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Of wine, cholesterol, and triglycerides

Posted by medconsumers on March 13, 2011

For years I’ve wondered why doctors continue to test women for high cholesterol when studies show it has no value in predicting heart attack or stroke. And more to the point, why prescribe cholesterol-lowering drugs to women for heart disease prevention when there’s no proven benefit? Yes, men appear to benefit from cholesterol-lowering, but surprisingly few as it turns out. Wouldn’t it be better—and safer—to simply tell us to have a daily glass of wine? My questions only became magnified this week when I came across the Copenhagen Heart Study (CHS), which has followed healthy people for over 33 years to see who develops cardiovascular problems. As with the Framingham Heart Study, the CHS has generated multiple smaller studies over the years.

I stumbled across the CHS for the first time when its latest findings appeared this month in Annals of Neurology. It focussed on what is probably the most feared consequence of cardiovascular disease—an ischemic stroke. Keep in mind when you read the CHS results that—for men and women—high cholesterol has long been considered a major risk factor for stroke, along with smoking and hypertension.

The CHS found that the blood fats known as triglycerides are more relevant to stroke risk than cholesterol. It concluded that increasing levels of nonfasting triglyceride are predictive of a woman’s high risk for stroke, while increasing cholesterol levels are not. As for men, increasing levels of nonfasting triglyceride are associated with an increased risk of stroke, but cholesterol becomes a risk for stroke only when it’s extremely high (348 mg/dl or higher). These findings were confirmed by a 31-year Norwegian study published last year in the European Journal of Epidemiology.

The standard blood test almost always includes measurement of triglycerides. The new twist introduced by the Danish researchers is nonfasting triglycerides. Their explanation: “except for the first hours of the early morning, most individuals are in the nonfasting state most of the time.” Triglycerides are stored in our fat tissue among other places; the major stimulus for triglyceride production is not fat intake, but carbohydrates and sugar. While earlier research indicates that triglyceride might be a better predictor of stroke, the CHS is the first to separate results by gender. Before we all start to get carried away with triglycerides, keep in mind that there is no proof that lowering someone’s triglycerides also lowers the risk of stroke.

Now for the wine…and here’s another reason to stay with the Danish research. If stroke is the main thing you’d like to avoid (and it is mine), there’s much to be said for drinking. I’ve always been intrigued by the population (observational) studies that show that people who drink alcohol have a lower risk of stroke than people who don’t. Denmark became an unintentional experiment in 1976 when this nation of liquor and beer drinkers turned rather suddenly and enthusiastically to wine. The change was due to the opening of the European market.

Here’s what the researchers found after following 13,000 men and women, age 30-70 years, for the first 12 years after wine became instantly more accessible. “Low to moderate intake of wine is associated with lower mortality from cardiovascular and cerebrovascular disease [stroke] and other causes. Similar intake of spirits implied an increased risk, while beer drinking did not affect mortality.”

This off-shoot of the CHS is interesting from several perspectives. It’s the first to study the health effects of wine drinking in a non-Mediterranean country; it did not show that other forms of alcohol had similar health benefits to wine, as all other studies have since found; and it had a broader definition of “low to moderate drinking” than U.S researchers typically use.

Low wine consumption was defined as 1 to 3 glasses of wine daily, moderate was 3 to 5 glasses of wine daily. There was a 49% decrease in total mortality among the moderate drinkers and a 30% decrease among those with low consumption, compared with people who never drank wine. As for Denmark’s increase in wine consumption during the 12-year-study period, it went from 17% of total alcohol consumption in 1975 to 30% in 1992. The CHS was financed by the Danish National Board of Health.

It’s likely that the medical profession will soon let go of the idea that cholesterol is an important risk factor. And the unwarranted enthusiasm for statins will dim slowly as we get to the end of this year when the patent for Lipitor runs out. This $10 billion-a-year cholesterol-lowering statin drug, which is excellent at lowering cholesterol but modest (at best) at lowering the chance of stroke or heart attack, will be the last of the statin drugs to lose exclusive rights.

Raise a glass of wine to that thought.

