Alcohol and the Vascular System

Abstract

There is a hypothesis that alcohol has a "cardioprotective" role (1). What is the hard evidence behind this belief? When distilled alcohol was first produced in the 13th century by Arnold of Villa Nova and Raimundus Lullus, it was called "aqua vitae ardens" and prescribed in small quantities as a medicament, particularly against contagious diseases. Similarly, when acetylsalicylic acid is nowadays used continuously for preventing vascular thrombi, only small amounts, in the order of 0.25-0.5 g or less each other day, may in fact be favourable, whereas slightly higher doses might have an opposite effect. If cardiovascularly favourable influences of alcohol are also pharmacological, they should be exerted within a corresponding concentration range as well. One finds that the whole problem of the finer and more detailed therapeutical effects of alcohol simply has not been approached; at least not with the standards of scientific medicine. The daily alcohol exposure involved in adult lifelong socially acceptable consumption may presently in many countries come close to 70 g. In this perspective, an alcohol intake of 40-20 g per day is considered to be moderate or low, and this is far beyond the doses which with all other agents ascribed specific preventive or curative properties can be regarded as strictly pharmacodynamical or pharmacological.Alcohol has not been tested and evaluated as a drug should be today. The data that really are available are statistical observations on various diagnoses in relation to nonpharmacological ranges of alcohol consumption or short-term experiments with intoxicating concentrations. These may well allow some conclusions concerning alcohol damage but hardly concerning the precise benefits of alcohol. From an epidemiological point of view it seems more probable that the low to moderate social drinking levels which are now loosely described as cardioprotective or by and large positive to health are instead the least damaging ones. They are as a rule contrasted, not with the continuum of higher intake, but with alcohol abstention (1, 2). However, alcohol abstention is infrequent and is not a uniform category, because several non-drinkers have quit due to some illness, which is thus the cause and not the result of their abstention (2). When taking such ecological fallacies and confounding factors into account, the evidence points at an aggressive rather than a protective net influence of alcohol on the cardiovascular system. MATERIAL AND METHODSWe have been studying some of the above questions in the ongoing preventive medical population programme in Malmo (3) since 1975. Whole birth-year cohorts of Malmo residents have been invited to a comprehensive health examination including several physiological and biochemical measurements and an extensive questionnaire, incorporating questions on demographic features, family history, present symptoms and medication, social and psychological data, tobacco consumption (41, alcohol abstention (2), and a modified Michigan Alcoholism Screening Test (Mm-...