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| Wine and Heart Disease |
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Wine has been espoused for centuries as a superior beverage. Louis Pasteur said, "Wine is the most healthful and most hygienic of beverages", and Plato remarked, "No thing more excellent nor more valuable than wine was ever granted mankind by God". Common to these endorsements is the view that wine is as good for the body as it is for the spirit. Modern scientific research supports this perception. David Goldberg at the University of Toronto has recently published an amusing and enlightening review of this subject.
Fifteen years ago, in an ecological epidemiology study, Selwyn St Leger and co-workers showed that there was a population-based association between a reduction in deaths from heart disease and increased wine consumption. More recently. Serge Renaud and Michel de Lorgeril at INSERM in Lyon brought the issue to public attention with a similar study "Wine, alcohol. platelets. and the French paradox for coronary heart disease." They used World Health Organization data to show that dairy fat consumption is highly correlated with coronary heart disease (CHD) mortality. A few French cities, however, had very high fat consumption, yet low CHD mortality rates - thus the "French paradox". When they added wine consumption as a factor that affected CHD mortality, the researchers got a better correlation, with wine being a negative correlate - it appeared to reduce heart disease. Michael Criqui and Brenda Ringel at the University of California, San Diego, subsequently investigated comparable data and
came to a similar conclusion: wine was one of the few dietary factors that correlated with reduced CHD mortality. Interestingly, they also showed that fruit consumption correlated with reduced CHD mortality.
There now appears to be no dispute that moderate wine consumption is associated with lower CHD mortality. A related question is whether or not total mortality rates decrease with increased wine consumption. and here there is still some argument. In an ecological study that compared entire populations, Criqui and Ringel showed that total mortality does not decrease as the population´s wine alcohol consumption increases. The authors attribute this effect to a compensating increase in mortality from other causes, which offsets the (decreasing CHD mortality. However, in prospective studies which distinguish between subjects based on consumption rates, the lowest total mortality occurs with moderate alcohol consumption (1-3 drinks/day), whether from beer, wine or spirits. For heavy drinkers, however, mortality is higher than non-drinkers, especially among women. Other studies agree that the lowest mortality occurs at moderate alcohol consumption levels. including the analysis of
health professionals by Eric Rimm and co-workers, at Harvard School of Public Health.
Despite the issues surrounding total mortality, it is clear that moderate alcohol consumption itself reduces CHD mortality. Several mechanisms for this are now recognised, of which the best known is alcohol´s ability to alter blood lipid levels by lowering total cholesterol and raising high density lipoprotein (HDL) levels.
But does wine confer any special benefit, and if so, is there an organic explanation for this effect that is unrelated to alcohol? Criqui and Ringel´s ecological data clearly show that wine alcohol consumption (correlation coefficient, r = -0.66) is much more strongly correlated with reduced CHD mortality than total alcohol consumption (r = -0.39). Also, when Arthur Klatsky and Mary Ann Armstrong of the Kaiser Permanente Medical Center in Oakland, California, singled out wine drinkers in their prospective study, the drinkers exhibited a lower CHD mortality role than the other subjects. Thus, in two types of studies, wine appears to have a special benefit. In their US-based study, Klatsky and Armstrong raised a concern that the correlation between wine consumption and reduced CHD mortality may not lie due to wine by itself, but perhaps to other lifestyle factors associated with wine consumption. For instance, in the US wine drinking correlates with increased income, which itself is related to reduced
mortality rates. On the other hand, Criqui and Ringel´s study is not subject to such a bias because the correlation between income and wine consumption does not hold true across the developed nations surveyed.
While future epidemiology studies can be designed to take into account such factors that still raise questions, epidemiological investigations are never capable of determining specific causes for observed effects. Therefore, it is important for chemists and biologists to establish whether or not there is a molecular mechanism by which wine nutrients could affect CHD.
One report has helped to define such an area for investigation. Michael Hertog and co-workers at the DLO State Institute for Quality Control of Agricultural Products, Wageningen, observed a direct correlation between reduced CHD mortality in elderly men and dietary levels of flavonols, one of the major classes of flavonoid phenolics. The investigators divided the subjects into three groups based on the content of flavonols in their diet. Flavonol consumption was based on their reported diets and the flavonol content of those foods. The best correlation between reduced CHD mortality and specific dietary components was with tea, onions and apples. The best correlation between CHD mortality and chemical constituents of the diet was with one flavonol: quercetin. This was an interesting outcome because previous studies had shown negligible absorption and rapid clearance of pure quercetin in humans. Surprisingly, Hertog´s group discounted any other phenolic compounds, even other flavonoids,
as having any potential effect on CHD.
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