Published online before print May 13, 2002, doi: 10.1161/01.CIR.0000018653.19696.01
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(Circulation. 2002;105:2836.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Meta-Analysis of Wine and Beer Consumption in Relation to Vascular Risk
From the Department of Vascular Medicine and Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy, and the Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Italy (G.d.G.). Dr Donati is presently affiliated with the Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Italy.
Correspondence to Licia Iacoviello, Consorzio Mario Negri Sud, Via Nazionale 66030, Santa Maria Imbaro, Italy. E-mail iaco{at}cmns.mnegri.it
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Abstract |
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Background— Many epidemiological studies have evaluated whether different alcoholic beverages protect against cardiovascular disease. We performed a meta-analysis of 26 studies on the relationship between wine or beer consumption and vascular risk.
Methods and Results— General variance-based method and fitting models were applied to pooled data derived from 26 studies that gave a quantitative estimation of the vascular risk associated with either beverage consumption. From 13 studies involving 209 418 persons, the relative risk of vascular disease associated with wine intake was 0.68 (95% confidence interval, 0.59 to 0.77) relative to nondrinkers. There was strong evidence from 10 studies involving 176 042 persons to support a J-shaped relationship between different amounts of wine intake and vascular risk. A statistically significant inverse association was found up to a daily intake of 150 mL of wine. The overall relative risk of moderate beer consumption, which was measured in 15 studies involving 208 036 persons, was 0.78 (95% confidence interval, 0.70 to 0.86). However, no significant relationship between different amounts of beer intake and vascular risk was found after meta-analyzing 7 studies involving 136 382 persons.
Conclusions— These findings show evidence of a significant inverse association between light-to-moderate wine consumption and vascular risk. A similar, although smaller association was also apparent in beer consumption studies. The latter finding, however, is difficult to interpret because no meaningful relationship could be found between different amounts of beer intake and vascular risk.
Key Words: cardiovascular diseases • wine • beer • meta-analysis
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Introduction |
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An inverse association between moderate alcohol consumption and vascular risk has been shown in many epidemiological studies.1–6 All-cause mortality as a function of alcohol use has been depicted as a J-shaped curve,6–8 reflecting a lower risk of coronary heart disease (CHD) at moderate consumption and an increased risk of certain cancers and cirrhosis at higher amounts.1,6–9 After wine intake was suggested as a possible explanation for the lower than expected CHD mortality rates in France,10 many studies have dealt with the question of whether different alcoholic beverages are equivalent in their ability to protect against CHD or if a specific beverage might offer a greater protection, 2–4 but data are inconclusive.1,3,11,12 A recent advisory from the American Heart Association13 concluded that the usual standards to recommend alcohol consumption as a CHD prevention approach are not met and that wine is indistinguishable from other types of alcoholic beverages. These conclusions have been challenged.14–16
See p 2806
We did a systematic review of the literature and a meta-analysis of selected studies to evaluate the relationship between wine and beer consumption and vascular risk. We also tried to give a quantitative estimate of this relationship.
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Methods |
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Search Strategy
First, a PUBMED search (http://www4.ncbi.nlm.nih.gov/PubMed) together with an assessment of the references of published studies was conducted until September 2001 to identify studies evaluating the relationship between alcohol consumption and vascular risk. More than 80 publications were identified. Next, publications reporting risks specific for wine and/or beer intake were selected, and 30 studies were identified.17–46 Some were multiple reports from the same cohort.20,43,44 One study46 was excluded because neither confidence intervals (CIs) nor precise probability values were reported. A total of 26 reports were identified for the meta-analysis. Two separate meta-analyses were conducted: the first used the 23 studies reporting data for wine,17–31,34–41 and the second used the 22 studies reporting data for beer.17–27,30–39,42 Finally, the studies were divided into 2 groups. The first group included studies that considered only a category of risk (drinkers versus nondrinkers), and the second was formed by studies that reported "trend" analyses of risk, ie, that considered more than one category of wine (beer) intake ("dose-response" meta-analysis).
