THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

  Transcripts: 518-1 to 518-3

Week: 518.1 Guest: Eric Rimm, Ph.D. Topic: Alcohol and The Heart - Part One Host: Richard Roeder Producer: Ed Graham

NEMA: This is a three part series about the analysis of some of the best studies on the effect of alcohol on heart disease. My guest is Dr. Eric Rimm from the Harvard School of Public Health.

NEMA: Dr. Rimm, talk about the analysis that you've done of the studies on the health effects of alcohol.

RIMM: Sure. Over the last actually now 25 years, there have been over 60 studies that have looked at alcohol and coronary heart disease and there's really overwhelming evidence now that people who drink in moderation have significantly lower rates of heart disease. It's only been recently in trying to describe what the French paradox is is that there seems to be much more media attention and interest in saying that red wine explains all of this alcohol benefit and so what we did was to pull out of those 60 or 65 studies that have looked at alcohol and heart disease - we pulled out the best studies that had information on alcohol beverage type because we felt that if there really was a substantial extra benefit for red wine, that there should be a lot of data to show that and what we found actually was that there was the same number of studies showing a benefit for beer as there was for wine and for liquor which would suggest that it's the alcohol itself and not other components of the beverage type.

NEMA: Now actually there was a relatively recent study that came out that was questioning whether it had anything to do with the alcohol or not. I'm not sure what the source of the study was but I remember this is something that's come out within the last couple of months that said grape juice seemed to have similar benefits without any alcohol in it. Are you aware of that study?

RIMM: Yeah. What we do know, I mean there has been lots of good biochemistry done to try to understand what's in red wine and we do know that red wine contains some antioxidants. What is not known is are those antioxidants important? How are they absorbed? Do they get into the heart? Do they work physiologically in the right place to reduce our risk of heart disease? There are a lot of antioxidants out there in almost all foods that we eat. Very few of them actually are probably important and at this point there really isn't enough evidence to suggest that the antioxidants in red wine are that important for lowering heart disease and I think that's why we found that there was the same number of studies finding a benefit for each beverage type so at this point, the evidence looking at red wine or at grapes or at grape juice - what they're doing is trying to measure some intermediary markers but we don't even know what those markers mean so they measure antioxidants and then the antioxidant capacity of the blood but we don't even know what that means since that's never actually been linked to heart disease.

NEMA: Okay. You said you considered 60 different studies in coming to your conclusions. How long a span have these studies been going on? Do these date back decades or are these all within the last few years?

RIMM: The first studies of alcohol and heart disease were published in the early 70s and since then, of the 60 or so studies, about 30 of them actually were where they had a population at the start of the study and they followed them over a certain time so they actually had specific measures of alcohol in individuals and they followed them over time to see who had heart attacks.

NEMA: Join me for part two on alcohol and the heart with Eric Rimm.

Transcripts:

Week: 518.2 Guest: Eric Rimm, Ph.D. Topic: Alcohol and The Heart - Part Two Host: Richard Roeder Producer: Ed Graham

NEMA: This is part two in a three part series on the effect of moderate alcohol consumption on heart disease. My guest is Dr. Eric Rimm from the Harvard School of Public Health.

RIMM: I think the unique thing about the alcohol/heart disease story is that they're from so many different countries and so many different types of populations across all different levels of society and there's just a very consistent finding. Almost every one of these studies finds that people who drink in moderation have a 25%-40% reduction in heart disease. So it's really one of the most consistent findings reported in the literature and it's just been only recently that people, the media or specific scientists have been pushing very hard for red wine as opposed to any alcohol-containing beverage and I think that's where they've sort of gone beyond what the data is able to show us.

NEMA: Is the mechanism or the mechanisms, are they understood as far as why this seems to be reducing heart disease?

RIMM: We do think we think we understand two of the most important mechanisms and that the first and I think by far the strongest is that in very carefully controlled experimental studies people given a set amount of alcohol over a two or three week period, you actually could watch their HDL cholesterol, their good cholesterol, go up by 10% to 20%-25% over that short period of time so there really is a cause and effect there where people are given alcohol and their HDL cholesterols go up and that's been seen in a lot of different populations where people who drink moderately tend to have higher HDL cholesterols. And the other important mechanism which we're really just starting to understand is measuring clotting factors in the blood. The ultimate event that leads to a heart attack is a blood clot so anything that can sort of slow our blood clotting or thin our blood may be important for reducing the risk of heart attacks and we do know that alcohol does have that effect on some of these clotting factors so I think those are the two best mechanisms and I think it is possible I think that there's something in red wine that may have some additional benefit. I just think it's very small and probably only explains only 1% or 3% of what we're seeing in the overall effect of alcohol and lowering risk of heart attacks.

