Alcohol and Coronary Heart Disease: Mechanisms of Action. M. Gaziano, Harvard Medical School, Boston, MA
The effects of alcohol consumption on cardiovascular disease are complex. While heavy alcohol increases total and cardiovascular disease mortality, moderate intake appears to exert a protective effect on coronary heart disease compared to nondrinking. The mechanisms by which moderate alcohol intake exerts this protective effect are now becoming better understood. Alcohol intake raises high density lipoprotein (HDL) cholesterol levels, and recent data strongly suggests that the observed protective effect is mediated by changes in total HDL as well as changes in HDL2 and HDL3 subtractions. While it is clear that changes in HDL are responsible for a large part of the protective effect of alcohol consumption, emerging data suggest that alcohol as well as other substances in alcoholic beverages may reduce the risk of cardiovascular disease by other mechanisms. These include platelet inhibition as well as alteration in fibrinogen, triglyceride, and Lp(a) levels. Various antioxidants found in wine may decrease risk of atherosclerotic disease by preventing oxidation of LDL.