Alcohol, wine and cardiovascular disease, two sides of the same coin

Abstract

Excessive alcohol consumption is associated with increased morbidity and mortality, as well as with severe labour and traffic accidents. In fact, the dangers of alcohol intake have been with us throughout human history. The book of Genesis reported one of the first episodes demonstrating the dangers of alcohol. Upon leaving the Ark after the great flood Noah ‘‘drank wine and became drunk’’ and his sons had to protect him from embarrassment. Since then, the medical consequences of excessive alcohol consumption are well known and include acute intoxication, alcohol dependence, cirrhosis of the liver, pancreatitis, hypertension, stroke, dilated cardiomyopathy, cardiac arrhythmias and sudden death [1, 2]. On the other hand, human beings have drunk alcoholic beverages, especially wine, since ancient times and many believe in the beneficial effects of moderate wine intake. As an example, remains of a unique wine, shedeh, was found in the tomb of the pharaoh Tutankhamon to accompany him on his long trip to the ‘‘other life’’ [3]. However, the first modern evidence that there is a scientific link between alcohol consumption and cardiovascular disease was made in the early part of the last century, when it was observed that individuals that died from alcoholic cirrhosis had cleaner arteries than they ought to according to their age and lifestyle habits, suggesting that alcohol could exert a protective effect against atherosclerosis. Since then, several epidemiological studies have suggested that light to moderate alcohol consumers have an increased survival and decreased risk for cardiovascular events than abstainers. A recent meta-analysis of 34 prospective cohort studies with more than 1 million subjects and almost 100,000 deaths by any cause showed a J-shaped association between self-reported alcohol consumption and mortality [4]. Current evidence suggests beneficial effects of moderate drinking on atherothrombotic events including coronary heart disease [5], ischemic stroke [6], peripheral arterial disease and, more recently, congestive heart failure [7]. Positive effects of moderate drinking on the quality of life, cognitive function, dementia and longevity have also been reported. These effects have been reported in a variety of patients, including diabetics, hypertensive subjects and patients with previous heart attack. As explained in the paper published by Di Castelnuovo et al. in this issue [8], the underlying mechanisms to explain the protective effects of moderate alcohol against coronary heart disease include an increase in high-density lipoprotein cholesterol (HDL-C), a decrease in platelet aggregation and coagulation effects, a reduction in the levels of fibrinogen and an increase in insulin sensitivity. This latter effect explains the reduced risk of diabetes in moderate drinkers. Additional beneficial effects of the intake of alcoholic fermented beverages against atherosclerosis have been attributed to their antioxidative and anti-inflammatory effects [9, 10] as well as their actions on vascular function. However, although there are few doubts as to the beneficial effects of moderate drinking on cardiovascular system, a number of reports concerning alcohol and cancer have been published recently. According to the data of the Million Women study [11], even light to moderate levels of alcohol consumption were predictive of an increased risk of several common cancers, mainly those of the breast. Previous R. Estruch (&) Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain e-mail: RESTRUCH@clinic.ub.es