Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1996 Mar 23;312(7033):731–736. doi: 10.1136/bmj.312.7033.731

Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits.

E B Rimm 1, A Klatsky 1, D Grobbee 1, M J Stampfer 1
PMCID: PMC2350477  PMID: 8605457

Abstract

OBJECTIVES: To review the effect of specific types of alcoholic drink on coronary risk. DESIGN: Systematic review of ecological, case-control, and cohort studies in which specific associations were available for consumption of beer, wine, and spirits and risk of coronary heart disease. SUBJECTS: 12 ecological, three case-control, and 10 separate prospective cohort studies. MAIN OUTCOME MEASURES: Alcohol consumption and relative risk of morbidity and mortality from coronary heart disease. RESULTS: Most ecological studies suggested that wine was more effective in reducing risk of mortality from heart disease than beer or spirits. Taken together, the three case-control studies did not suggest that one type of drink was more cardioprotective than the others. Of the 10 prospective cohort studies, four found a significant inverse association between risk of heart disease and moderate wine drinking, four found an association for beer, and four for spirits. CONCLUSIONS: Results from observational studies, where alcohol consumption can be linked directly to an individual's risk of coronary heart disease, provide strong evidence that all alcoholic drinks are linked with lower risk. Thus, a substantial portion of the benefit is from alcohol rather than other components of each type of drink.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Artaud-Wild S. M., Connor S. L., Sexton G., Connor W. E. Differences in coronary mortality can be explained by differences in cholesterol and saturated fat intakes in 40 countries but not in France and Finland. A paradox. Circulation. 1993 Dec;88(6):2771–2779. doi: 10.1161/01.cir.88.6.2771. [DOI] [PubMed] [Google Scholar]
  2. Barboriak J. J., Barboriak D. P., Anderson A. J., Hoffman R. G. Drinking patterns and preferences among heart patients. Curr Alcohol. 1981;8:293–299. [PubMed] [Google Scholar]
  3. Barnard M. J., Linter S. P. Wine and coronary heart disease. Lancet. 1992 Aug 1;340(8814):313–314. [PubMed] [Google Scholar]
  4. Barros D'Sa A. A. Twenty five years of vascular trauma in Northern Ireland. BMJ. 1995 Jan 7;310(6971):1–2. doi: 10.1136/bmj.310.6971.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Criqui M. H., Cowan L. D., Tyroler H. A., Bangdiwala S., Heiss G., Wallace R. B., Cohn R. Lipoproteins as mediators for the effects of alcohol consumption and cigarette smoking on cardiovascular mortality: results form the Lipid Research Clinics Follow-up Study. Am J Epidemiol. 1987 Oct;126(4):629–637. doi: 10.1093/oxfordjournals.aje.a114702. [DOI] [PubMed] [Google Scholar]
  6. Criqui M. H., Ringel B. L. Does diet or alcohol explain the French paradox? Lancet. 1994 Dec 24;344(8939-8940):1719–1723. doi: 10.1016/s0140-6736(94)92883-5. [DOI] [PubMed] [Google Scholar]
  7. Ducimetiere P., Guize L., Marciniak A., Milon H., Richard J., Rufat P. Arteriographically documented coronary artery disease and alcohol consumption in French men. The CORALI Study. Eur Heart J. 1993 Jun;14(6):727–733. doi: 10.1093/eurheartj/14.6.727. [DOI] [PubMed] [Google Scholar]
  8. Farchi G., Fidanza F., Mariotti S., Menotti A. Alcohol and mortality in the Italian rural cohorts of the Seven Countries Study. Int J Epidemiol. 1992 Feb;21(1):74–81. doi: 10.1093/ije/21.1.74. [DOI] [PubMed] [Google Scholar]
