Cardiovascular System

Throughout the developed world, cardiovascular disease is the leading cause of death and accounts for up to 50% of all deaths. Considering this, it is of outmost relevance that epidemiological studies are showing consistently a reduced mortality from coronary heart disease (CHD) and other forms of cardiovascular diseases (CVD) by 25-30% in middle-aged and elderly individuals.

Moderate wine drinkers seem to live longer than those who abstain or drink heavily. This widely accepted association is known as the J-curve. The relative risk of dying from CVD is lowest among light to moderate drinkers and greater among abstainers. However, the risk increases steadily with each drink above moderation. Thus, while one or two glasses can be considered “good for your health”, drinking more than the guidelines will not provide more benefits, only more harm!

In a recent most comprehensive meta-analysis, an international research team examined results from 84 longitudinal cohort studies from all over the world comparing drinkers of alcoholic beverages with non-drinkers for the outcomes of overall mortality and mortality from cardiovascular disease (CVD), coronary heart disease (CHD) and stroke as well as incident coronary heart disease and incident stroke.
Meta-analyses for each of these outcomes were performed. The researchers carefully accounted for possible confounding factors.

As result, the cardiovascular mortality risk for drinkers of alcoholic beverages compared to non-drinkers was significantly reduced by 25%. Dose-response analysis revealed that the lowest risk of coronary heart disease mortality occurred with 15-30 g of alcohol a day but for stroke mortality ≤ 15 g of alcohol a day. Very importantly, also with regards to all cause mortality, moderate drinkers had an advantage compared to abstinent individuals: up to 15 g/day, their total mortality risk was 13% lower.
The scientists concluded that light to moderate alcohol consumption is associated with a reduced risk of multiple cardiovascular outcomes and total mortality and further, they suggested that current scientific data indicate causality.

The results of another meta-analysis concerning the biochemical and physiological mechanisms showed that moderate consumption of alcoholic beverages (up to 15 g alcohol a day for women and up to 30 g alcohol a day for men) has beneficial effects on a variety of biomarkers linked to the risk of coronary heart disease.

 

Mechanisms

Approximately half of the cardio-protective effects of wine are believed to be due to alcohol itself since it has a beneficial effect on blood lipids.

Vascular disease occurs when bad cholesterol (LDL) is deposited in artery walls and builds up atherosclerotic deposits, eventually rupturing, causing a clot to form which can instantaneously block mostly or completely the flow through the coronary artery. Alcohol stimulates the production of the “good” high density lipoprotein cholesterol (HDL) which is believed to remove cholesterol deposits from arteries and veins where it can form plaques.

It also reduces the “stickiness” or the clotting together of red blood cells which could form a clot and block the blood flow in an artery (thrombosis) resulting in a heart attack or stroke. In addition, it lowers the fibrinogen level which is a pro-inflammatory, thus alcohol works as an anti-inflammatory agent that affects the blood vessels positively and is involved in delaying the development of atherosclerosis.

Wine, in addition, contains phenolic substances
such as resveratrol, anthocyanins, flavonols and catechins which act as antioxidants and inhibit “bad” LDL cholesterol from being incorporated in the artery wall. These antioxidants also reduce the damage caused by the body's free radicals (toxic waste products) which contribute to causing degenerative diseases in the body such as cancer, Alzheimer's disease, Parkinson's disease and ageing. Furthermore, rather than the phenolic compounds themselves, their metabolites might be the real key players in cardiovascular and cancer protection. It should be noted that the antioxidant activity in unfermented grape juice is lower than in the finished wine - antioxidant activity increases during fermentation and maturation. Antioxidant levels will depend on the processing, filtering as well as on the variety, vintage, altitude and soil.

The phenolic compounds are also associated with reducing blood clotting and also maintaining the ability of the blood vessel wall to expand and contract.

The findings described in
the above quoted meta-analyses provide the most thorough examination of the literature and strengthen the case for a causal link between alcohol intake and a reduced risk of coronary heart disease, suggesting that the lower risk of heart disease observed among moderate drinkers is caused by the alcoholic beverage itself, and not by other associated lifestyle factors. The scientific evidence is very convincing that regular moderate consumption of alcoholic beverages, in particular wine,  can provide cardiovascular benefits in older adults.

