A recent paper in the New England Journal of Medicine concluded that “greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality” (Trichopoulou et al. 2003). This conclusion is supported by a 30 year follow-up study in seven countries, which considered the association between diet and cardiovascular disease and cancer (Farchi et al. 1992, 2000). Beneficial components of a Mediterranean-style diet include the daily consumption of fruits and vegetables, which typically contain a high concentration of phenolic compounds, and are associated with a reduced risk of cardiovascular disease (Grundy 1986, Block 1992, Block et al. 1992, Ames et al. 1993, Hertog et al. 1993, Kinsella et al. 1993, Halliwell et al. 1995, Willett et al. 1995, Renaud 1996, Ness and Powles 1997). Cardiovascular disease accounted for 40 % of all deaths in Australia in 1998.
Traditionally, wine has also been considered a component of a Mediterranean-style diet (Farchi et al. 2000). Moderate wine consumption as an integral part of any daily diet has become increasingly important. This is apparent from many of the clinical studies that have been undertaken on the effects of wine and the wine-derived phenolic compounds on the risk of developing or dying from cardiovascular disease. This is also exemplified in an epidemiological study assessing the geographical distribution of cardiovascular disease in Spain, one of the 18 Mediterranean countries. A higher rate of cardiovascular disease was observed in those Spanish regions which consumed less wine, despite having, overall, a Mediterranean-style diet; the general rate of cardiovascular disease was, however, still less than that of countries consuming a higher fat and lower phenolic compound diet, such as the USA (Rodriguez Artalejo et al. 1996). The amount of wine associated with a reduced risk of cardiovascular disease is generally considered as two to four glasses of wine containing 10 g of ethanol per day (Jackson et al. 1992, Palomaki and Kaste 1993).
Indeed, the moderate consumption of wine has been observed to supplement the cardioprotective effects of an already high phenolic diet, and more importantly, to counter the harmful effects of a high fat diet on blood clotting, endothelial function and lipid oxidation, which contribute to the development of cardiovascular disease (Leighton et al. 1999, Curveas et al. 2000, Mezzano et al. 2001, Mansvelt et al. 2002). Furthermore, it has been observed that when subjects are on a low phenolic diet the regular consumption of red wine in the short-term is unable to improve endothelial function or prevent the oxidation of lipids such as LDL (Greenrod et al. unpublished data).
In addition, wine consumers have generally been observed to have fewer risk factors for cardiovascular disease compared with beer and spirits consumers (Klatsky et al. 1990, Klatsky and Armstrong 1993, Gronbaek et al. 2000, Jensen et al. 2002). This is reflected in an approximately 25 to 35% lower risk of cardiovascular disease for wine consumers compared to consumers of beer and spirits, respectively (Klatsky 2003), which is purportedly related to diet, alcohol consumption patterns and lifestyle characteristics. For example, wine consumers generally consume a Mediterranean-style diet (Tjonneland et al.1999) where wine, in comparison to beer and spirits, is generally consumed with the food, slowly or over a longer period of time, which would attenuate a high blood alcohol concentration associated with cellular and tissue damage, prolong any acute and short-term antioxidative and blood clotting effects, and prevent any rebound effects of the ethanol components of the beverage (Klatsky 2003). These acute local effects on blood clotting are temporary and return to normal within 24 hours (Renaud et al. 1984, Renaud et al. 1992, Hendriks et al. 1994), as are the effects on free radical damage to DNA, which return to baseline or normal within eight hours (Fenech et al. 1997). The lowering effects of wine consumption on systolic blood pressure are also readily reversible; ¾ within seven to 14 days (Puddey et al. 1985).
If the antioxidative effects of the wine-derived phenolic compounds are dose dependent, then the daily consumption of wine would also be required for maintenance of an appropriate concentration in blood plasma and tissues. For example, approximately 10 µmol/L of total phenolic compounds is required for significant antioxidative activity in vitro (Frankel et al. 1993).
Thus, the regular consumption of wine, which has been determined as daily, maintains the effects on blood clotting, systolic blood pressure (Klatsky et al. 1977, Gillman et al. 1995, Klatsky 1995) and DNA, as well as promoting any potential longer-term effects on the antioxidant capacity of plasma. It is therefore allied with maximal cardio- and cancer-protection (McElduff and Dobson 1997).
Conversely, binge drinking, which is considered to be the consumption of re than six standard drinks per drinking session, is seen to significantly increase systolic blood pressure, which significantly increases the risk of a heart attack or stroke (Hillbom and Kaste 1981, Kozarevic et al. 1983, Hillbom et al. 1984, Donahue et al. 1986, Suhonen et al. 1987, Renaud and Ruf 1996).
The typical diet of an Australian has evolved over the past 40 years from a diet higher in fats and lower in phenolic compounds (Noah and Trusswell 2003). In 2003, Australia’s consumption of the primary components of a Mediterranean-style such as cereals, wheat, rice, maize, potato, pulses, olive oil, other vegetable oils, vegetables, fruits, wine, meats, animal fats, milk, milk products and fish, is now generally within the range of the 18 Mediterranean countries (Noah and Trusswell 2003), although our consumption of wine is generally a little less. Paradoxically our risk of cardiovascular disease generally remains greater, which suggests that cigarette smoking, lifestyle, obesity and genetic predisposition may also be important risk factors for cardiovascular disease.