Data Extraction
Some studies17,20,29,31,32,34,39,40 had not taken the intake of different types of alcoholic beverages into account (type A), whereas in others (type B) the bias of combined drinking of different alcoholic beverages in the same population was either formally excluded using drinkers of only a specific type of beverages21–25,27,41,42 or was taken into account in multivariate analyses of risk.18,19,26,28,30,33,35–37 In studies reporting more than one clinical end point, results on combined (fatal and nonfatal) events and on CHD with respect to other vascular events were used. Relative risks were extracted as a measure of the relation between vascular events and wine or beer consumption (whatever the amount consumed in drinkers versus nondrinkers meta-analysis and for each specific consumption category in the dose-response meta-analysis). Whenever possible, the amount of a "drink" (mL/d) was taken as quantified by each author (as it occurred in all beer studies); otherwise, to allow meaningful comparisons among different categorizations of wine intake, a "drink" was considered equivalent to 130 mL of wine. If not otherwise reported in the study, it was assumed that wine contains 12% and beer 6% ethanol. Other sources of heterogeneity in the methodological quality of the studies were taken into account by performing sensitivity analysis,47,48 and prespecified subgroups were considered according to type of cohort or event in case group, sex, adjustment for different types of alcoholic beverages or for indicators of social class level, presence of ex-drinkers or light drinkers in the reference group, and use of the same reference group for both wine and beer.
Statistical Analyses
In the drinkers versus nondrinkers meta-analysis, data were combined using the general variance-based method49 that requires information on the relative risks (RR) or odds ratios estimate and their 95% CIs for each study. When no CIs were presented, they were calculated by transforming probability values (2 studies).17,34 The 95% CIs were used to assess the variance and the relative weight of each study. Adjusted RR, when available, was preferred. Publication bias was tested using funnel plot asymmetry.50 Results from subgroup analyses were reported with 99% CI to account for multiple comparisons. Data from studies reporting trend analysis were pooled with a weighted, least-squares regression model.51 In this method, the natural logarithm of the adjusted RR of vascular disease was regressed as a function of beverage intake. Midpoints of consumption categories were used for calculations. For open-ended, high-intake categories, the midpoint of the category was estimated to be 20% greater than the lower boundary specified by the original investigators.51 Study effect was modeled with indicator variables. This approach may be extended to fit a J-shaped trend, including linear and quadratic terms. The full model is as follows: log (RR)=
ixstudyi+ß1x(beverage dose)+ß2x(square of beverage dose)+error. Statistical analyses were performed using the SAS package (version 8.2 for Windows).52
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Results |
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Wine
Drinkers Versus Nondrinkers Meta-Analysis
Thirteen studies on the association between wine intake and vascular risk (11 on CHD and 2 on cerebrovascular disease [CVD]) involved 201 308 persons (Table 1). Overall RR of drinkers with respect to nondrinkers was 0.68 (95% CI, 0.59 to 0.77; Figure 1). No heterogeneity was observed (P=0.10). Similar findings were obtained in prospective or case-control studies. Test for sample-size bias failed to show a funnel plot asymmetry (P=0.56). An extensive sensitivity analysis was performed (Table 2). The inverse association of wine with vascular risk remained statistically significant in pooling studies where either CHD or CVD were the only events considered or that separately considered either nonfatal vascular events or cardiovascular mortality. The RR of wine drinkers was also significantly reduced in studies that formally excluded ex-drinkers17,20,21,22,23 or "light or occasional" drinkers18,19,22–29 from the reference group or that had adjusted for different types of alcoholic beverages or for indicators of social class level19–27,29 or compared both wine and beer drinking groups with the same reference group.18–20,22–27 Six studies17,19,20,21,28,29 were conducted on men only, and meta-analysis showed a RR of 0.87 compared with a RR of 0.53 in a pool of the other studies that were conducted on both sexes.
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Dose-Response Meta-Analysis
Ten studies reported trend analysis of the association between different categories of wine intake and vascular risk (7 on CHD and 3 on CVD) involving 176 042 persons (Table 3). Dose-response curves (RRs at different amounts of wine intake) for each study are reported in Figure 2. The best fitting model includes a linear and a quadratic term and was used to construct an average dose-response curve. The complex relationship found was interpreted as a J-shaped curve because, after an initial progressive decrease in the vascular risk by increasing amounts of wine, the curve reaches a plateau at higher intake and tends to revert at the highest amounts explored. When only the 7 prospective studies were considered, the fitting of the quadratic model considerably improved, and this was used to construct the average dose-response curve in Figure 3. A maximum reduction was predicted at 750 mL/day, but statistical significance was only reached up to the amount of 150 mL/day. In subgroup analysis, studies considering CHD or CVD or cardiovascular mortality as separate end points showed similar J-shaped curves that did not reach statistical significance.
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Beer
Drinkers Versus Nondrinkers Meta-Analysis
Fifteen studies on the association between beer intake and vascular risk (13 on CHD and 2 on CVD) involved 208 096 persons (Table 1). Overall RR reduction in favor of beer drinkers was 0.78 (95% CI, 0.70 to 0.86; Figure 4). No heterogeneity (P=0.82) or funnel plot asymmetry (P=0.90) was observed. Similar results were observed in prospective and case-control studies and when studies in which CHD or nonfatal vascular events were considered separately. Significant results were also obtained by pooling studies that had adjusted for different types of alcoholic beverages or for indicators of social class or excluded ex-drinkers17,20,21,22,23 or light or occasional drinkers18,19,22–27,30–32 from the reference groups. The RR of beer drinkers was lower in the studies that included both sexes than in those with only men; both results were statistically significant.