  9. Fitzpatrick D. F., Hirschfield S. L., Coffey R. G. Endothelium-dependent vasorelaxing activity of wine and other grape products. Am J Physiol. 1993 Aug;265(2 Pt 2):H774–H778. doi: 10.1152/ajpheart.1993.265.2.H774. [DOI] [PubMed] [Google Scholar]
  10. Friedman L. A., Kimball A. W. Coronary heart disease mortality and alcohol consumption in Framingham. Am J Epidemiol. 1986 Sep;124(3):481–489. doi: 10.1093/oxfordjournals.aje.a114418. [DOI] [PubMed] [Google Scholar]
  11. Gaziano J. M., Buring J. E., Breslow J. L., Goldhaber S. Z., Rosner B., VanDenburgh M., Willett W., Hennekens C. H. Moderate alcohol intake, increased levels of high-density lipoprotein and its subfractions, and decreased risk of myocardial infarction. N Engl J Med. 1993 Dec 16;329(25):1829–1834. doi: 10.1056/NEJM199312163292501. [DOI] [PubMed] [Google Scholar]
  12. Giovannucci E., Colditz G., Stampfer M. J., Rimm E. B., Litin L., Sampson L., Willett W. C. The assessment of alcohol consumption by a simple self-administered questionnaire. Am J Epidemiol. 1991 Apr 15;133(8):810–817. doi: 10.1093/oxfordjournals.aje.a115960. [DOI] [PubMed] [Google Scholar]
  13. Giovannucci E., Stampfer M. J., Colditz G. A., Manson J. E., Rosner B. A., Longnecker M., Speizer F. E., Willett W. C. A comparison of prospective and retrospective assessments of diet in the study of breast cancer. Am J Epidemiol. 1993 Mar 1;137(5):502–511. doi: 10.1093/oxfordjournals.aje.a116703. [DOI] [PubMed] [Google Scholar]
  14. Hennekens C. H., Willett W., Rosner B., Cole D. S., Mayrent S. L. Effects of beer, wine, and liquor in coronary deaths. JAMA. 1979 Nov 2;242(18):1973–1974. [PubMed] [Google Scholar]
  15. Hulley S. B., Gordon S. Alcohol and high-density lipoprotein cholesterol: causal inference from diverse study designs. Circulation. 1981 Sep;64(3 Pt 2):III–63. [PubMed] [Google Scholar]
  16. Idjradinata P., Pollitt E. Reversal of developmental delays in iron-deficient anaemic infants treated with iron. Lancet. 1993 Jan 2;341(8836):1–4. doi: 10.1016/0140-6736(93)92477-b. [DOI] [PubMed] [Google Scholar]
  17. Kagan A., Yano K., Rhoads G. G., McGee D. L. Alcohol and cardiovascular disease: the Hawaiian experience. Circulation. 1981 Sep;64(3 Pt 2):III–31. [PubMed] [Google Scholar]
  18. Kaufman D. W., Rosenberg L., Helmrich S. P., Shapiro S. Alcoholic beverages and myocardial infarction in young men. Am J Epidemiol. 1985 Apr;121(4):548–554. doi: 10.1093/oxfordjournals.aje.a114032. [DOI] [PubMed] [Google Scholar]
  19. Kittner S. J., Garcia-Palmieri M. R., Costas R., Jr, Cruz-Vidal M., Abbott R. D., Havlik R. J. Alcohol and coronary heart disease in Puerto Rico. Am J Epidemiol. 1983 May;117(5):538–550. doi: 10.1093/oxfordjournals.aje.a113576. [DOI] [PubMed] [Google Scholar]
  20. Klatsky A. L., Armstrong M. A. Alcoholic beverage choice and risk of coronary artery disease mortality: do red wine drinkers fare best? Am J Cardiol. 1993 Feb 15;71(5):467–469. doi: 10.1016/0002-9149(93)90460-t. [DOI] [PubMed] [Google Scholar]
  21. Klatsky A. L., Armstrong M. A., Friedman G. D. Alcohol and mortality. Ann Intern Med. 1992 Oct 15;117(8):646–654. doi: 10.7326/0003-4819-117-8-646. [DOI] [PubMed] [Google Scholar]
  22. Klatsky A. L., Armstrong M. A., Friedman G. D. Relations of alcoholic beverage use to subsequent coronary artery disease hospitalization. Am J Cardiol. 1986 Oct 1;58(9):710–714. doi: 10.1016/0002-9149(86)90342-5. [DOI] [PubMed] [Google Scholar]
