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Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardial Infarction (PRIME)

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c6077 (Published 24 November 2010) Cite this as: BMJ 2010;341:c6077

The J-shaped curve: An evolving perspective

Ruidavets et al(1) confirm that consumption of low levels of alcohol
is associated with reduced cardiovascular mortality, but importantly, also
suggest that this effect only results in those with regular moderate
consumption, and that the effect is probably through an anti-thrombotic
action(2). Yet in spite of this, and much other evidence, there is still a
lot of resistance to this idea in the clinical and research community(3).
Perhaps it is difficult to understand why alcohol, a substance that
clearly causes harm in excess, could be beneficial in low doses.

A population genetics perspective may help. In the evolution of
thrombosis, a balance is to be achieved between the risk of early death
from traumatic haemmorhage, and the risk of later death from intramural
thrombosis of a critical artery. Whereas our species evolved in an
environment where there was a significant risk of trauma, that is no
longer true, and so the regular intake of an anti-thrombotic agent will
adjust our thrombotic tendency to the adaptive peak of our current milieu.

Low dose alcohol may not be much different to taking aspirin or
warfarin in adjusting our physiology to the new adaptive peak, but alcohol
may have fewer side-effects. Given the complexities of promoting sensible
consumption of alcohol in its currently available forms, should we not be
exploring the potential benefits of a low-dose ethanol pill for widespread
human consumption?

Mahmood Bhutta
Research Fellow, University of Oxford

1.Ruidavets JB, Ducimetiere P, Evans Aet al. Patterns of alcohol
consumption and ischaemic heart disease in culturally divergent countries:
the Prospective Epidemiological Study of Myocardial Infarction (PRIME).
BMJ (Clinical research ed;341:c6077.
2.Salem RO, Laposata M. Effects of alcohol on hemostasis. Am J Clin Pathol
2005;123 Suppl:S96-105.
3.Fillmore KM, Stockwell T, Chikritzhs T, Bostrom A, Kerr W. Moderate
alcohol use and reduced mortality risk: systematic error in prospective
studies and new hypotheses. Ann Epidemiol 2007;17:S16-23.

Competing interests: No competing interests
06 December 2010
Mahmood F Bhutta
Research Fellow
University of Oxford
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