Alcohol and cardiovascular disease: possible protection via effects on aortic stiffness.

A J-shaped relationship between alcohol consumption and mortality from coronary disease and ischaemic stroke has been described in many population studies [1,2] and has stimulated research into the possible mechanisms involved. The biggest single protective mechanism is likely to be mediated by increases in high-density lipoprotein (HDL)-cholesterol and associated apoprotein levels [3]. Other plausible mechanisms include effects on the clotting/coagulation systems with decreased platelet adhesiveness, decreased circulating fibrinogen and lipoprotein (a) levels and increased components of the fibrinolytic pathways [4,5]. More recently, decreases in C-reactive protein levels and other immune or inflammatory mediators have been described in both crosssectional population studies and randomized controlled trials [6–8]. Antioxidant activity in wine [9], and to a lesser extent in beer [10,11], has also been proposed to play a role in cardioprotection from alcoholic beverages, particularly by those investigating the so-called ‘French Paradox’. Beneficial effects of regular alcohol drinking on insulin sensitivity and the risk of diabetes have also been reported in some population studies [12–14], although obesity is a strong confounder, and the effects on glucose tolerance could not be confirmed in a randomized controlled trial involving a reduction of alcohol consumption in regular drinkers [15]. Countering these potentially beneficial mechanisms of alcohol are its long-term blood pressure-raising effects [16], its role as a powerful prooxidant, which may overwhelm any antioxidant effects of different beverage types in vivo [10], pro-arrhythmic actions and, with higher doses, pro-coagulant and anti-fibrinolytic effects, myocardial depressant activity and important hazards of binge drinking [17,18].