ABSTRACT
The term French paradox was coined in 1992 to describe the relatively low incidence of cardiovascular disease
in the French population, despite a relatively high dietary intake of saturated fats,
and potentially attributable to the consumption of red wine. After nearly 20 years,
several studies have investigated the fascinating, overwhelmingly positive biological
and clinical associations of red wine consumption with cardiovascular disease and
mortality. Light to moderate intake of red wine produces a kaleidoscope of potentially
beneficial effects that target all phases of the atherosclerotic process, from atherogenesis
(early plaque development and growth) to vessel occlusion (flow-mediated dilatation,
thrombosis). Such beneficial effects involve cellular signaling mechanisms, interactions
at the genomic level, and biochemical modifications of cellular and plasma components.
Red wine components, especially alcohol, resveratrol, and other polyphenolic compounds,
may decrease oxidative stress, enhance cholesterol efflux from vessel walls (mainly
by increasing levels of high-density lipoprotein cholesterol), and inhibit lipoproteins
oxidation, macrophage cholesterol accumulation, and foam-cell formation. These components
may also increase nitric oxide bioavailability, thereby antagonizing the development
of endothelial dysfunction, decrease blood viscosity, improve insulin sensitivity,
counteract platelet hyperactivity, inhibit platelet adhesion to fibrinogen-coated
surfaces, and decrease plasma levels of von Willebrand factor, fibrinogen, and coagulation
factor VII. Light to moderate red wine consumption is also associated with a favorable
genetic modulation of fibrinolytic proteins, ultimately increasing the surface-localized
endothelial cell fibrinolysis. Overall, therefore, the “French paradox” may have its
basis within a milieu containing several key molecules, so that favorable cardiovascular
benefits might be primarily attributable to combined, additive, or perhaps synergistic
effects of alcohol and other wine components on atherogenesis, coagulation, and fibrinolysis.
Conversely, chronic heavy alcohol consumption and binge drinking are associated with
increased risk of cardiovascular events. In conclusion, although mounting evidence
strongly supports beneficial cardiovascular effects of moderate red wine consumption
(one to two drinks per day; 10–30 g alcohol) in most populations, clinical advice
to abstainers to initiate daily alcohol consumption has not yet been substantiated
in the literature and must be considered with caution on an individual basis.
KEYWORDS
Wine - cardiovascular disease - coronary artery disease - atherosclerosis
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Prof. Giuseppe Lippi
U.O. Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio,
Azienda Ospedaliero-Universitaria di Parma
Strada Abbeveratoia, 2/a, 43100 - Parma Italy
Email: giuseppe.lippi@univr.it
Email: ulippi@tin.it
