Cardiovascular protective effect of moderate wine consumption: Evidence after the French Paradox

The protective effect of moderate alcohol consumption on the risk of cardiovascular disease has been consistently shown in many epidemiological studies. Antiatherogenic alterations in plasma lipoproteins, particularly increase in high density lipoprotein (HDL) cholesterol, are considered as the most plausible mechanism of the protective effect of alcohol consumption on coronary artery disease (CHD). Other potential mechanisms contributing to the cardioprotective effect of moderate alcohol consumption include antithrombotic alterations of blood platelet function, as well as of the coagulation and fibrinolysis balance. Since early observations suggested that consuming alcohol in the form of wine might confer a protection against CHD above that expected from its alcohol content, the topic "wine and health" has become more and more popular. Many epidemiological studies have explored this possibility, by comparing specific alcoholic beverage types in respect to their relative capacity to reduce the risk of CHD. In parallel, experimental studies have been done, in which wine and wine-derived products have been tested for their capacity to interfere with molecular and cellular mechanisms relevant to the pathogenesis of CHD. Wine might indeed conceivably nave other non-ethanol related beneficial effects. The biological rationale for such a hypothesis has been linked to the enrichment in grape-derived, non-alcoholic components, that possibly make it peculiar in respect to other alcoholic beverages. In fact, while the mechanisms underlying the effects of alcohol on cardiovascular disease have oeen limited to lipid metabolism and the haemostatic system, those related to wine consumption have also been extended to specific antioxidant and vasorelaxant properties of its polyphenolic constituents. The purpose of this mini-review is to summarize: 1) the epidemiological studies reporting comparisons between wine and other alcoholic beverages and the relative risk of CHD; 2) the experimental and interventional studies with wine or wine-derived products aimed at finding biological explanations for the possible superior cardioprotective effects of wine consumption.