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Dose-Response Meta-Analysis
Seven studies reported trend analysis of the association between different categories of beer intake and vascular risk (5 on CHD and 2 on CVD); they involved 136 382 persons (Table 3). Dose-response curves for each study are reported in Figure 5. Both a linear and a quadratic model failed to show any significant relationship between different amounts of beer intake and vascular risk (Figure 5) when considering either all studies or subgroups. The apparent continuously decreasing risk with increasing beer consumption was not statistically significant at any amount of beer, eg, at 750 mL of daily beer intake, the predicted reduction of risk was 0.87 (95% CI, 0.57 to 1.33).
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Discussion |
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Epidemiological studies have suggested that mortality and CHD are lower for people who drink low-to-moderate amounts of alcohol than for those who do not drink or who drink heavily.1–11,53 Evidence obtained from this meta-analysis indicates an average significant reduction of 32% of overall vascular risk associated with drinking wine. Not only were nonfatal vascular end points significantly reduced in wine drinkers, but so was cardiovascular mortality. In studies with only men, the protection offered by wine was surprisingly small (13%) and not significant, in contrast with studies enrolling both sexes (47%). Whether women are more susceptible to the benefit of wine or if they are more likely to drink lower amounts, thus taking its maximal advantage,1,51,54 remains to be established. In relation to the reported association between moderate alcohol consumption and increased risk of breast cancer,51 our finding suggests that the overall effect of moderate wine intake on women’s health may actually be favorable. In agreement with the relation between alcohol intake and all-cause mortality previously reported,3,6–9 we observed a J-shaped relationship between wine intake and vascular risk suggesting that light-to-moderate wine drinkers have lower vascular risk than either heavier drinkers or nondrinkers.
Beer drinking was also associated with a reduced risk of vascular events, although at an extent lower than that observed with wine. A significant inverse association was still apparent when only CHD was considered but, unlike with wine, it did not reach statistical significance when CVD events or cardiovascular mortality were separately evaluated, likely due to the small number of available studies. Risk reduction connected with beer drinking was smaller but, unlike wine, still significant in studies in which only men were included. This suggests that women might be particularly responsive to alcohol itself rather than to the nonalcoholic components11 of these beverages. The most important difference between wine and beer consumption was observed in the meta-analysis of studies reporting trend analysis. In contrast with wine, the fitted models failed to show any significant relationship between different amounts of beer intake and vascular risk, even when different subgroups were analyzed. Thus, the inverse association between beer consumption and vascular risk observed in the drinkers versus nondrinkers meta-analysis should be interpreted with caution.
Strength and Potential Limitations of This Meta-Analysis
The results of any meta-analysis, especially in nonexperimental epidemiology, may be invalid due to publication bias or confounding effect.1 This was not the case here, because no sample size bias could be shown by funnel plot, nor were the results affected by any of the adjustments considered. Self-reported wine or beer consumption is thought to be inaccurate. Underreporting on wine or beer drinkers would, however, result in a tendency for RRs to be biased toward the null hypothesis, whereas our meta-analysis showed significant associations. Errors in reporting beer intake might have contributed to our failure to draw any statistically significant dose-response curve from studies on this beverage.
Irregular (binge) drinkers may be frequent in cohorts of beer drinkers and might have obscured a possible dose-dependent risk reduction in regular beer drinkers. The choice of nondrinkers as a reference group has been questioned because this group may include ex-drinkers who have quit because of health problems.1,3,7,20 We performed a subanalysis restricted to studies that excluded either ex-drinkers or very light or occasional drinkers from the reference group, but the estimated overall risk still seemed to be significantly reduced. The relative 10% overall difference between the RR of wine versus beer drinkers was unchanged in studies that assessed both wine and beer drinking versus the same reference group. However, the potential confounding effect of the combined drinking of different types of alcoholic beverages in the same population was excluded by pooling data from studies that had taken this issue into consideration. Uncontrolled confounding by other known risk factors can also be reasonably excluded because the great majority of studies were adjusted for these variables; in particular, the overall results were confirmed by analyzing subgroups from studies that also adjusted for indicators of social class.
