Have Danes solved the French paradox - patients at highest risk of having a heart attack get the most health benefits from drinking alcoholic beverages - Brief Article

Science News, March 30, 1996 by Janet Raloff

Danish scientists have published a study that they argue goes a long way toward explaining why the French, despite generally high concentrations of cholesterol in their blood, don't experience the high rates of heart disease seen in other groups with simi larly elevated cholesterol.

Hans Ole Hein of State University Hospital in Copenhagen listened to discussions of this so-called French paradox at a meeting in Bordeaux, France, 3 years ago. It set him mulling over how he might investigate one putative explanation-that the French drin k a lot of wine, a beverage studies have indicated could significantly cut the risk of heart disease.

Hein figured that the French, who tend to dine on cholesterol-elevating high-fat entrees, probably have high concentrations of low-density lipoprotein (LDL) cholesterol, a major risk factor for heart disease. So, using a group of 2,800 Danish men that his team had been following since 1985, he examined the relationship between LDL cholesterol in the blood and drinking's impact on the frequency of first heart attacks.

Among the 20 percent of men with the highest LDL cholesterol (at least 203 milligrams per deciliter of blood), 16.4 percent of teetotalers developed heart attacks in 6 years, the researchers report in the March 23 British Medical Journal. The frequency wa s just 8.7 percent in those who regularly consumed up to three servings of alcoholic beverages a day and a mere 4.4 percent in men who consumed more. Alcoholic drinks provided no reduction in heart attack risk among the 20 percent of men having the lowest LDL readings (140 mg/dl or less) and only weak benefits for those in between.

These data indicate that people at highest risk of heart disease benefit most from alcohol's protection, observes Eric B. Rimm of the Harvard School of Public Health in Boston. In the same issue of the journal, Rimm and his coworkers review 12 earlier stu dies on alcohol and heart risk to find out whether there is anything especially protective about wine. Like the Danish study, says Rimm, his review indicates that "it doesn't matter what beverage you get the alcohol from."

While R. Curtis Ellison, a cardiovascular epidemiologist at Boston University School of Medicine, agrees that all alcoholic drinks offer heart benefits, he contends that only by randomly assigning similar individuals to different drinks and following them for years-which probably can't be done-could one conclude that people who choose one form of alcohol over another don't also differ in social, physiological, or other factors that might affect risk. Like Hein, however, he believes the data are now strong enough for physicians to begin recommending a drink with dinner for most patients at high risk of heart disease.

On that point, Marion Nestle of New York University disagrees heartily. Citing "the enormous social impacts of alcohol on society"-including drunk driving, violence against women and children, and gun-related accidents-she says that "under no circumstance s should people who aren't drinking be encouraged to do so." She would advocate instead exercise, a better diet, and not smoking.