  23. Klatsky A. L., Armstrong M. A., Friedman G. D. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. Am J Cardiol. 1990 Nov 15;66(17):1237–1242. doi: 10.1016/0002-9149(90)91107-h. [DOI] [PubMed] [Google Scholar]
  24. Klatsky A. L., Armstrong M. A., Kipp H. Correlates of alcoholic beverage preference: traits of persons who choose wine, liquor or beer. Br J Addict. 1990 Oct;85(10):1279–1289. doi: 10.1111/j.1360-0443.1990.tb01604.x. [DOI] [PubMed] [Google Scholar]
  25. Kozararevic D., McGee D., Vojvodic N., Racic Z., Dawber T., Gordon T., Zukel W. Frequency of alcohol consumption and morbidity and mortality: The Yugoslavia Cardiovascular Disease Study. Lancet. 1980 Mar 22;1(8169):613–616. doi: 10.1016/s0140-6736(80)91116-2. [DOI] [PubMed] [Google Scholar]
  26. LaPorte R. E., Cauley J. A. Wine, age, and coronary heart disease. Lancet. 1981 Jan 10;1(8211):105–105. doi: 10.1016/s0140-6736(81)90044-1. [DOI] [PubMed] [Google Scholar]
  27. LaPorte R. E., Cresanta J. L., Kuller L. H. The relationship of alcohol consumption to atherosclerotic heart disease. Prev Med. 1980 Jan;9(1):22–40. doi: 10.1016/0091-7435(80)90057-2. [DOI] [PubMed] [Google Scholar]
  28. Langer R. D., Criqui M. H., Reed D. M. Lipoproteins and blood pressure as biological pathways for effect of moderate alcohol consumption on coronary heart disease. Circulation. 1992 Mar;85(3):910–915. doi: 10.1161/01.cir.85.3.910. [DOI] [PubMed] [Google Scholar]
  29. Maclure M. Demonstration of deductive meta-analysis: ethanol intake and risk of myocardial infarction. Epidemiol Rev. 1993;15(2):328–351. doi: 10.1093/oxfordjournals.epirev.a036124. [DOI] [PubMed] [Google Scholar]
  30. Manson J. E., Tosteson H., Ridker P. M., Satterfield S., Hebert P., O'Connor G. T., Buring J. E., Hennekens C. H. The primary prevention of myocardial infarction. N Engl J Med. 1992 May 21;326(21):1406–1416. doi: 10.1056/NEJM199205213262107. [DOI] [PubMed] [Google Scholar]
  31. Maxwell S., Cruickshank A., Thorpe G. Red wine and antioxidant activity in serum. Lancet. 1994 Jul 16;344(8916):193–194. doi: 10.1016/s0140-6736(94)92795-2. [DOI] [PubMed] [Google Scholar]
  32. Monro J., Brostoff J., Carini C., Zilkha K. Food allergy in migraine. Study of dietary exclusion and RAST. Lancet. 1980 Jul 5;2(8184):1–4. doi: 10.1016/s0140-6736(80)92887-1. [DOI] [PubMed] [Google Scholar]
  33. Moore R. D., Pearson T. A. Moderate alcohol consumption and coronary artery disease. A review. Medicine (Baltimore) 1986 Jul;65(4):242–267. doi: 10.1097/00005792-198607000-00004. [DOI] [PubMed] [Google Scholar]
  34. Nanji A. A. Alcohol and ischemic heart disease: wine, beer or both? Int J Cardiol. 1985 Aug;8(4):487–489. doi: 10.1016/0167-5273(85)90126-3. [DOI] [PubMed] [Google Scholar]
  35. Nanji A. A., French S. W. Alcoholic beverages and coronary heart disease. Atherosclerosis. 1986 May;60(2):197–198. doi: 10.1016/0021-9150(86)90011-0. [DOI] [PubMed] [Google Scholar]
  36. Renaud S. C., Beswick A. D., Fehily A. M., Sharp D. S., Elwood P. C. Alcohol and platelet aggregation: the Caerphilly Prospective Heart Disease Study. Am J Clin Nutr. 1992 May;55(5):1012–1017. doi: 10.1093/ajcn/55.5.1012. [DOI] [PubMed] [Google Scholar]
  37. Renaud S., de Lorgeril M. Wine, alcohol, platelets, and the French paradox for coronary heart disease. Lancet. 1992 Jun 20;339(8808):1523–1526. doi: 10.1016/0140-6736(92)91277-f. [DOI] [PubMed] [Google Scholar]
  38. Ridker P. M., Vaughan D. E., Stampfer M. J., Glynn R. J., Hennekens C. H. Association of moderate alcohol consumption and plasma concentration of endogenous tissue-type plasminogen activator. JAMA. 1994 Sep 28;272(12):929–933. doi: 10.1001/jama.1994.03520120039028. [DOI] [PubMed] [Google Scholar]