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Conclusions |
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Association does not prove cause and effect, but the presence of a dose-response relation in wine meta-analysis, although of a complex, J-shaped type, is of importance.1,51 Definite proof could only be obtained by large long-term intervention trials. Such trials seem to be unfeasible for several reasons, including ethical concerns. The evidence for the benefit connected with wine consumption should, therefore, critically include molecular and cell biology studies, animal and observational epidemiological studies, and their meta-analyses.53,55 On this basis, what should cardiologists advice their patients regarding wine or beer consumption?13–16,53 First, patients and their relatives should be informed of what lifestyle changes might be beneficial to them. Besides insisting on the control of risk factors, abstainers should be informed that in the absence of contraindications and in the context of healthy eating and lifestyle, low-to-moderate wine consumption may contribute to better health. People who are already regular light-to-moderate wine consumers should be encouraged to continue. The hazards of excess drinking should always be highlighted, and heavy drinkers should be pushed to cut their consumption to a moderate level.
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Acknowledgments |
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This work was partially supported by the EU project FAIR-CT973261 and the Abruzzo Region (Programma Operativo Multiregionale "Sviluppo Locale Patti Territoriali per l’Occupazione," Progetto 1, Sottoprogramma 9, Misura 3, Azione 3.4).
Received February 11, 2002; revision received April 3, 2002; accepted April 4, 2002.
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References |
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1. Maclure M. Demonstration of deductive meta-analysis: ethanol intake and risk of myocardial infarction. Epidemiol Rev. 1993; 15: 328–351.
2.
Rimm EB, Klatsky A, Grobbee D, et al. Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits. BMJ. 1996; 312: 731–736.
3. Cleophas TJ. Wine, beer and spirits and the risk of myocardial infarction: a systematic review. Biomed Pharmacother. 1999; 53: 417–423.[CrossRef][Medline] [Order article via Infotrieve]
4. Constant J, Alcohol, ischemic heart disease, and the French paradox. Coron Artery Dis. 1997; 8: 645–649.[Medline] [Order article via Infotrieve]
5.
Marmot MG. Alcohol and coronary heart disease. Int J Epidemiol. 2001; 30: 724–729.
6.
Doll R, Peto R, Hall E, et al. Mortality in relation to consumption of alcohol: 13 years’ observations on male British doctors. BMJ. 1994; 309: 911–918.
7. Corrao G, Bagnardi V, Zambon A, et al. Exploring the dose-response relationship between alcohol consumption and the risk of several alcohol-related conditions: a meta-analysis. Addiction. 1999; 94: 1551–1573.[CrossRef][Medline] [Order article via Infotrieve]
8. La Vecchia C. Alcohol in the Mediterranean diet: assessing risks and benefits. Eur J Cancer Prev. 1995; 4: 3–5.[Medline] [Order article via Infotrieve]
9. Renaud SC, Gueguen R, Schenker J, et al. Alcohol and mortality in middle-aged men from eastern France. Epidemiology. 1998; 9: 184–188.[CrossRef][Medline] [Order article via Infotrieve]
10. Renaud S, De Lorgeril M, Wine, alcohol, platelets, and the French paradox for coronary heart disease. Lancet. 1992; 339: 1523–1526.[CrossRef][Medline] [Order article via Infotrieve]
11. Rotondo S, de Gaetano G. Protection from cardiovascular disease by wine and its derived products: epidemiological evidence and biological mechanisms. World Rev Nutr Diet. 2000; 87: 90–113.[Medline] [Order article via Infotrieve]
12. Klatsky AL, Armstrong MA. Alcoholic beverage choice and risk of coronary artery disease mortality: do red wine drinkers fare best? Am J Cardiol. 1993; 71: 467–469.[CrossRef][Medline] [Order article via Infotrieve]
13.
Goldberg IJ, Mosca L, Piano MR, et al. AHA Science Advisory: wine and your heart: a science advisory for healthcare professionals from the Nutrition Committee, Council on Epidemiology and Prevention, and Council on Cardiovascular Nursing of the American Heart Association. Circulation. 2001; 103: 472–475.
14. Ellison RC. AHA Science Advisory on wine and health: a confusing message about alcohol consumption. Circulation. 2001; 104: E72.
15. Peele S. American Heart Association advisory, "wine and your heart," is not science-based. Circulation. 2001; 104: E73.
16.
Klatsky A. Could abstinence from alcohol be hazardous to your health? Int J Epidemiol. 2001; 30: 739–742.
17. Kozararevic D, McGee D, Vojvodic N, et al. Frequency of alcohol consumption and morbidity and mortality: the Yugoslavia Cardiovascular Disease Study. Lancet. 1980; 1: 613–616.[CrossRef][Medline] [Order article via Infotrieve]
18.