 

Blood Pressure

High blood pressure (hypertension) occurs when vessel walls lose their flexibility causing excess pressure on arterial walls. If the elevated blood pressure is not reduced, the risk of heart disease, stroke, visual loss, and kidney failure increases. Early detection and treatment is lifesaving. The treatment often involves a modification of lifestyle. It has been a general, long-held belief that consumption of alcoholic beverages, in any form, in any quantity, raises blood pressure, and, therefore, many of those at risk have been advised not to drink at all.

Epidemiological studies suggest a lower risk of morbidity and mortality among lighter drinkers. The investigators found that the association between intake of alcoholic beverages and risk of cardiovascular disease (CVD) followed a J-shaped curve, whereas  alcohol drinking is linearly associated with blood pressure, and the CVD risk also increases  linearly according to blood pressure level.  However, several studies indicate that moderate wine consumption does not increase or can even decrease blood pressure. This effect seems mostly due to relaxed blood vessels immediately after consuming alcoholic beverages.
The non-alcoholic elements of wine, such as polyphenols may have additional antioxidant, anti-inflammatory and blood vessel relaxant properties.

International comparisons and some prospective research data suggest that wine is more protective against coronary heart disease (CHD) than liquor or beer. Possibly beneficial non-alcohol compo­nents in wine may exert the extra protection by wine, but a healthier drinking pattern or more favorable risk traits in wine drinkers (such as a healthier lifestyle) may be involved. Heavy drinking or a binge drinking pattern definitely associated with an increased risk of hypertension. Reducing the intake of alcoholic beverages to moderate levels often leads to substantial reduction of elevated blood pressure.

The above summary provides an overview of the topic, for more details and specific questions, please refer to the articles in the database.

Click here to view the Original Article by K. Gemes et al
OBJECTIVES: To investigate and quantify the potential dose-response association between alcohol consumption and risk of coronary artery disease (CAD). METHODS: We searched the PubMed database from inception to March 2015 and reviewed the reference list of relevant articles to identify prospective studies assessing the association between alcohol consumption and risk of CAD. Study-specific relative risk (RR) estimates were combined using a random-effects model. Publication bias was estimated using Begg's funnel plot and Egger's regression asymmetry test. The meta-analysis included 18 prospective studies, with a total of 214 340 participants and 7756 CAD cases. The pooled adjusted RRs were 0.62 (95% confidence interval [CI] 0.56-0.68) for highest alcohol consumption amount versus lowest amount. Begg's and Egger's regression tests provided no evidence…
BACKGROUND: Although considerable research describes the cardiovascular effects of habitual moderate and heavy alcohol consumption, the immediate risks following alcohol intake have not been well characterized. Based on its physiological effects, alcohol may have markedly different effects on immediate and long-term risk. METHODS AND RESULTS: We searched CINAHL, Embase, and PubMed from inception to March 12, 2015, supplemented with manual screening for observational studies assessing the association between alcohol intake and cardiovascular events in the following hours and days. We calculated pooled relative risks and 95% confidence intervals for the association between alcohol intake and myocardial infarction, ischemic stroke, and hemorrhagic stroke using DerSimonian and Laird random-effects models to model any alcohol intake or dose-response relationships of alcohol intake and…
BACKGROUND: Habitual moderate alcohol consumption is associated with a lower risk of acute myocardial infarction (MI), whereas heavy (binge) drinking is associated with higher cardiovascular risk. However, less is known about the immediate effects of alcohol consumption on the risk of acute MI and whether any association differs by beverage type or usual drinking patterns. METHODS: We conducted a case-crossover analysis of 3869 participants from the Determinants of Myocardial Infarction Onset Study who were interviewed during hospitalization for acute MI in one of the 64 medical centers across the United States in 1989-1996. We compared the observed number of times that each participant consumed wine, beer, or liquor in the hour preceding MI symptom onset with the expected frequency based…
The aim of this paper is to analyze the a priori dietary indexes used in the studies that have evaluated the role of the Mediterranean Diet in influencing the risk of developing cardiovascular disease. All the studies show that this dietary pattern protects against cardiovascular disease, but studies show quite different effects on specific conditions such as coronary heart disease or cerebrovascular disease. A priori dietary indexes used to measure dietary exposure imply quantitative and/or qualitative divergences from the traditional Mediterranean Diet of the early 1960s, and, therefore, it is very difficult to compare the results of different studies. Based on real cultural heritage and traditions, we believe that the a priori indexes used to evaluate adherence to the Mediterranean…

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