Academic journal article Alcohol Research

Focus On: The Cardiovascular System: What Did We Learn from the French (Paradox)?

Academic journal article Alcohol Research

Focus On: The Cardiovascular System: What Did We Learn from the French (Paradox)?

Article excerpt

Although the deleterious effects of chronic heavy alcohol consumption on the cardiovascular system--including hypertension, cardiomyopathy, (1) and arrhythmias--have been documented as early as the late 19th century (Bollinger 1884), interest in possible beneficial effects of moderate drinking only arose about two decades ago. In November 1991, CBS correspondent Morley Safer presented a segment during the news show "60 Minutes" that discussed what became known as the "French Paradox"-the fact that the French, despite their life style of eating diets high in saturated fats and having a very high rate of smoking, only suffer about one-quarter the rate of coronary heart disease (CHD) compared with the U.S. population. The news segment attributed this to the French people's consumption of wine, especially red wine. As a result of the broadcast, wine sales in the United States skyrocketed, and interest in research on the cardiovascular effects of alcohol increased. Thus, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) issued several requests for research in this area, initiating serious investigation of this issue.

Epidemiological studies performed in various countries over the last decades have described the relationship between alcohol intake and mortality as a J-shaped curve--that is, light-to-moderate drinking is associated with decreased mortality, whereas heavy alcohol intake has a detrimental effect. Moderate drinking in the United States is defined as no more than one drink per day for women and no more than two drinks per day for men. (For more information, see the textbox.) Thus, light-to-moderate drinking consistently has been associated with a reduced risk of coronary artery disease and death compared with abstinence (e.g., Fuchs et al. 1995; Lindeman et al. 1999; Mukamal et al. 2010; Renaud et al. 1999). This observation has led to several questions, including the following:

* What is the effect of variations in drinking patterns (i.e., quantity and frequency of drinking, binge drinking)?

* Does the observed beneficial effect result from the alcohol itself or from other compounds in alcoholic beverages?

* What are the mechanisms underlying such effects?

This review briefly addresses the first two questions, before expanding more extensively on the third question regarding the mechanism of cardioprotection, of which much has been learned in the past 10 years. The article will focus on recent data identifying a phenomenon called ethanol-induced preconditioning as well as on an unexpected player in alcohol-induced cardioprotection, the alcohol-metabolizing mitochondrial enzyme aldehyde dehydrogenase 2 (ALDH2).

Alcohol--Friend or Foe?

The World Health Organization (WHO) has estimated that every American over 15 years of age consumes more than 6.1 liters of pure alcohol (i.e., ethanol) per year (WHO 2007). Whereas excessive ethanol consumption has a negative impact on health, acute and chronic moderate consumption appears to have beneficial effects, especially on the heart (Gaziano et al. 2000; Renaud et al. 1998; Rimm et al. 1991; Stampfer et al. 1988; Thun et al. 1997; also see the textbox). Specifically, patients who consume moderate amounts of alcohol before and after an acute heart attack (i.e., myocardial infarction) have an improved prognosis (Chen et al. 1999^; Krenz et al. 2001a; Mukamal et al. 2001; Muntwyler et al. 1998). In addition to causing beneficial changes in lipid levels in the blood (see Renaud and de Lorgeril 1992; Rimm et al. 1999), alcohol produces protective effects through a phenomenon called preconditioning (Chen et al. 1999b; Guiraud et al. 2004; Krenz et al. 2001 a; Miyamae et al. 1997). Both of these mechanisms will be discussed in more detail in the section "Mechanisms of Alcohol-Induced Cardioprotection."

Influence of Quantity and Frequency of Drinking

To date, most epidemiological studies analyzing associations between beneficial or detrimental effects and drinking levels have used average volume of alcohol consumption as a measure. …

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