Friedman LA, Kimball AW. Coronary heart disease mortality and alcohol consumption in Framingham. Am J Epidemiol. 1986; 124: 481–489.
19. Rimm EB, Giovannucci EL, Willett WC, et al. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet. 1991; 338: 464–468.[CrossRef][Medline] [Order article via Infotrieve]
20. Klatsky AL, Armstrong MA, Friedman GD. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. Am J Cardiol. 1990; 66: 1237–1242.[CrossRef][Medline] [Order article via Infotrieve]
21.
Wannamethee SG, Shaper AG. Type of alcoholic drink and risk of major coronary heart disease events and all-cause mortality. Am J Public Health. 1999; 89: 85–90.
22.
Rosenberg L, Slone D, Shapiro S, et al. Alcoholic beverages and myocardial infarction in young women. Am J Public Health. 1981; 71: 82–85.
23.
Kaufman DW, Rosenberg L, Helmrich SP, et al. Alcoholic beverages and myocardial infarction in young men. Am J Epidemiol. 1985; 121: 548–554.
24.
Sacco RL, Elkind M, Boden-Albala B, et al. The protective effect of moderate alcohol consumption on ischemic stroke. JAMA. 1999; 281: 53–60.
25. Gaziano JM, Hennekens CH, Godfried SL, et al. Type of alcoholic beverage and risk of myocardial infarction. Am J Cardiol. 1999; 83: 52–57.[CrossRef][Medline] [Order article via Infotrieve]
26. Thrift AG, Donnan GA, McNeil JJ. Heavy drinking, but not moderate or intermediate drinking, increases the risk of intracerebral hemorrhage. Epidemiology. 1999; 10: 307–312.[CrossRef][Medline] [Order article via Infotrieve]
27. Brenner H, Rothenbacher D, Bode G, et al. Coronary heart disease risk reduction in a predominantly beer-drinking population. Epidemiology. 2001; 12: 390–395.[CrossRef][Medline] [Order article via Infotrieve]
28.
Marques-Vidal P, Ducimetiere P, Evans A, et al. Alcohol consumption and myocardial infarction: a case-control study in France and Northern Ireland. Am J Epidemiol. 1996; 143: 1089–1093.
29. Cleophas TJ, Tuinenberg E, van der Meulen J, et al. Wine consumption and other dietary variables in males under 60 before and after acute myocardial infarction. Angiology. 1996; 47: 789–796.
30. Theobald H, Bygren LO, Carstensen J, et al. A moderate intake of wine is associated with reduced total mortality and reduced mortality from cardiovascular disease. J Stud Alcohol. 2000; 61: 652–656.[Medline] [Order article via Infotrieve]
31.
Bianchi C, Negri E, La Vecchia C, et al. Alcohol consumption and the risk of acute myocardial infarction in women. J Epidemiol Community Health. 1993; 47: 308–311.
32. Simons LA, McCallum J, Friedlander Y, et al. Alcohol intake and survival in the elderly: a 77 month follow-up in the Dubbo study. Aust N Z J Med. 1996; 26: 662–670.[Medline] [Order article via Infotrieve]
33. Salonen JT, 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: 533–543.[CrossRef][Medline] [Order article via Infotrieve]
34. Yano K, Rhoads GG, Kagan A, Coffee, alcohol and risk of coronary heart disease among Japanese men living in Hawaii. N Engl J Med. 1977; 297: 405–409.[Abstract]
35. Stampfer MJ, Colditz GA, Willett WC, et al. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. N Engl J Med. 1988; 319: 267–273.[Abstract]
36.
Truelsen T, Grønbaek M, Schnohr P, et al. Intake of beer, wine, and spirits and risk of stroke: the Copenhagen city heart study. Stroke. 1998; 29: 2467–2472.
37.
Grønbaek M, Becker U, Johansen D, et al. Type of alcohol consumed and mortality from all causes, coronary heart disease, and cancer. Ann Intern Med. 2000; 133: 411–419.
38. Tavani A, La Vecchia C, Negri E, et al. Alcohol intake and risk of myocardial infarction in Italian men. J Epidemiol Biostat. 1996; 1: 31–39.
39.
Malarcher AM, Giles WH, Croft JB, et al. Alcohol intake, type of beverage, and the risk of cerebral infarction in young women. Stroke. 2001; 32: 77–83.
40.
Farchi G, Fidanza F, Mariotti S, et al. Alcohol and mortality in the Italian rural cohorts of the Seven Countries Study. Int J Epidemiol. 1992; 21: 74–81.
41.
Renaud SC, Gueguen R, Siest G, et al. Wine, beer, and mortality in middle-aged men from eastern France. Arch Intern Med. 1999; 159: 1865–1870.
42.