  39. Rimm E. B., Giovannucci E. L., Willett W. C., Colditz G. A., Ascherio A., Rosner B., Stampfer M. J. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet. 1991 Aug 24;338(8765):464–468. doi: 10.1016/0140-6736(91)90542-w. [DOI] [PubMed] [Google Scholar]
  40. Rosenberg L., Slone D., Shapiro S., Kaufman D. W., Miettinen O. S., Stolley P. D. Alcoholic beverages and myocardial infarction in young women. Am J Public Health. 1981 Jan;71(1):82–85. doi: 10.2105/ajph.71.1.82. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Salonen J. T., Puska P., Nissinen A. Intake of spirits and beer and risk of myocardial infarction and death--a longitudinal study in Eastern Finland. J Chronic Dis. 1983;36(7):533–543. doi: 10.1016/0021-9681(83)90131-5. [DOI] [PubMed] [Google Scholar]
  42. Schmidt W., Popham R. E. Alcohol consumption and ischemic heart disease: some evidence from population studies. Br J Addict. 1981 Dec;76(4):407–417. doi: 10.1111/j.1360-0443.1981.tb03239.x. [DOI] [PubMed] [Google Scholar]
  43. Segall J. J. Wine and coronary heart disease. Lancet. 1992 Aug 1;340(8814):313–313. [PubMed] [Google Scholar]
  44. St Leger A. S., Cochrane A. L., Moore F. Factors associated with cardiac mortality in developed countries with particular reference to the consumption of wine. Lancet. 1979 May 12;1(8124):1017–1020. doi: 10.1016/s0140-6736(79)92765-x. [DOI] [PubMed] [Google Scholar]
  45. Stampfer M. J., Colditz G. A., Willett W. C., Speizer F. E., Hennekens C. H. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N Engl J Med. 1988 Aug 4;319(5):267–273. doi: 10.1056/NEJM198808043190503. [DOI] [PubMed] [Google Scholar]
  46. Stampfer M. J., Rimm E. B., Walsh D. C. Commentary: alcohol, the heart, and public policy. Am J Public Health. 1993 Jun;83(6):801–804. doi: 10.2105/ajph.83.6.801. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Stampfer M. J., Sacks F. M., Salvini S., Willett W. C., Hennekens C. H. A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction. N Engl J Med. 1991 Aug 8;325(6):373–381. doi: 10.1056/NEJM199108083250601. [DOI] [PubMed] [Google Scholar]
  48. Suh I., Shaten B. J., Cutler J. A., Kuller L. H. Alcohol use and mortality from coronary heart disease: the role of high-density lipoprotein cholesterol. The Multiple Risk Factor Intervention Trial Research Group. Ann Intern Med. 1992 Jun 1;116(11):881–887. doi: 10.7326/0003-4819-116-11-881. [DOI] [PubMed] [Google Scholar]
  49. Thornton J., Symes C., Heaton K. Moderate alcohol intake reduces bile cholesterol saturation and raises HDL cholesterol. Lancet. 1983 Oct 8;2(8354):819–822. doi: 10.1016/s0140-6736(83)90738-9. [DOI] [PubMed] [Google Scholar]
  50. Wiebers D. O., Adams H. P., Jr, Whisnant J. P. Animal models of stroke: are they relevant to human disease? Stroke. 1990 Jan;21(1):1–3. doi: 10.1161/01.str.21.1.1. [DOI] [PubMed] [Google Scholar]
  51. Willett W. C., Green A., Stampfer M. J., Speizer F. E., Colditz G. A., Rosner B., Monson R. R., Stason W., Hennekens C. H. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med. 1987 Nov 19;317(21):1303–1309. doi: 10.1056/NEJM198711193172102. [DOI] [PubMed] [Google Scholar]
  52. Yano K., Rhoads G. G., Kagan A. Coffee, alcohol and risk of coronary heart disease among Japanese men living in Hawaii. N Engl J Med. 1977 Aug 25;297(8):405–409. doi: 10.1056/NEJM197708252970801. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES