It seems appropriate then to take a few steps back and see what we know about what does work. Not smoking, along with exercise and a healthy diet are unquestionably the first steps in reducing the risk of cardiovascular disease. But how is a healthy diet defined? Regular consumption of red wine has long been identified as a significant element in a heart-healthy diet, though randomized prospective clinical trials such as those used in drug development are few. Nevertheless, a positive pattern emerges for wine consumption especially with meals.
Wine consumption is known to affect cardiovascular disease risk factors in several ways: First, alcohol in moderate amounts also raises the HDL/LDL ratio, though in light of the Niaspan study the benefit of this effect seems debatable. Alcohol also helps prevent thrombosis, or clotting in the arteries which is the critical event in heart attack. A 2008 prospective clinical trial from the Netherlands pointed to additional benefits from alcohol, observing that the addition of white wine but not grape juice to the diet of postmenopausal women improved insulin sensitivity—a good thing for cardiovascular risk—while raising HDL and lowering LDL along with triglycerides, another bad actor. At a more fundamental level, tissue levels of a substance called adiponectin were increased, providing a possible explanation for less weight gain observed among middle-aged wine drinkers. A similar trial in men, looking a a broader range of alcoholic beverages, found positive effects on blood pressure and various markers of inflammation in the blood after red wine or beer consumption but not whiskey or white wine.
As anti-alcohol activists point out, alcohol also has deleterious effects on blood pressure, but intervention studies find that the threshold for this is at about 4 drinks per day. So alcohol seems to be at least acceptable if not beneficial in moderate amounts, and when combined with the long list of properties associated with the antioxidant polyphenols in wine, it seems clear that a glass or two of wine with dinner should be a central part of a heart-healthy diet.