NEMA: Obviously one of the things that's going to arise out of a study like this or a study of these studies is that the question of threshold is important because no one would argue that alcohol past a certain point contributes to as many diseases or more than it helps protect you from. What kind of quantity were you talking about and at what point does alcohol become more of a health threat than a health aid?

RIMM: That's a very complex question and a very important question to ask because whenever you talk about alcohol it really is a double-edge sword and even someone who starts out drinking only a half a drink a day, say then go on to drink a drink a day and then they can't control their consumption and go up to two and three and four so it's not like fruits and vegetables where you can say you have five and there's never a problem with an addiction problem or becoming abusive so in these very well done studies that have looked at alcohol and total mortality, in general the threshold or those people that have the longest longevity or the lowest risk of overall mortality drink in the range of one to two drinks a day. For women it's probably closer to one drink and for men it's around two drinks.

NEMA: Join me for part three on alcohol and the heart with Eric Rimm.

Transcripts:

Week: 518.3 Guest: Eric Rimm, Ph.D. Topic: Alcohol and The Heart - Part Three Host: Richard Roeder Producer: Ed Graham

NEMA: This is part three in a three part series on the positive health effects of moderate alcohol consumption on heart disease. My guest is Dr. Eric Rimm from the Harvard School of Public Health. I asked Dr. Rimm how much alcohol is considered moderate.

RIMM: For women it's probably closer to one drink and for men it's around two drinks. And along with that are all the caveats. Clearly somebody who has an alcohol problem or has existing diseases or is taking medications should really consult their physician before they get into the pattern of drinking one or two drinks a day so it's not a recommendation that can be made for everybody but among a healthy population that control their consumption, the lowest mortality tends to be among people who drink one or two drinks a day.

NEMA: And what does one or two drinks mean? Obviously a beer is not the same as liquor, is not the same as wine.

RIMM: In terms of the alcohol content, they're actually very similar. A shot of liquor will have a similar amount of alcohol as will a 12 ounce can of beer or a five ounce glass of wine. I mean, that's sort of a common portion size and that's why when we say one or two drinks we don't necessarily need to specify because they all have similar amounts of alcohol.

NEMA: How about men versus women? Now certainly in general more and more studies are showing up that show that women suffer more when they drink excessive amounts of alcohol than men do. Does the protective effect when they drink in moderation seem to be similar to the protective effect in men?

RIMM: Yes. Everything in women seems to be at slightly lower levels and that may have to do with in general women have a slightly lower ability to metabolize alcohol early on and so therefore, give a woman a can of beer and give a man a can of beer and the woman will get actually slightly more in her bloodstream because she's less able to metabolize it but therefore what you see is that men who drink two drinks a day have the lowest risk of heart disease and women who drink one or one and a half drinks a day have the lowest risk of heart disease so for women it's generally slightly less but on the other side of the coin, there has now been a number of very well conducted studies showing a slight positive association between alcohol consumption and breast cancer so for women it's much more difficult and it really has to depend on the individual woman deciding herself maybe with her physician depending on are they at highest risk for heart disease, are they at highest risk for breast cancer so a woman who has a number of risk factors for breast cancer, that is they have a family history of breast cancer, may have no children, may have very early age puberty, all those things may be risk factors for breast cancer. So someone who's at higher risk for breast cancer may want to only drink two or three times a week as opposed to once or twice a day.

NEMA: Did you see in all of these studies that you looked at any pattern of any other disease process maybe being helped or a person being protected from another disease process by the consumption of alcohol?

RIMM: We have looked at that. In these particular studies we were looking only at alcohol and heart disease but there actually is now a reasonable amount of evidence that healthy individuals who drink moderately actually don't develop diabetes as much, adult onset diabetes. We do know that alcohol actually taken with a meal may slow the overall process of metabolism of the meal and if you just go out and eat a candy bar, your blood sugar goes up very quickly, however, a candy bar - this is not a great example - but a candy bar with alcohol actually may slow the glucose and the sugar going into your bloodstream.