The Complex Association Between Alcohol Consumption and Myocardial Infarction: Always Good for a New Paradox
First mention of alcohol as a component of diet and communal events dates back to the 7th millennium B.C. Famous ancient savants like Hippocrates used alcohol as a solvent for herb extracts, an antiseptic, and to counteract lethargy and diarrhoea, while in medieval times alcohol was well within the armamentarium of anaesthetics, sedatives, disinfectants, and diuretics. Nowadays, alcohol is no longer administered for medicinal purposes, but is a frequent constituent of regular diet favoured for its broad availability and lack of effective sale restrictions. In 2010, the worldwide average amount of pure alcohol consumed per person aged 15 or over was 6.2 litres per year or 13.5 grams per day.1 There is now solid evidence that alcohol, when consumed on a regular basis and at low volumes (up to one drink for women and two drinks for men daily), confers protection against cardiovascular disease, whereas regular amounts of more than four to five drinks daily and heavy episodic drinking have opposite effects.2,3 The J-shaped association applies to low- and high-risk individuals, the primary prevention setting, and to survivors of myocardial infarction. Sex differences are attributed to distinct gastric alcohol dehydrogenase (ADH) activity and body distribution volumes.4 Consumption of alcohol during meals on a daily basis is deemed an ideal drinking pattern, characterized by prolonged absorption and persistency, because its most favourable effects are transient and it blunts postprandial glucose spikes. Strictly speaking, however, the bulk of studies supporting this knowledge operate in high-income countries with little evidence available from South America, Africa or Asia, except China and Japan.2 In this regard, the study by Leong et al. in the current issue of Circulation delivers unique and, to some extent, surprising results
- Received June 4, 2014.
- Accepted June 6, 2014.