To Drink or Not to Drink? That is the Question!
To Drink or Not to Drink? That is the Question!
Abstract & Commentary
Synopsis: A randomized, diet-controlled interventional study demonstrates that moderate alcohol consumption reduces plasma C-reactive protein and fibrinogen levels.
Source: Sierksma A, et al. Eur J Clin Nutr. 2002;56: 1130-1136
C-reactive protein (CRP) is a marker for systemic inflammation and predicts cardiovascular events among apparently healthy men and women.1 This study was done to evaluate the effect of moderate alcohol consumption on CRP and fibrinogen.
It was a randomized, diet-controlled, crossover study. Ten middle-aged men and 10 postmenopausal women, all apparently healthy, nonsmoking, and moderate alcohol drinkers, were included. One women dropped out because of a treatment-unrelated cause. The remaining 19 subjects completed the experiment successfully.
Men consumed 4 glasses and women 3 glasses of beer or nonalcoholic beer (control) with evening dinner during 2 consecutive periods of 3 weeks. The total diet was supplied to the subjects and had essentially the same composition during these 6 weeks.
Before each treatment period there was a 1-week washout period to compensate for possible carry-over effects.
Plasma CRP and fibrinogen levels were decreased by 35% (P = 0.02) and 12.4% (P = 0.001), respectively, after 3 weeks consumption of beer, as compared to nonalcoholic beer consumption.
Moderate alcohol consumption significantly reduced CRP and fibrinogen levels. An anti-inflammatory action of alcohol may explain the link between moderate alcohol consumption and cardiovascular death.
Comment by Ralph R. Hall, MD, FACP
There are many facets to this study. First of all, this is a very small but well-designed experiment. As studies have shown, it is not only red wine that has protective effects on cardiovascular disease but rather alcohol in general. Many will be delighted to note that the alcohol in beer has these beneficial effects.
Preliminary guidelines have been established regarding the use of the CRP and the management of patients with elevated levels.
Kereiakes in a mini-review,2 notes that high-sensitivity CRP testing is available in clinical settings throughout the world. Since only about half the patients with coronary heart disease have hypercholesterolemia, perhaps the addition of measuring and lowering the CRP will significantly lower the morbidity and mortality from this disease. It is of note that statins lower CRP levels 25-50 %.
Who should have a CRP test? Individuals who are at high risk for cardiovascular disease should be treated aggressively regardless of the CRP level (see Table below). The test is therefore superfluous in high-risk patients. In patients who are at intermediate risk, using American Heart Association criteria, a positive test result may add incentive to adhere to therapy. Many physicians believe the test is not useful in low-risk patients. However, a positive test in a low-risk patient may be an indication for a more aggressive approach. We have much to learn about the usefulness of the CRP test.
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Risk Levels Interpretation2
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A recent editorial by Goldberg, regarding the studies on the effectiveness of alcohol in the prevention of coronary heart disease, discusses the impossibility of eliminating confounding differences between groups such as exercise and smoking.3 As he points out, however, the reproducibility of the association between alcohol and heart disease is compelling.
Do these studies mean that we should recommend alcohol for our patients? I think not! Abuse of alcohol comes at a devastatingly high price.4 We should be recommending the reduction of intake in those patients who are consuming more than 2 drinks per day. We can reassure those who have moderate alcohol intake their habits are not harmful, but there is a need to guard against higher rates of consumption later in life.
For a more detailed discussion on the management of elevated CRP, the review by Kereikes2 is recommended.
Dr. Hall is Emeritus Professor of Medicine at University of MissouriKansas City School of Medicine.
References
1. Edward TH, et al. Circulation. 2003;107:370-372.
2. Kereiakes DJ. Circulation. 2003;107:373-374.
3. Goldberg IJ. N Engl J Med. 2003;348:163-164.
4. Hanson GR, Ting-Kai L. JAMA. 2003;289:1031-1032.
A randomized, diet-controlled interventional study demonstrates that moderate alcohol consumption reduces plasma C-reactive protein and fibrinogen levels.Subscribe Now for Access
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