbances. alcohol's impact on the nervous system can also include disruptions of memory and learning (see effects of alcohol on memory), such as resulting in a blackout phenomenon. strokes epidemiological studies of middle-aged populations generally find the relationship between alcohol intake and the risk of stroke to be either u- or j-shaped. there may be very different effects of alcohol based on the type of stroke studied. the predominant form of stroke in western cultures is ischemic, whereas non-western cultures have more hemorrhagic stroke. in contrast to the beneficial effect of alcohol on ischemic stroke, consumption of more than two drinks per day increases the risk of hemorrhagic stroke. the national stroke association estimates this higher amount of alcohol increases stroke risk by 50%. "for stroke, the observed relationship between alcohol consumption and risk in a given population depends on the proportion of strokes that are hemorrhagic. light-to-moderate alcohol intake is associated with a lower risk of ischemic stroke which is likely to be, in part, causal. hemorrhagic stroke, on the other hand, displays a log-linear relationship with alcohol intake." brain alcohol misuse is associated with widespread and significant brain lesions. alcohol related brain damage is not only due to the direct toxic effects of alcohol; alcohol withdrawal, nutritional deficiency, electrolyte disturbances, and liver damage are also believed to contribute to alcohol-related brain damage. cognition and dementia excessive alcohol intake is associated with impaired prospective memory. this impaired cognitive ability leads to increased failure to carry out an intended task at a later date, for example, forgetting to lock the door or to post a letter on time. the higher the volume of alcohol consumed and the longer consumed, the more severe the impairments. one of the organs most sensitive to the toxic effects of chronic alcohol consumption is the brain. in the united states approximately 20% of admissions to mental health facilities are related to alcohol-related cognitive impairment, most notably alcohol-related dementia. chronic excessive alcohol intake is also associated with serious cognitive decline and a range of neuropsychiatric complications. the elderly are the most sensitive to the toxic effects of alcohol on the brain. there is some inconclusive evidence that small amounts of alcohol taken in earlier adult life is protective in later life against cognitive decline and dementia. however, a study concluded, "our findings suggest that, despite previous suggestions, moderate alcohol consumption does not protect older people from cognitive decline." wernicke–korsakoff syndrome is a manifestation of thiamine deficiency, usually as a secondary effect of alcohol misuse. the syndrome is a combined manifestation of two eponymous disorders, korsakoff's psychosis and wernicke's encephalopathy. wernicke's encephalopathy is the acute presentation of the syndrome and is characterised by a confusional state while korsakoff's psychosis main symptoms are amnesia and executive dysfunction. "banana bags", intravenous fluid containers containing vitamins and minerals (bright yellow due to the vitamins), can be used to mitigate these outcomes. essential tremor essential tremors—or, in the case of essential tremors on a background of family history of essential tremors, familial tremors—can be temporarily relieved in up to two-thirds of patients by drinking small amounts of alcohol. ethanol is known to activate aminobutyric acid type a (gabaa) and inhibit n-methyl-d-aspartate (nmda) glutamate receptors, which are both implicated in essential tremor pathology and could underlie the ameliorative effects. additionally, the effects of ethanol have been studied in different animal essential tremor models. (for more details on this topic, see essential tremor). sleep main article: alcohol use and sleep chronic use of alcohol used to induce sleep can lead to insomnia: frequent moving between sleep stages occurs, with awakenings due to headaches and diaphoresis. stopping chronic alcohol misuse can also lead to profound disturbances of sleep with vivid dreams. chronic alcohol misuse is associated with nrem stage 3 and 4 sleep as well as suppression of rem sleep and rem sleep fragmentation. during withdrawal rem sleep is typically exaggerated as part of a rebound effect. mental health effects high rates of major depressive disorder occur in heavy drinkers. whether it is more true that major depressive disorder causes self-medicating alcohol use, or the increased incidence of the disorder in people with an alcohol use disorder is caused by the drinking, is not known though some evidence suggests drinking causes the disorder. alcohol misuse is associated with a number of mental health disorders and alcoholics have a very high suicide rate. a study of people hospitalized for suicide attempts found that those who were alcoholics were 75 times more likely to go on to successfully commit suicide than non-alcoholic suicide attempts. in the general alcoholic population the increased risk of suicide compared to the general public is 5-20 times greater. about 15 percent of alcoholics commit suicide, the most common methods being overdosing and cutting/scratching. there are high rates of suicide attempts, self-harm, suicidal ideation, and self-harm ideation in people with substance dependence who have been hospitalized. use of other illicit drugs is also associated with an increased risk of suicide. about 33 percent of suicides in the under 35s are correlated with alcohol or other substance misuse. social skills are significantly impaired in people that have alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. the social skills that are impaired by alcohol use disorder include impairments in perceiving facial emotions, prosody perception problems and theory of mind deficits; the ability to understand humor is also impaired in people with an alcohol use disorder. studies have shown that alcohol dependence relates directly to cravings and irritability. another study has shown that alcohol use is a significant predisposing factor towards antisocial behavior in children. depression, anxiety and panic disorder are disorders commonly reported by alcohol dependent people. alcoholism is associated with dampened activation in brain networks responsible for emotional processing (e.g. the amygdala and hippocampus). evidence that the mental health disorders are often induced by alcohol misuse via distortion of brain neurochemistry is indicated by the improvement or disappearance of symptoms that occurs after prolonged abstinence, although problems may worsen in early withdrawal and recovery periods. psychosis is secondary to several alcohol-related conditions including acute intoxication and withdrawal after significant exposure. chronic alcohol misuse can cause psychotic type symptoms to develop, more so than with other illicit substances. alcohol misuse has