The Role Of Lifestyle

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It has been suggested that differences in findings regarding specific types of drinks, and in particular the low risk seen in wine drinkers compared to other drinkers, may be due to differences in patterns of drinking and to differences in risk traits between those choosing different beverages [11]. The Kaiser Permanente Study observed wine drinkers to have the most favourable coronary risk traits and liquor (spirit) drinkers to have the least favourable traits. Interestingly, the beneficial effect of alcohol on CHD was weakest in the liquor (spirits) drinkers [18]. In this cohort ofBritish middle-aged men, about 15% reported wine drinking and these men had many advantageous characteristics. In particular, they were from a higher socio-economic background, they were more likely to be light drinkers and they had more favourable lifestyle patterns (less smoking, less obesity, more physical activity) than beer and spirit drinkers. These beneficial characteristics were to a considerable degree responsible for the lower relative risk of CHD and all cause mortality in wine drinkers compared to beer drinkers, although a significant reduction in all cause mortality largely due to cardiovascular causes persisted after adjustment.

Adjustment in multivariate analyses is unlikely to fully take into account the multiple advantageous lifestyle characteristics of wine drinkers. Furthermore, given that wine drinkers tend to come from a higher socioeconomic background, these men are likely to have other advantages not measured in this and other studies e. g., healthier diet and better access to health care. It is a matter of conjecture as to how much more of the remaining association could be due to residual confounding. A cross sectional study conducted in Copenhagen, comprising over 23,000 men and 25,000 women aged 50-64 years showed wine drinkers to have a healthier diet than non-wine drinkers [26], It seems likely that the significantly lower risk of all cause and cardiovascular mortality seen in wine drinkers in this and other studies is a consequence of the multiple healthier lifestyle characteristics and higher socio-economic status in wine drinkers resulting in lower fatality, rather than the result of a specific benefit of wine. HDL-cholesterol cannot explain the lower absolute risk of wine drinking compared to other types of alcohol drinkers as the dose-response relationship between alcohol intake and HDL-cholesterol was similar in male beer, spirit and wine drinkers [27] and wine drinkers showed identical levels of HDL-cholesterol to non-wine drinkers (Table 3.2).

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