Assessing alcohol and health.

In a recent study published in the American Journal of Hypertension, even red wine that has had the alcohol removed reduced stiffness in the arteries of patients with coronary artery disease (CAD). In addition, the effect on diastolic blood pressure was favorable in the alcohol-free group, whereas alcohol consumption prevented the lowering of diastolic blood pressure levels. (Diastolic pressure is taken in between contractions, when ventricular filling occurs.)

Although the study, which was conducted by the Department of Nutrition and Dietetics at Harokopio University in Athens, Greece, was of only 15 patients, similar results were reported in February of last year in the American Heart Journal. That study was also conducted in part by Dr. Emmanouil N. Karatzis (of Alexandra University Hospital in Athens), and found that the acute dysfunction of the cells lining the heart cavity and blood vessels which occurs when people smoke cigarettes was mitigated significantly by consuming red wine with the cigarettes, regardless of whether the alcohol had been removed from the wine.

Arterial stiffness is a significant cause of increased blood pressure, which in turn may cause cardiovascular events. The newer study looked at the subjects' arterial stiffness and blood pressure during a fast, and then 30, 60, and 90 minutes after they drank 250 milliliters of red wine. This is about eight and a half ounces, or one-third of a bottle. (The typical glass of wine contains six ounces.) The patients drank either regular wine or wine with the alcohol removed.

Though the alcohol-free group enjoyed the decrease in diastolic blood pressure, the best effects on central systolic (arterial) blood pressure were seen in the alcohol group. Alcohol lowered central systolic pressure 7.4 mm Hg in the wine group, and 5.4 mm Hg in the alcohol-free group. However, as noted above, both regular and non-alcoholic red wine significantly decreased arterial stiffness in the patients, by 10.5% for wine drinkers versus 6.1% for alcohol-free subjects. In both groups, the effects lasted about 90 minutes.

It appears, then, that red wine contains powerful antioxidants that provide health benefits apart from the anti-clotting properties of alcohol. Dealcoholized red wine can reduce arterial stiffness without increasing blood pressure. Further research might involve measuring total antioxidant capacity soon after drinking red wine.

Alcohol enjoys a complicated relationship with bodily health, to say the least. It has long been thought that, in general, lowering alcohol intake reduces cardiovascular risk by reducing blood pressure. Yet alcohol wine lowered arterial pressure to a greater degree than dealcoholized wine in the present study's subjects. The researchers call for more studies of the long-term effects of wine consumption on not only arteries and cardiovascular health but on the body in general. The greatest absolute benefit may well be for older populations with shorter lifespans and the highest risk of coronary disease than young adults with more decades of alcohol consumption ahead of them, and therefore for whom cirrhosis is a greater risk.

Two new reviews will be made available in November in the Journal of Hypertension that explore and analyze what data we have collected thus far on alcohol's role in human health. The first review concludes that "the hypertensive patient over the age of 60 who drinks over 16 drinks per week should be advised to reduce his or her alcohol intake but a daily drink may be advisable and the patient should not stop drinking entirely. It is not suggested that the non-drinker should start drinking, but most hypertensives are over the age of 60 when community studies suggest that drinking alcohol does more good than harm."

The other review, from the University of Western Australia, stresses alcohol's differing roles in fighting or contributing to stroke, which the author emphasizes is based on stroke type. Because alcohol raises HDL ("good" cholesterol) levels and lowers blood platelet adhesiveness, it is associated with decreased risk of ischemic stroke. This type of stroke is caused by a low oxygen state due to low blood supply, often because of an obstruction in the arteries.

On the other hand, alcohol's role in thinning the blood and decreasing clotting mechanisms would implicate increased consumption in increased risk of hemorrhagic stroke, which is caused by massive bleeding. Binge drinking is associated with increased risk of all types of stroke.

The review concludes, "Put simply, for the majority of those in a Western environment who control their drinking and its circumstances, up to one drink a day in women or one or two drinks a day in men appears to be associated with the greatest net health benefits and the lowest risk ... [T]his is also likely to be the case for hypertensives, with the rider that risks of alcohol-related stroke are likely to be greater with poorly controlled blood pressure, and alcohol should always be considered as a contributor to poor compliance or drug resistance in drinkers."

Finally, factors like smoking habits and unhealthy dietary patterns, in combination with a sedentary lifestyle, tend to be more associated with heavy drinking. By contrast, healthy-eating patterns, physical activity, and lower levels of smoking tend to be found more frequently in light to moderate drinkers. Although most studies attempt to adjust for some of these confounding factors, the adjustments are likely to be inadequate due to measurement errors. This makes studies on the long-term effects of alcohol consumption notoriously hard to conduct and often unreliable.

(Am. J. Hypertens., 2005, Vol. 18, No. 9, pp. 1161-1167; J. Hypertens., 2005, Vol. 23, No. 11, pp. 1947-1951; pp. 1953-1955)