For more information
-Not convinced that women with high cholesterol but no heart disease will not benefit from cholesterol-lowering drugs? Read this and be sure to click into the link to the 2004 JAMA study referenced within the article. As for the effectiveness of these drugs in men, click here And lastly click here to see the effectiveness of cholesterol-lowering drugs for people who already have heart disease.

-Triglycerides are more relevant to heart disease than cholesterol, according to extensive research dating back to the 1950s. For more on this topic, see Gary Taubes’s book, Good Calories, Bad Calories—Challenging the conventional wisdom on diet, weight control, and disease.” click here

-Here’s the 1995 Copenhagen Heart Study results about the 12-year period following the broad availability of wine. click here

-Need a more recent wrap-up of all the best wine-heart disease studies? Read this analysis of 21 such studies that confirmed the finding that light- to moderate-drinking is better for the heart than not drinking. As for stroke mortality, even just one drink a day will lower your chances. And by the way, binge drinking is a major no no. click here

-Too many white people in these drinking and stroke prevention studies? Here’s one with the same finding in favor of moderate drinking but the participants are broadly representative of the U.S. population (be sure to scroll way down).

Maryann Napoli, Center for Medical Consumers(c)

20 Responses to “Of wine, cholesterol, and triglycerides”

  1. Lorraine Bauder said

    A long time moderate wine drinking friend morphed into an alcoholic a few years ago with devistating financial and family results. My husband and i have enough similar cases in each of our family backgrounds for us to avoid any alchohol and encourage our children to do likewise. Has anyone compared the effects of consumption of unfermented red/purple grapes or juice, chocolate or whatever compared to red wine?

  2. Boris Klapwald said

    i thought that alcohol in any form (wine,etc.) has the ability to destroy brain cells. no?

    • medconsumers said

      Chronic excessive alcohol intake, probably, but this level of consumption was not addressed in my article.

  3. Suzanne Antisdel said

    Thanks SO much for doing this, Maryann. We Americans are still burdened with Puritan attitudes, which undeniably are reflected in the difference between European and American definitions of “moderate drinking.” I drink wine every night with my dinner. Besides being excellent for my health, it tastes good. And I have refused to take cholesterol-lowering drugs. They don’t taste good at all.

  4. Shirley Sallas said

    I went on Lipitor because of my high cholesterol (248 total) and immediately
    saw results 0f a 70 point drop to 178 total. After reading your article on
    statins I decided to stop taking Lipitor. I was told you can’t just stop taking
    them. How does one stop properly?

    • medconsumers said

      We can’t answer medical questions, but here’s something to mull over. Virtually all clinical trials involving statin drugs for people without heart disease are funded by companies that make these cholesterol-lowering drugs. Why would any drug company put a dime into research to find out how one can stop taking them properly?

    • Jane M said

      I was on Lipitor for five years and didn’t realize how many deleterious side effects I was having. I know they tell you not to stop, but I did, after I had cut the 20mg in half for a few weeks. After I stopped my memory started to return and my explosive bouts of anger stopped right away.

      The doctors just want the chance to get you back in the office so they can convince you not to stop taking them.

      They are bad, bad, bad. I think we’re going to find out that a lot of Alzheimers is related to the taking of stain drugs.

  5. Katherine Snelson said

    Hi MaryAnn, I feel confused and anxious, with a doctor telling me I should be taking a statin and reading your articles and the research behind them. I’ve been avoiding alcohol because I prefer my calories in chocolate ( 70% or higher) and nuts. Isn’t my liver happier without the alcohol? I suppose my liver would be lots happier without the statins.
    (I’m 72 and my cholesterol is about 235 with Pravastatin.)

    • medconsumers said

      Hello Katherine
      Only you can answer the question of what makes your liver happy. As for your doctor who may not know about statins’ lack of benefit to women without heart disease, print out this article from the Journal of the American Medical Association and show it to him or her. You need only print out the first one or two pages, but make sure you include the section called “Conclusions.” This is an old study (2004) done at a time before statins reigned supreme as the cholesterol-lowering drug of choice. Still, it showed no benefit to lipid-lowering—by any drug—in women who do not have heart disease. And the benefit is all that great even for women who do have heart disease. I know of no other study that has contradicted these conclusions. By benefit, I mean, no reduced chance of heart attack, stroke, or premature death. Statins are great at lowering cholesterol, but that’s about it.