Bobak M, Skodova Z, Marmot M. Effect of beer drinking on risk of myocardial infarction: population based case-control study. BMJ. 2000; 320: 1378–1379.
43. Klatsky AL, Armstrong MA, Friedman GD. Relation of alcoholic beverage use to subsequent coronary artery disease hospitalization. Am J Cardiol. 1986; 58: 710–714.[CrossRef][Medline] [Order article via Infotrieve]
44. Klatsky AL, Armstrong MA, Friedman GD. Red wine, white wine, liquor, beer, and risk for coronary artery disease hospitalization. Am J Cardiol. 1997; 80: 416–420.[CrossRef][Medline] [Order article via Infotrieve]
45.
Grønbaek M, Deis A, Sorensen TIA, et al. Mortality associated with moderate intakes of wine, beer, or spirits. BMJ. 1995; 310: 1165–1169.
46.
Hennekens CH, Willett W, Rosner B, et al. Effects of beer, wine, and liquor in coronary deaths. JAMA. 1979; 242: 1973–1974.
47.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting: Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000; 283: 2008–2012.
48. Di Castelnuovo A, de Gaetano G, Donati MB, et al. Platelet glycoprotein receptor IIIa polymorphism PIA1/PIA2 and coronary risk: a meta-analysis. Thromb Haemost. 2001; 85: 626–633.[Medline] [Order article via Infotrieve]
49. Petitti DB. Meta-Analysis, Decision Analysis, and Cost-Effectiveness Analysis: Methods for Quantitative Synthesis in Medicine. New York: Oxford University Press; 1994.
50.
Egger M, Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315: 629–634.
51.
Longnecker MP, Berlin JA, Orza MJ, et al. A meta-analysis of alcohol consumption in relation to risk of breast cancer. JAMA. 1988; 260: 652–656.
52. SAS Institute Inc. SAS/STAT User Guide, Version 8.2 for WINDOWS. Cary, NC: SAS Institute Inc; 1989.
53. Rotondo S, Di Castelnuovo A, de Gaetano G. The relationship between wine consumption and cardiovascular risk: from epidemiological evidence to biological plausibility. Ital Heart J. 2001; 2: 1–8.[Medline] [Order article via Infotrieve]
54.
Stampfer MJ, Hu FB, Manson JE, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000; 343: 16–22.
55. Truswell AS. Levels and kinds of evidence for public-health nutrition. Lancet. 2001; 357: 1061–1062.[CrossRef][Medline] [Order article via Infotrieve]
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 S. S. Bassuk and J. E. Manson Lifestyle and Risk of Cardiovascular Disease and Type 2 Diabetes in Women: A Review of the Epidemiologic Evidence American Journal of Lifestyle Medicine, June 1, 2008; 2(3): 191 - 213. [Abstract] [PDF]
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A. M. Baros, T. M. Wright, P. K. Latham, P. M. Miller, and R. F. Anton Alcohol consumption, %CDT, GGT and blood pressure change during alcohol treatment Alcohol Alcohol., March 1, 2008; 43(2): 192 - 197. [Abstract] [Full Text] [PDF]
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 J. Spaak, A. C. Merlocco, G. J. Soleas, G. Tomlinson, B. L. Morris, P. Picton, C. F. Notarius, C. T. Chan, and J. S. Floras Dose-related effects of red wine and alcohol on hemodynamics, sympathetic nerve activity, and arterial diameter Am J Physiol Heart Circ Physiol, February 1, 2008; 294(2): H605 - H612. [Abstract] [Full Text] [PDF]
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 B. Burstein, A. Maguy, R. Clement, H. Gosselin, F. Poulin, N. Ethier, J.-C. Tardif, T. E. Hebert, A. Calderone, and S. Nattel Effects of Resveratrol (trans-3,5,4'-Trihydroxystilbene) Treatment on Cardiac Remodeling following Myocardial Infarction J. Pharmacol. Exp. Ther., December 1, 2007; 323(3): 916 - 923. [Abstract] [Full Text] [PDF]
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M. Vazquez-Agell, E. Sacanella, E. Tobias, M. Monagas, E. Antunez, R. Zamora-Ros, C. Andres-Lacueva, R. M. Lamuela-Raventos, J. Fernandez-Sola, J. M. Nicolas, et al. Inflammatory Markers of Atherosclerosis Are Decreased after Moderate Consumption of Cava (Sparkling Wine) in Men with Low Cardiovascular Risk J. Nutr., October 1, 2007; 137(10): 2279 - 2284. [Abstract] [Full Text] [PDF]
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 S. M. Shenouda and J. A. Vita Effects of Flavonoid-Containing Beverages and EGCG on Endothelial Function J. Am. Coll. Nutr., August 1, 2007; 26(4): 366S - 372S. [Abstract] [Full Text] [PDF]
