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The New England Journal of Medicine suggested in an editorial
that there is a need for a study explicitly designed to evaluate
the efficacy of alcohol in lowering the risk of heart attack among
patients who already suffer from cardiovascular disease. The suggestion
will be controversial, particularly among doctors who believe
that even the most cautious advocacy of the health benefits of
moderate alcohol consumption might encourage more people to drink
at dangerous levels. Others feel that despite the harms associated
with alcohol misuse, the possible health benefits of the chemical
should not be rejected.
The editorial observes that epidemiological data such as that
coming from the US health professionals study are complemented
by the findings indicating possible ways in which the beneficial
effects are actually achieved. These include the increase in the
level of high-density lipoprotein cholesterol ("good cholesterol")
in the bloodstream of moderate drinkers and changes in the capacity
of the blood to break down clots. ‘Would it ,therefore, be prudent
based on these 2 types of evidence to set up a formal trial to
evaluate the efficacy of alcohol, just as new drugs are assessed
in clinical trials? A group of people would need to be divided
into two halves, one scheduled to receive alcohol and the second
not. Over the ensuing years the occurrence of cardiovascular disease
in the two sub groups could be compared’.Doctors would be in a
much stronger position to advise their patients to use alcohol,
if the benefits had been confirmed by rigours clinical trials.
Addressing the dilemma, the New England Journal of Medicine argues
that few doctors would use a therapy that might reduce the heart
attack rate by 25-50% as it "would result in thousands of additional
deaths per year due to cancer, motor vehicle deaths and liver
disease". A clinical trial among healthy individuals being "unlikely"
it feels.
In the case of individuals with established coronary disease the
journal reaches a different conclusion. It argues, "It may be
time to randomly assign patients who already have cardiovascular
disease, and who are receiving appropriate therapies, to an alcoholic
beverage treatment study. In such patients the side effects of
alcohol may be acceptable. We would then obtain data demonstrating
whether or not alcohol is safe and effective when administered
with other effective medications. At that point, one could advise
patients with cardiovascular disease on the use of alcoholic beverages
as a medical therapy."
Source. To Drink or Not to Drink? New England Journal of Medicine
(2003), 348, 163-4,Goldberg, I.J., Division of Preventive Medicine
and Nutrition, Columbia University College of physicians and Surgeons,
New York, USA. |
