Arthur L. Klatsky, MD is a Senior Consultant in Cardiology and an Adjunct Investigator at the Division of Research at the Kaiser Permanente Medical Center, Oakland, California.  He has done extensive research on the effects of alcohol on cardiovascular health.  He and his colleagues published the seminal article, “Alcohol consumption before myocardial infarction. Results from the Kaiser-Permanente epidemiologic study of myocardial infarction” in the Annals of Internal Medicine in 1974. Since then, Dr. Klatsky has published numerous articles on the effects of moderate alcohol consumption on all-cause mortality, cardiovascular disease, and breast cancer.

We had the opportunity to hear Dr. Klatsky lecture on, “Beer, Wine, and Alcohol: Scientific Truths at the Start of a New Decade” at the Society of Medical Friends of Wine 71^st annual dinner and meeting held at the San Francisco Ritz-Carlton on January 24, 2010. Here are a few salient points that he made in his lecture:

· There are problems with designing randomized controlled trials on the impact of alcohol consumption and health:

· Not feasible for conditions resulting from heavy drinking

· Problematic for chronic conditions related to light-moderate drinking

· Do exist for several intermediate (surrogate) markers

Conclusion: We are left with much dependence upon observational epidemiology.

· Underreporting of alcohol consumption effects study results by:

· Lowering the threshold for harm

· Creating spurious continuous relationships

· Lessening apparent benefit

· Mechanism of alcohol-coronary artery disease protection:

· Increase in HDL (probably explains 50%)

· Decrease fibrinogen, anti-platelet, thromboxane A

· Increase prostacyclin and endogenous t-PA

· Decrease insulin resistance

· Increase “preconditioning”

· Decrease stress (unlikely mechanism)

· Do red wine drinkers fare best?

· Suggested by ecologic studies but not seen in US population studies

· Possibilities:

· Confounding by user traits – wine drinkers have high socioeconomic status

· Drinking pattern – wine with food, temperate, slow, (almost) daily more favorable vs. binge-drinking

· Non-alcoholic ingredients in wine may have beneficial effects, i.e., antioxidant effect

· Conclusion: The jury is still out.

Below is the abstract from his most recent publication.

Physiol Behav. 2009 Dec 30. [Epub ahead of print]

Alcohol and cardiovascular health.

Klatsky AL.

Kaiser Permanente Medical Care Program, Oakland, CA, USA.

The substantial medical risks of heavy alcohol drinking as well as the probable existence of a less harmful or safe drinking limit have been evident for centuries. Modern epidemiology studies suggest lowered risk of morbidity and mortality among lighter drinkers. Thus, defining "heavy" drinking as >/=3 standard drinks per day, the alcohol-mortality relationship is a J-curve with risk highest for heavy drinkers, lowest for light drinkers and intermediate for abstainers. A number of non-cardiovascular and cardiovascular problems contribute to the increased mortality risk of heavier drinkers. The lower risk of light drinkers is due mostly to lower risk of the most common cardiovascular condition, coronary heart disease (CHD). These disparate relationships of alcoholic drinking to various cardiovascular and non-cardiovascular conditions constitute a modern concept of alcohol and health. Increased cardiovascular risks of heavy drinking include: (1) alcoholic cardiomyopathy, (2) systemic hypertension (high blood pressure), (3) heart rhythm disturbances, and (4) hemorrhagic stroke. Lighter drinking is not clearly related to increased risk of any cardiovascular condition and, in observational studies, is related to lower risk of CHD, ischemic stroke, and diabetes mellitus. A protective hypothesis for CHD is supported by evidence for plausible biological mechanisms attributable to ethyl alcohol. International comparisons and some prospective study data suggest that wine is more protective against CHD than liquor or beer. Possible non-alcohol beneficial components in wine (especially red) support possible extra protection by wine, but a healthier pattern of drinking or more favorable risk traits in wine drinkers may be involved. Copyright © 2009. Published by Elsevier Inc.

PMID: 20045009 [PubMed - as supplied by publisher]