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10.2008

Massachusetts Beverage Business

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Article By: Harvey Finkel, MD

Much in the news media lately have been dire warnings about childhood obesity and high cholesterol, both significant risk factors for cardiovascular and other diseases that lead to early disability and death. We have known since the studies of soldiers during the Korean War that atherosclerosis, the disease process that eventuates in heart attacks and strokes, begins stealthily in early life.

So, is there any hope of correcting the course for those of us already too old for hip-hop?

Although impressive reduction of cardiovascular risk associated with moderate drinking has been amply and repeatedly confirmed, one may continue to have the report of a most interesting study.


Researchers at the Medical University of South Carolina in Charleston, reporting in the March, 2OO8 issue of the american journal of medicine (King DE, Mainous AG III, Geesey ME. Adopting Moderate Alcohol Consumption in Middle Age: Subsequent Cardiovascular Events. am j med 2OO8; 121: 2O1-2O6), found that people who began drinking moderately in middle age experienced prompt cardiovascular benefit.

The study involved 7697 men and women aged 45 to 64, without cardiovascular disease, who were nondrinkers. They were followed for ten years, particularly for initiation of drinking and for development of cardiovascular disease. Six percent of the group began moderate drinking, defined as 1 to 14 drinks per week for men, 1 to 7 for women. After adjustment for other risk factors, a reduction of 38 percent in cardiovascular disease occurred within four years of initiating drinking. These benefits were seen chiefly among those who drank predominantly wine (color unspecified). Moderate drinkers had modest improvement in HDL (“good”) cholesterol levels, but no increase in risk of hypertension.

The results for heavier drinkers (O.4 percent) were neither better nor worse than for the nondrinkers. The study is thought not to have gone on long enough to demonstrate differences in overall mortality or complications of excessive drinking. The authors, however, state, “People who newly begin consuming alcohol in middle age rarely do so beyond recommended amounts.”

Trying to figure out the relationship, if any, between drinking and breast cancer has caused investigators much heartburn. The results of many research studies over a number of years have been murky, confusing, even contradictory. You can find support for nearly any position you might care to take.  Without firm conviction, one might pay some attention to the data suggesting that modest drinking doesn’t, but more than that may, mildly increase risk, and to studies indicating that increased risk of breast cancer with drinking occurs only in women deficient in the vitamin folic acid. It should be kept in mind that breast cancer is a huge and frightening problem, but it should not be forgotten that many more women are disabled or die because of cardiovascular disease than breast cancer, so the established cardiovascular benefits of moderate drinking would, in general, trump any increased cancer risk. We hope one day to be able to accurately predict individual risk. One’s personal physician can make a stab at it now. Keeping consumption moderate helps us keep on the right side of the line.

With this preface, we can readily see why studies like the one I will review herein are helpful. From the Institut Universitaire de Recherche Clinique in Montpellier, France, we have a project examining “the association between drinking pattern of alcoholic beverages, particularly wine, and breast cancer.” Published in the June, 2OO8, issue of the annals of epidemiology (Bessaoud F, Daurès JP. Patterns of Alcohol [Especially Wine] Consumption and Breast Cancer Risk: A Case-Control Study Among a Population in Southern France. ann epidemiol 2OO8; 18: 467-475), it reports on 437 women with breast cancer and 922 matched controls.

Women averaging less than 1.5 drinks per day had more than a 4O percent risk reduction for breast cancer compared to nondrinkers. For women who drank more, risk increased, but not significantly. There were too few heavy drinkers to allow conclusions to be drawn about them. Wine drinkers fared better than consumers of aperitifs, beer or spirits. Drinking frequency did not influence risk. Some of the numerical results are confusingly presented. The authors speculate that there exists a threshold of consumption, particularly of wine, below which breast cancer risk decreases or is unaffected. They conclude that moderate drinking, particularly of wine, does not increase the risk of breast cancer. More studies are needed.

Surely the prostate gland is one of Nature’s poorest designs. Cancer of this organ is exceedingly common, and even more likely to be troublesome, because of its strategic location at the outlet of the urinary bladder. It is the noncancerous enlargement of the prostate (benign prostatic hypertrophy or BPH) that afflicts nearly all men, in middle age or more certainly later on. Trying to make sense of whether and which dietary factors might affect the risk of developing BPH, a research group in Seattle studied 18,88O men aged 55 or older for seven years to determine whether what they were ingesting (diet, supplements and alcohol) had any influence. The study was recently published in the american journal of epidemiology (Kristal AR, Arnold KB, Schenk JM, et al. Dietary Patterns, Supplement Use, and the Risk of Symptomatic Benign Prostatic Hyperplasia: Results from the Prostate Cancer Prevention Trial. am j epidemiol 2OO8; 167: 925-934).

Risk of BPH decreased as alcohol consumption increased (no limit was observed). Risk also decreased in association with a diet low in fat and red meat and high in protein and vegetables [drat]. Various antioxidant nutrient supplements were not beneficial. (Wine’s polyphenolic antioxidants were not tested.) The authors speculated without evidence that alcohol’s benefit was mediated by its reduction of testosterone.

Finally, let us glance at what Gronbaeck’s group in Copenhagen is learning (Flensborg-Madsen T, Knop J, Mortensen EL, et al. Beverage Preference and Risk of Alcohol-Use Disorders: A Danish Prospective Cohort Study. j stud alcohol drugs 2OO8; 69: 371-377). In studying 18,146 men and women over 26 years, they found that, irrespective of the weekly amount of alcohol consumed, the risk of medical disorders related to alcohol of female wine drinkers is one-eighth that of women who drink only beer and spirits. For men, the risk in wine drinkers is about one-fourth that of beer and spirit drinkers. The authors suspect that the most likely explanation for these intriguing differences may be “that lifestyle factors and personal characteristics are associated with beverage preference”.

So, we have been reassured that moderate drinking, particularly of wine, is good for the cardiovascular system, even if begun in middle age; can, in appropriate conditions, not only not increase, but reduce the risk of breast cancer; decreases the risk of distressing enlargement of the prostate; and that wine is associated with remarkably lesser risk for alcohol-related disorders compared to beer and spirits. All this seems good news for the mature folk among us, for the women, for the men, and for those who lean toward wine.

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