Understanding the Mechanisms That Link Alcohol and Lower Risk of Coronary Heart Disease

[摘要] For more than 75 years, pathologists have recognized that alcohol consumption has a surprising link to atherosclerosis (1). In those early studies, postmortem examinations of deceased heavy drinkers identified less atherosclerosis than was expected from age and sex, suggesting that alcohol consumption is atheroprotective. In the ensuing 8 decades, investigators have made substantial strides in understanding this relationship, including confirmation of the strength and shape of the association of alcohol consumption with lower risk of coronary heart disease (CHD),2 its consistency across beverage types and in different populations, and its associations with various forms of cardiovascular disease.One of the most important aspects of the alcohol–CHD relationship that continues to draw interest is its underlying mechanism. There are a number of reasons for this interest. First, because no long-term randomized trial of alcohol consumption on CHD incidence or prognosis is likely anytime in the near future, the evidence base will continue to be largely observational, with all of the attendant limitations therein. Consequently, the presence of a plausible mechanism provides reassurance that the observed association is not the result of confounding by such factors as baseline health or socioeconomic status. Second, given the many difficulties with recommending alcohol intake, even in moderation, a better understanding of the mechanisms involved could lead to safer therapies that harness these same pathways to prevent CHD. Finally, because the relationships of alcohol consumption with candidate pathways can be readily tested in randomized trials, even when its relationship with CHD cannot, identification of key pathways helps to direct trialists to the best biomarkers and intermediate outcomes to test in short-term feeding studies. For all of these reasons, studies attempting to draw the full links between alcohol consumption, CHD, and the pathways that connect them remain important.Epidemiologists have taken 2 approaches to this challenge. …

[学科分类] 过敏症与临床免疫学