Criqui M H
University of California, San Diego, Department of Family and Preventive Medicine, La Jolla 92093-0607, USA.
Novartis Found Symp. 1998;216:159-67; discussion 167-72. doi: 10.1002/9780470515549.ch10.
The association between alcohol intake and atherosclerotic cardiovascular disease (CVD) in epidemiological studies is consistent and shows some protection from CVD at consumption levels of one to two drinks per day, but a sharp increase in CVD associated with three or more drinks per day. Analyses of potential mediators of effects of alcohol on CVD show that it increases high density lipoprotein (HDL) cholesterol levels and favourably influences thrombotic factors, especially fibrinogen, and also fibrinolytic factors. Some evidence also suggests moderate alcohol consumption may reduce insulin resistance. However, studies also show an adverse effect of alcohol, particularly at higher doses, on blood pressure (leading to hypertension) and directly on the myocardium (leading to arrhythmias and myocardiopathy). Statistical modelling of the alcohol-CVD relationship is consistent in several studies, with a protective pathway via elevated HDL cholesterol and an adverse pathway through elevated blood pressure. Other possible mediators influenced by alcohol have not yet been examined in this type of analysis. The French Paradox has led to speculation that wine is the only protective alcoholic beverage for CVD, or at least that it has a stronger effect. Multiple non-ethanol components of wine have been studied in the laboratory and have been shown to have antioxidant or anticoagulant effects. Although wine does appear more protective in ecological studies, studies within cohorts show similar effects across alcoholic beverages, suggesting confounding in ecological studies by diet, lifestyle, or other variables. The key component of alcoholic beverages thus appears to be ethanol, consistent with the known potent effects of ethanol on HDL cholesterol and thrombotic factors. The upswing in CVD risk with three or more drinks per day is sharp and emphasizes that benefit from alcohol is limited to moderate consumption only. This upswing also cautions against any public health recommendation to drink alcohol, since many persons will not or cannot limit their intake to moderate levels.
流行病学研究中酒精摄入量与动脉粥样硬化性心血管疾病（CVD）之间的关联是一致的，且表明每天饮用一到两杯酒对心血管疾病有一定的保护作用，但每天饮用三杯或更多酒会使心血管疾病显著增加。对酒精影响心血管疾病的潜在中介因素的分析表明，它会提高高密度脂蛋白（HDL）胆固醇水平，并对血栓形成因素，尤其是纤维蛋白原以及纤溶因子产生有利影响。一些证据还表明，适度饮酒可能会降低胰岛素抵抗。然而，研究也表明，酒精，尤其是高剂量时，会对血压（导致高血压）以及直接对心肌（导致心律失常和心肌病）产生不良影响。酒精与心血管疾病关系的统计模型在多项研究中是一致的，存在通过升高HDL胆固醇的保护途径以及通过升高血压的不良途径。酒精影响的其他可能中介因素尚未在这类分析中进行研究。法国悖论引发了一种推测，即葡萄酒是唯一对心血管疾病有保护作用的酒精饮料，或者至少其作用更强。葡萄酒中的多种非乙醇成分已在实验室中进行了研究，并已证明具有抗氧化或抗凝作用。尽管在生态学研究中葡萄酒似乎更具保护作用，但队列研究表明，各种酒精饮料的效果相似，这表明生态学研究中存在饮食、生活方式或其他变量的混杂因素。因此，酒精饮料的关键成分似乎是乙醇，这与乙醇对HDL胆固醇和血栓形成因素的已知强效作用一致。每天饮用三杯或更多酒时心血管疾病风险的急剧上升强调，酒精的益处仅限于适度饮用。这种上升也告诫不要提出任何鼓励饮酒的公共卫生建议，因为许多人不会或无法将饮酒量限制在适度水平。