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 L. H. Opie and S. Lecour The red wine hypothesis: from concepts to protective signalling molecules Eur. Heart J., July 2, 2007; 28(14): 1683 - 1693. [Abstract] [Full Text] [PDF]
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 G. C. Gee, J. Liang, J. Bennett, N. Krause, E. Kobayashi, T. Fukaya, and Y. Sugihara Trajectories of Alcohol Consumption among Older Japanese Followed from 1987 1999 Research on Aging, July 1, 2007; 29(4): 323 - 347. [Abstract] [PDF]
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 C. Schafer, A. Parlesak, J. Eckoldt, C. Bode, J. C. Bode, W. Marz, and K. Winkler Beyond HDL-cholesterol increase: phospholipid enrichment and shift from HDL3 to HDL2 in alcohol consumers J. Lipid Res., July 1, 2007; 48(7): 1550 - 1558. [Abstract] [Full Text] [PDF]
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 A. Di Castelnuovo, S. Costanzo, V. Bagnardi, M. B. Donati, L. Iacoviello, and G. de Gaetano Alcohol Dosing and Total Mortality in Men and Women: An Updated Meta-analysis of 34 Prospective Studies Arch Intern Med, December 11, 2006; 166(22): 2437 - 2445. [Abstract] [Full Text] [PDF]
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L. BAGLIETTO, D. R. ENGLISH, J. L. HOPPER, J. POWLES, and G. G. GILES AVERAGE VOLUME OF ALCOHOL CONSUMED, TYPE OF BEVERAGE, DRINKING PATTERN AND THE RISK OF DEATH FROM ALL CAUSES Alcohol Alcohol., November 1, 2006; 41(6): 664 - 671. [Abstract] [Full Text] [PDF]
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J. de Leiris, M. de Lorgeril, and F. Boucher Ethanol and cardiac function Am J Physiol Heart Circ Physiol, September 1, 2006; 291(3): H1027 - H1028. [Full Text] [PDF]
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C. Maraldi, S. Volpato, S. B. Kritchevsky, M. Cesari, E. Andresen, C. Leeuwenburgh, T. B. Harris, A. B. Newman, A. Kanaya, K. C. Johnson, et al. Impact of inflammation on the relationship among alcohol consumption, mortality, and cardiac events: the health, aging, and body composition study. Arch Intern Med, July 24, 2006; 166(14): 1490 - 1497. [Abstract] [Full Text] [PDF]
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 L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Circulation, June 20, 2006; 113(24): e873 - e923. [Abstract] [Full Text] [PDF]
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 L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Stroke, June 1, 2006; 37(6): 1583 - 1633. [Abstract] [Full Text] [PDF]
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K. J. Mukamal, M. K. Jensen, M. Gronbaek, M. J. Stampfer, J. E. Manson, T. Pischon, and E. B. Rimm Drinking Frequency, Mediating Biomarkers, and Risk of Myocardial Infarction in Women and Men Circulation, September 6, 2005; 112(10): 1406 - 1413. [Abstract] [Full Text] [PDF]
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U. Schminke, J. Luedemann, K. Berger, D. Alte, R. Mitusch, W. G. Wood, A. Jaschinski, S. Barnow, U. John, and C. Kessler Association Between Alcohol Consumption and Subclinical Carotid Atherosclerosis: The Study of Health in Pomerania Stroke, August 1, 2005; 36(8): 1746 - 1752. [Abstract] [Full Text] [PDF]
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P. E. Szmitko and S. Verma Antiatherogenic potential of red wine: clinician update Am J Physiol Heart Circ Physiol, May 1, 2005; 288(5): H2023 - H2030. [Abstract] [Full Text] [PDF]
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 L. L.J. Koppes, J. M. Dekker, H. F.J. Hendriks, L. M. Bouter, and R. J. Heine Moderate Alcohol Consumption Lowers the Risk of Type 2 Diabetes: A meta-analysis of prospective observational studies Diabetes Care, March 1, 2005; 28(3): 719 - 725. [Abstract] [Full Text] [PDF]
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 I Janszky, M Ericson, M Blom, A Georgiades, J-O Magnusson, H Alinagizadeh, and S Ahnve Wine drinking is associated with increased heart rate variability in women with coronary heart disease Heart, March 1, 2005; 91(3): 314 - 318. [Abstract] [Full Text] [PDF]
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L. RETTERSTOL, K. E. BERGE, O. BRAATEN, L. EIKVAR, T. R. PEDERSEN, and L. SANDVIK A DAILY GLASS OF RED WINE: DOES IT AFFECT MARKERS OF INFLAMMATION? Alcohol Alcohol., March 1, 2005; 40(2): 102 - 105. [Abstract] [Full Text] [PDF]
