An update on alcohol and atherosclerosis : Current Opinion in Lipidology (original) (raw)

Therapy and clinical trials

Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA

Correspondence to Kenneth J. Mukamal, MD, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA E-mail: [email protected]

Abbreviations

apo: apolipoprotein

CRP: C-reactive protein

HDL: high-density lipoprotein

HDL-C: high-density lipoprotein cholesterol

IMT: intima-media thickness

LDL: low-density lipoprotein

LDL-C: low-density lipoprotein cholesterol

Abstract

Purpose of review

Epidemiological studies consistently link moderate alcohol use with a lower risk of cardiovascular disease, but a number of important issues remain controversial. These include the putative impact of non-alcoholic constituents of some alcoholic beverages, the role of genetic factors, potential mechanisms for this association, and confirmation of the relationship in experimental models.

Recent findings

Although high-density lipoprotein cholesterol (HDL-C) is considered the primary mediator of the cardiovascular effects of moderate drinking, recent evidence has shown the alcohol-HDL-C relation is not linear beyond the range of moderate drinking. Moderate alcohol use also has important inverse relations with inflammatory factors. Some, but not all, animal models confirm the anti-atherogenic effects of ethanol and highlight inflammatory factors as one possible mechanism. The non-alcoholic constituents of red wine also have anti-atherogenic and perhaps even life-extending properties in vitro, but their relevance to humans remains uncertain. Genetic variants of the apolipoprotein E and interleukin 6 genes in humans may modify how alcohol influences atherosclerosis, further emphasizing the importance of HDL-C and inflammatory factors as mediators.

Summary

The robust relationship between moderate drinking and lower risk of cardiovascular disease remains an intriguing area of investigation. Clarifying potential gene-environment interactions and translational research into uses for non-alcoholic components will be important areas for future investigation.