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Cardioprotective Benefits of Red Wine Remain Uncertain on the Heart, But May Reduce Stroke

Heart Disease. Enthusiasm for the possibility that drinking wine or other alcoholic beverages can lower cholesterol and reduce coronary heart disease risk has come under consideration by an American Heart Association advisory panel. The panel's report, led by Dr. Ira J. Goldberg, Professor of Medicine, Columbia University, urges physicians to emphasize heart protective steps that may be less appealing, but that are supported by research. The hypothesis that drinking wine, particularly red wine, counteracts harmful effects of dietary cholesterol and saturated fat grew out of surveys showing lower rates of coronary heart disease, despite high fat diets, in parts of Europe where wine is consumed regularly. This so-called "French paradox" deserves further investigation, particularly since the pattern of consumption of alcoholic beverages may be a marker for lifestyle factors and coronary heart disease risk. More than 60 studies have shown that moderate alcohol consumption can increase the HDL cholesterol, the so-called "good" cholesterol. One to 2 alcoholic drinks daily may increase HDL by about 12%, an amount also seen with exercise and medications. Another theory attributes the benefits of red wine to antioxidants and flavonoids. There is no proof, however, that consuming antioxidants actually lowers the risk of coronary heart disease. The advisory panel warns that the proposed benefits of alcohol consumption should be weighed against the adverse effects of alcohol consumption on the liver, intellectual performance, and overall lifestyle.

Stroke. On the other hand, light to moderate alcohol consumption appears to be associated with a reduced risk of ischemic stroke in young women. Researchers from the Centers for Disease Control and Prevention reported findings from a survey of 224 women (15-44 years) who had suffered an ischemic stroke within the last year, as well as 392 women who had not had a stroke. The women whose average intake was 2 alcoholic drinks a day, had an almost 60% lower stroke risk than those who never drank. Wine appeared to have a beneficial effect, while beer and liquor were not as strongly related to stroke risk. Wine may have had a greater benefit because it contains flavonoids, compounds in fruits and vegetables that may protect against heart disease and cancer.

The complexity of the association between wine or alcohol and heart disease and stroke is based on the fact that they are multifactorial diseases and alcohol may have different effects dependent on the type of heart disease or stroke. The ideal study (one that is randomized, has a placebo group, and has adequate patients) to answer whether wine and spirits should be used for preventive measures is not available. Until such a study is available, the individual must answer the question of when enough is enough. Nothing in excess!

Adapted from Circulation, 2001; 103:472-5 and Stroke 2001; 32:77-83.


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