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Alcohol consumption and cardiovascular risk: mechanisms of action and epidemiologic perspectives
Authors of a review published in Future Cardiology state that ‘An inverse association between moderate alcohol intake and cardiovascular risk, in particular coronary disease and ischemic stroke, has been demonstrated in many epidemiologic studies. In addition, several not primarily vascular diseases are also known to occur less frequently in moderate drinkers than in nondrinkers, whereas excess drinking is unquestionably harmful. As a consequence, clarification as to exact dosage limits and mechanisms regarding the benefit of moderate alcohol intake versus its harmful effects at higher doses is often sought.

Alcohol affects several biochemical factors that have potential cardio-protective benefits, including lipids, platelet aggregation (blood clotting), fibrinogen, tissue-plasminogen activator, plasminogen-activator inhibitor and omega-3 fatty acids. Wine possibly acts through mechanisms that might provide additional cardiovascular benefits. Mechanisms supporting the protective effect of moderate alcohol intake against cardiovascular disease, and epidemiologic evidence concerning the relationship between alcohol dosing and vascular and all-cause mortality are discussed in this review’.

The review conclusions include

The rates of vascular and total mortality are lower for people who drink low-to-moderate amounts of alcoholic beverages than for individuals who do not drink at all.

The cardioprotective nature of alcohol has been attributed to both its antithrombotic properties and its ability to increase high density lipoprotein (HDL = “good” cholesterol) levels.

Moreover, wine (or other antioxidant rich alcoholic beverages) due to its polyphenols content, might offer additional advantages and greater cardiovascular benefits than ethanol alone.

Available epidemiologic data, based at the moment on observational studies, confirm the hazards of excess drinking, but also indicate the existence of a potential window of alcohol intake that may confer a net beneficial effect of drinking, at least in terms of survival, both in men and in women.

Methodological limitations of an observational study design, the role of uncontrolled confounding factors, and the optimal choice of the reference group are important issues to be carefully considered in future studies on alcohol and health.

Besides insisting on the control of risk factors, abstainers should be informed that in the absence of contraindications and in the context of healthy eating and lifestyle, low-to-moderate, non-bingeing consumption of alcoholic beverages may contribute to better health.

Individuals who are already regular light-to-moderate consumers of alcoholic beverages should be encouraged to continue.

The hazards of excess drinking should always be highlighted, and heavy drinkers should be pushed to cut their consumption to a low-to-moderate level.

Source: Alcohol consumption and cardiovascular risk: mechanisms of action and epidemiologic perspectives. Di Castelnuovo A, Costanzo S, di Giuseppe R, de Gaetano G, Iacoviello L. Future Cardiol. 2009 Sep;5(5):467-77.

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