  6. Patricia Lilley said

    I have read many articles about the benefits of drinking wine for health benefits; however, no one seems to address the sugar content of wine/alcohol. Or what diabetics can do to lower their risk of heart disease/stroke.

  7. Steven Andreca said

    But doesn’t alcohol raise triglycerides? And doesn’t wine have an awfully unfavourable ratio between the alcohol, that not only raises triglycerides but does much other harm, and whatever substance is the good stuff, of which I heard you would have to consume the equivalent found in thousands of glasses of wine per day to get the true benefit?

    Cheers.
    Steven

    • medconsumers said

      Whether alcohol raises or lowers triglylcerides, whether or not resveratrol is the key ingredient ingredient in red wine, the fact remains that there’s a large number of published studies showing that low- to moderate wine drinking is associated with health benefits. At best, all these studies can do is show an association between good health and low- to moderate wine drinking. In other words, there could be some other characteristic that separates wine drinkers from others. Here’s one: a 2006 study found that wine drinkers might eat more healthful foods than people who drink beer.

      More to the point, the mass movement to lower everyone’s cholesterol (including children) with statins appears to have helped only a small fraction of all who take these drugs. Perhaps we should be more skeptical when the next blood lipid is identified as predictive of a future heart attack and in need of longer-term drug treatment.

      • Steven Andreca said

        Your point about association (as opposed to causation) is correct. I think that the benefits shown by those studies are shown despite the wine consumption, not because of it.

        I recently read an excellent book on this subject, called “Know Your Chances: Understanding Health Statistics”, which I reccommend.

        Steven

  8. Bill Ullman said

    Hi Maryann –

    I have a problem with your wine article.

    Neither the article nor the linked BMJ paper make any reference to the type of wine used in the study, or what it is about wine that makes it beneficial stroke-wise. The general reader needs to know that there is some evidence (correlative) that flavenoids, including tannin, may be the ingredients that account for wine’s cardio (stroke) benefits, but neither article mentions that these substances are present only very minimally in white wines and their occurrence in red wines varies enormously. As for reds, cabernet sauvignon and shiraz have high levels of both tannin & other flavenoids, while pinot noir and chianti have very little. The wine drinker also needs to know that another common hypothesis is that tannin is largely responsible for the widely-experienced “red wine headache.” Finally, teetotalers and headache suffers should know that tannin is abundant in tea, cheeses, nuts and cocoa-based chocolate.

    Bill (in still-snowy Maine)

    • medconsumers said

      Hi Bill

      The Copenhagen Heart Study, quoted in this article, was not designed to address any of your excellent points. It simply looked at mortality from heart and cerebrovascular disease. It is just one of hundreds of alcohol-heart disease studies. I chose to quote it for three reasons: It spawned the nonfasting triglyceride research; it appears to be the first to look at wine drinking in a non-Mediterranean country, and it has the unique feature of following the cardiovascular health of a country that turned rather quickly to wine drinking.

      Maryann

  9. I’ve seen the assessment by NNT (one of my favorite sites to turn to) and I feel that the added risk is equivalent to the extremely small benefit – in other words, statistically speaking any benefit is cancelled out.

  10. I have known that lowering a woman’s cholesterol has no benefit and may possibly have a life shortening effect for about three years now. It’s hard to understand why big pharma is allowed to promote toxic drugs to a class of people (men without heart disease and all women) when there is no proven benefit. It’s even harder to understand why doctors prescribe those drugs. And the worst part is that millions of people have accepted the medical community’s direction to take statins, now in some cases because their cholesterol is above 200! I cannot imagine the damage this might be doing. I truly expect the next big “HRT” type class action suit against big pharma will be over statins.

    • medconsumers said

      Thanks for your thoughts, Sandra. Re your point about cholesterol-lowering drugs as ineffective for men without heart disease: Statins are in fact helpful to middle-aged men without heart disease. To see how fell will benefit, see link at the end of this article under “For more information.” Better yet, here it is again.

      • Jane M said

        When my husband started a statin drug he became impotent within 6 months; it took 2 years to return to near normal after quitting. For that small benefit, I think most men would forgo statins if they knew they could become impotent.

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