Wine, Chocolate, and Coffee: Forbidden Joys?

Thomas F. Lüscher


Eur Heart J. 2021;42(44):4520-4522. 

In This Article


Intentionally fermented beverages existed as early as the Neolithic age; in a prehistoric burial site in a cave near Haifa, residues of 13 000-year-old beer, apparently used for ritual feasts, was found. At that time, fermentation was the only way to preserve beverages.

Today, we still enjoy alcoholic beverages in different forms, although we have lots of means for preservation. We consume the same amount of alcohol with any drink as the glass for beer is the largest, the one for wine is smaller and the smallest is used for spirits. However, the ingredients other than alcohol differ: Wine contains cardioprotective antioxidant flavonoids and resveratrol stimulating the longevity gene SIRT1.[1] Beer contains grain, mostly malted barley, but also hops and yeast. Barley grass also contains flavonoids, superoxide dismutase, and vitamins and grains polyphenols and phytosterols that also provide antioxidant effects. Whisky contains barley, yeast, and water, besides lots of alcohol.

Is alcohol good or bad? Infusion of alcohol in healthy volunteers increases muscle sympathetic nerve activity and blood pressure (Graphical Abstract).[2] Alcohol stimulates the release of corticotropin-releasing hormone in the brain, which has sympatho-excitatory effects. As such dexamethasone suppresses the pressor response of alcohol. These sympathoexcitatory effects are the reason why, after too heavy a party, we wake up at 3 am with palpitations unable to get back to sleep.

It has been implied that this sympatho-excitatory effect may explain why habitual alcohol consumption is does-dependently associated with an increase in blood pressure. However, in prospectively followed 28 848 women from the Women's Health Study and 13 455 men from the Physicians' Health Study free of baseline hypertension, CV disease, and cancer, light-to-moderate alcohol consumption decreased hypertension risk in women, but increased it in men. The threshold for hypertension risk emerged at 4 drinks per day or more in women but already at 1 drink per day or more in men.[3]

Besides its sympathoexcitatory effects, the calory intake associated with habitual alcohol consumption leads to increases in body weight, which may also contribute to the increases in blood pressure. Furthermore, the sympatho-excitatory action may explain the strong association of daily alcohol consumption with atrial fibrillation;[4] indeed, the risk of the arrhythmia increases already with one drink a day and continues to increase with any additional drink per day.

Does alcohol protect from myocardial infarction and stroke? The INTERHEART study with a case–control design (not randomized as nobody wanted to end up in the placebo group…) showed some protection with moderate alcohol consumption (i.e. up to 4 drinks/week),[5] an observation confirmed by a systematic review and meta-analysis[6] However, others have challenged that conclusion. A genetic epidemiology study involving >500 000 subjects found that the apparent protective effect of moderate alcohol intake against stroke is largely non-causal. Alcohol consumption uniformly increased blood pressure and stroke risk in that analysis and appeared to have little effect on myocardial infarction.[7] Also, concerning is the fact that alcohol consumption, even at moderate levels, is associated with adverse brain outcomes in a dose-dependent fashion including hippocampal atrophy, differences in corpus callosum microstructure, and faster decline in lexical fluency.[8] Finally, high-level alcohol consumption has been linked to dementia due to reduction in brain volume and MRI signs of brain damage (Graphical Abstract). Thus, overall alcohol provides little if any health protection.