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J. A Vita Polyphenols and cardiovascular disease: effects on endothelial and platelet function Am. J. Clinical Nutrition, January 1, 2005; 81(1): 292S - 297S. [Abstract] [Full Text] [PDF]
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 O. H Franco, L. Bonneux, C. de Laet, A. Peeters, E. W Steyerberg, and J. P Mackenbach The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75% BMJ, December 18, 2004; 329(7480): 1447 - 1450. [Abstract] [Full Text] [PDF]
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 R. M. Pinder and M. Sandler Alcohol, wine and mental health: focus on dementia and stroke J Psychopharmacol, December 1, 2004; 18(4): 449 - 456. [Abstract] [PDF]
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R. Vliegenthart, H.-H. S. Oei, A. P. M. van den Elzen, F. J. A. van Rooij, A. Hofman, M. Oudkerk, and J. C. M. Witteman Alcohol Consumption and Coronary Calcification in a General Population Arch Intern Med, November 22, 2004; 164(21): 2355 - 2360. [Abstract] [Full Text] [PDF]
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A. Y Strandberg, T. E Strandberg, V. V Salomaa, K. Pitkala, and T. A Miettinen Alcohol consumption, 29-y total mortality, and quality of life in men in old age Am. J. Clinical Nutrition, November 1, 2004; 80(5): 1366 - 1371. [Abstract] [Full Text] [PDF]
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L. Frost and P. Vestergaard Alcohol and Risk of Atrial Fibrillation or Flutter: A Cohort Study Arch Intern Med, October 11, 2004; 164(18): 1993 - 1998. [Abstract] [Full Text] [PDF]
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E. Badia, E. Sacanella, J. Fernandez-Sola, J. M. Nicolas, E. Antunez, D. Rotilio, G. de Gaetano, A. Urbano-Marquez, and R. Estruch Decreased tumor necrosis factor-induced adhesion of human monocytes to endothelial cells after moderate alcohol consumption Am. J. Clinical Nutrition, July 1, 2004; 80(1): 225 - 230. [Abstract] [Full Text] [PDF]
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S. Volpato, M. Pahor, L. Ferrucci, E. M. Simonsick, J. M. Guralnik, S. B. Kritchevsky, R. Fellin, and T. B. Harris Relationship of Alcohol Intake With Inflammatory Markers and Plasminogen Activator Inhibitior-1 in Well-Functioning Older Adults: The Health, Aging, and Body Composition Study Circulation, February 10, 2004; 109(5): 607 - 612. [Abstract] [Full Text] [PDF]
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 M. K. Duggirala, C. M. Bridges, T. G. McLeod, C. S. Lieber, A. B. Lowenfels, A. Di Castelnuovo, L. Iacoviello, G. de Gaetano, K. J. Mukamal, E. B. Rimm, et al. Alcohol and Coronary Heart Disease N. Engl. J. Med., April 24, 2003; 348(17): 1719 - 1722. [Full Text] [PDF]
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 R. A. Vogel Vintners and vasodilators: are French red wines more cardioprotective? J. Am. Coll. Cardiol., February 5, 2003; 41(3): 479 - 481. [Full Text] [PDF]
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K. J. Mukamal, K. M. Conigrave, M. A. Mittleman, C. A. Camargo Jr., M. J. Stampfer, W. C. Willett, and E. B. Rimm Roles of Drinking Pattern and Type of Alcohol Consumed in Coronary Heart Disease in Men N. Engl. J. Med., January 9, 2003; 348(2): 109 - 118. [Abstract] [Full Text] [PDF]
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 OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02) Evid. Based Nurs., January 1, 2003; 6(1): e1 - 1. [Full Text] [PDF]
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 Does Drinking Wine or Beer Reduce Vascular Risk? Journal Watch Emergency Medicine, September 25, 2002; 2002(925): 13 - 13. [Full Text]
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M. de Lorgeril, P. Salen, J.-L. Martin, F. Boucher, F. Paillard, and J. de Leiris Wine Drinking and Risks of Cardiovascular Complications After Recent Acute Myocardial Infarction Circulation, September 17, 2002; 106(12): 1465 - 1469. [Abstract] [Full Text] [PDF]
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E. B. Rimm and M. J. Stampfer Wine, Beer, and Spirits: Are They Really Horses of a Different Color? Circulation, June 18, 2002; 105(24): 2806 - 2807. [Full Text] [PDF]
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