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More than 30 years’ research have emphasised that lifestyle, exercise, diet and weight reduction are by far the most effective strategies to cut the risk of coronary heart disease (CHD). Alcohol consumption, as a protective habit, has attracted considerable attention. Meta-analyses have demonstrated consistently both protection from CHD and reductions in total mortality.1 2 In fact, moderate alcohol drinkers with a healthy diet who are not overweight have a reduced incidence of myocardial infarction compared with those with similar habits who abstain from alcohol.3 Regular moderate drinking of alcohol after acute myocardial infarction affords at least a similar level of protection from further events as drug treatment, and has also proved beneficial after coronary stenting.4–6
Wine has often been the preferred drink for those showing the greatest degree of protection, yet controversy has raged as to whether the benefits are from alcohol alone, or from other constituents of wine. Regular alcohol drinking augments high-density lipoprotein cholesterol and can increase insulin sensitivity or reduce diabetes, which both provide a degree of protection from CHD.7–9 Although the biggest focus has been on CHD, other atherothrombotic conditions merit consideration. For instance, red wine consumption reduced the incidence of ischaemic stroke when white wine and other alcoholic drinks did not provide any protection,10 which supports the opinion that red wine has greater anti-atherosclerotic or antithrombotic actions than alcohol alone because it contains a variety of polyphenols with their own profile of protective properties. The emerging theme from recent investigations of red wine polyphenols is the close similarity to the actions of dark chocolate or cocoa.
The beneficial effects of polyphenols, including those from red wine and cocoa, have often been attributed to their antioxidant actions. But the general conclusion from studies over the past few …