Saturnino P. Javier, MD, FPCP, FPCC, FACC
IS WINE good for the heart? This is one of the commonest questions a patient may ask inside a cardiologist’s clinic. The appropriate answer must take into consideration many things – the volume, the frequency, the kind. It also matters to know the profile of the patient who is asking.
There are some basic truths that we must learn about wine. Wine has alcohol – like other hard liquor, spirits, aperitifs, digestifs, among others. There are many kinds of alcohol, but the alcohol we generally refer to for drinking is ethyl alcohol which is a colorless, volatile liquid which is the intoxicating element of wine, beer, hard liquor among others.
In as much as different beverages have varying contents of alcohol, some standards have been set. In general, a bottle of beer (12 ounce) has 4 percent alcohol by volume although some draft beer can have as much as 9 percent. The “drink equivalent” of this beer is a 4-ounce glass of wine, or a 1.5-ounce shot of whiskey, scotch, or other 80-proof spirits, or a 1- ounce shot of 100-proof spirits.
The most judicious recommendation about alcohol consumption is to do so in moderation. The key word is “moderate”. The American Heart Association (AHA) maintains that moderate alcohol consumption is associated with a reduction in the risk of death from cardiovascular disease. Moderate alcohol consumption is one to two drinks per day for men and one drink per day for women. A drink is not a bottle of Robert Mondavi or half a bottle of Johnnie Walker. A drink is more like a bottle of beer, a glass of wine, or a shot of whiskey.
Moderate alcohol consumption has beneficial effects. What good can alcohol do? Alcohol can raise the level of good cholesterol (the HDL-cholesterol), can reduce inflammation and decrease the stickiness of certain blood cell components, particularly the platelets.
A physician giving advice about alcohol-drinking must recognize that while alcohol consumption has beneficial effects, it also has well-recognized adverse consequences when taken excessively. Importantly, there are patients, whose profiles and family backgrounds do not make them ideal candidates to be allowed, advised, or encouraged even moderate alcohol consumption.
Excessive alcohol intake can lead to alcoholism, high blood pressure, obesity, stroke, breast cancer, suicide, and accidents. Some physicians have taken the extra-cautious approach of prohibiting alcohol intake absolutely. As AHA has maintained, “prohibiting alcohol consumption would deny a potentially sizable health benefit to people who would otherwise choose to drink”.
So who should not drink? Some of the restricted groups include those with a personal or family history of alcoholism, excessive elevation of triglyceride levels (those with hereditary types of cholesterol and triglyceride problems), those with pancreatitis, liver disease, certain blood disorders, heart failure, and uncontrolled hypertension. Pregnant women should avoid alcohol. Those who are maintained on certain medications that can interact with alcohol should not drink, or should clear this up with their physicians. For obvious reasons, those whose jobs require full concentration and focus, e.g. drivers and machine operators, should not drink.
Some of the putative benefits of alcohol are attributed to its ability to increase HDL-cholesterol (the good cholesterol), its antioxidant properties, or anti-clotting properties.
The most recognized benefit of alcohol is a small increase in HDL-cholesterol. Yet, it should be recognized that such increase can also be obtained with regular exercise, without incurring the potential deleterious effects of alcohol. Likewise, many of the clinical trials investigating antioxidants like vitamin E have not consistently shown protective effect for the heart. The AHA does NOT recommend drinking alcohol with the objective of preventing clot formation, or increasing antioxidant levels, because there are other measures, pharmacological and otherwise, which can achieve similar results. Wine of whatever vintage, brand, or price, cannot substitute for healthy lifestyle measures, or for proven treatment agents given for identified medical conditions.
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Vital Signs Issue 74 Vol. 4, April 1-31 2015