Perspectives in Pharmacology Alcohol Use, Vascular Disease, and Lipid-Lowering Drugs

Many epidemiological and clinical studies have shown that light-to-moderate alcohol (Alc) consumption is associated with reduced risk of coronary heart disease (CHD) and total mortality in middle-aged and elderly men and women. The plausible mechanisms for the putative cardioprotective effects include increased levels of high-density lipoprotein cholesterol, prevention of clot formation, reduced platelet aggregation, promotion of blood clot dissolution, and lowering of plasma lipoprotein (a) concentration. Individuals who need to be treated with lipidlowering drugs, such as dyslipidemic or CHD patients, may benefit from these effects of Alc. Because hypolipidemic treatment is usually continued for life, an important issue is the suitability of Alc consumption in these patients. In the present review, the beneficial effects of Alc consumption on CHD risk, its side effects, and its safety and suitability when coadministered with hypolipidemic drugs are discussed. Many epidemiological and clinical studies have shown that light-to-moderate alcohol (Alc) consumption is associated with reduced risk of coronary heart disease (CHD) and total mortality in the middle-aged and elderly of both genders (Rimm et al., 1999; Rehm et al., 2003). Men and women who consume a moderate amount of Alc, defined as one to four and one to two drinks, respectively, for 5 or 6 days per week had substantial reduction of major coronary events compared with nondrinkers [odds ratios: men 0.31 (95% confidence interval 0.22 to 0.45); women 0.33 (0.18 to 0.59)] (McElduff and Dobson, 1997). One thousand years ago, a “prescientific” observation of the beneficial effect of Alc was described by Hildegard of Bingen (1098–1179; Bingen, Germany), who applied a special “wine recipe” to treat cardiovascular disease (Böhm et al., 2004). The inverse alcohol-atherosclerosis association was also pointed out by pathologists early in the previous century. At the same time, there is no doubt that treatment with lipid-lowering drugs has decreased cardiovascular disease mortality (Collins et al., 2003; Harrington, 2004). Treatment with lipid-lowering drugs is recommended for lifetime, unless there are contraindications. The question is whether physicians can also recommend social Alc consumption to their patients while they are on lipid-lowering drug therapy. This review focuses on the issue of concomitant Alc consumption and lipid-lowering drug use.