The French paradox: Possible involvement of ethanol in the protective effect against cardiovascular diseases

OBJECTIVES: This review surveyed the literature on the cardioprotective effects of moderate alcohol consumption. METHODS: The putative cardioprotective effects of alcohol and other substances in alcoholic beverages are discussed by taking "the French paradox" as a starting point. A survey of the literature highlighted various hypotheses explaining the protective effects of moderate alcohol consumption. RESULTS: The positive effects of moderate quantities of alcohol have been attributed in part to increased plasma levels of high-density lipoprotein, an inhibition of platelet aggregation, and improved endothelial function. Many investigators have claimed that wine is the significant factor explaining the French paradox. Red wine has been shown ex vivo to inhibit low-density lipoprotein oxidation, increase antioxidant capacity in humans, and reduce susceptibility of human plasma to lipid peroxidation. The non-alcoholic fraction of wine, represented mainly by phenolic compounds, may be the primary factor responsible for this protective effect. However, the protective effects are not restricted to a particular type of alcoholic drink, suggesting that alcohol per se rather than compounds specific to certain beverages reduces mortality risk. CONCLUSIONS: It is difficult to explain the effect of alcohol on risk factors associated with cardiovascular diseases by a uniform biochemical mechanism. Moreover, its protective effects are counterbalanced by its addictive properties.