饮酒对心血管系统影响的双向效应争论中的共识与分歧

doi:10.12114/j.issn.1007-9572.2022.0299

中国全科医学 ›› 2022, Vol. 25 ›› Issue (30): 3747-3754.DOI: 10.12114/j.issn.1007-9572.2022.0299

所属专题：指南/共识最新文章合集

饮酒对心血管系统影响的双向效应争论中的共识与分歧

任金霞¹^,², 骆雷鸣¹^,^*()

1．100039　北京市，驻京局北京老干部活动中心
2．100853　北京市，中国人民解放军总医院第二医学中心心内科

收稿日期:2022-04-28 修回日期:2022-05-25 出版日期:2022-10-20 发布日期:2022-06-27
通讯作者: 骆雷鸣
任金霞，骆雷鸣.饮酒对心血管系统影响的双向效应争论中的共识与分歧[J].中国全科医学，2022，25（30）：3747-3754.[www.chinagp.net]
作者贡献：任金霞负责选题、建立立论观点及查阅文献、整理研究结果、分析观点；骆雷鸣负责对选题指导，对文章涉及观点及立论依据进行审阅和修订，对文章整体负责。

Consensus and Disagreement in the Debate on the Bidirectional Effects of Alcohol Consumption on the Cardiovascular System

Jinxia REN¹^,², Leiming LUO¹^,^*()

1. Beijing Veteran Cadre Activity Center of Beijing Bureau, Beijing 100039, China
2. Department of Cardiology, Second Medical Center, PLA General Hospital, Beijing 100853, China

Received:2022-04-28 Revised:2022-05-25 Published:2022-10-20 Online:2022-06-27
Contact: Leiming LUO
About author:
REN J X, LUO L M. Consensus and disagreement in the debate on the bidirectional effects of alcohol consumption on the cardiovascular system[J]. Chinese General Practice, 2022, 25 (30) : 3747-3754.

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摘要/Abstract

摘要： 当今世界饮用酒精饮料的人群日益增加。饮酒可诱发多种疾病，对人类健康构成严重威胁，但其对心血管系统是否存在积极影响尚有争议。传统观念认为，少到中等量饮酒（女性每日摄取纯酒精≤ 1个标准量，男性每日摄取纯酒精≤ 2个标准量，1个标准量=12~15 g纯酒精）可能有益于治疗心血管系统疾病（如动脉粥样硬化性心血管疾病），而过量饮酒（每日摄取纯酒精> 2个标准量）则会导致心血管系统损害，即"J"型曲线的双向效应。近年来，针对上述传统观念是否正确的争论愈演愈烈，并涉及饮酒方式、酒精饮料类型及所影响的不同类型心血管疾病等诸多方面。本文通过汇总、分析国内外相关研究的最新成果，讨论饮酒对心血管系统影响的双向效应争论中的共识与分歧，发现尽管目前相关研究并未形成一致观点，但多数研究结果提示，少到中等量饮酒可能有益于心血管健康，尤其是对于中老年人及已存在动脉粥样硬化性心血管疾病的患者，可为今后制订与心血管疾病防控相关的生活方式干预指南提供思路。

关键词: 心血管系统, 饮酒, 酒精性饮料, 酗酒, "J"型曲线效应, 葡萄酒, 异议和争论

Abstract:

Today's world, there is an increasing number of people drinking alcoholic beverages. Drinking alcohol can induce several diseases and is a serious threat to human health, but whether it has a positive effect on the cardiovascular system is controversial. Traditional beliefs have suggested that small to moderate amounts of alcohol consumption (female intake of ≤ 1 standard amounts of alcoholic beverages daily, male intake of ≤ 2 standard amounts of alcoholic beverages daily, 1 standard amounts of alcoholic beverages=12-15 g pure ethanol) might be beneficial for the treatment of cardiovascular diseases (such as atherosclerotic cardiovascular disease) , whereas heavy drinking (intake of > 2 standard amounts of alcoholic beverages daily) leads to impairment of the cardiovascular system, the bidirectional effect of a "J" - shaped curve. In recent years, there has been a growing debate on whether traditional ideas are correct, involving many aspects such as the pattern of drinking, the type of alcoholic beverage and the different types of CVD that they affect. This article discusses the consensus and disagreement in the debate on bidirectional effects of drinking on cardiovascular system by pooling and analyzing recent results from relevant studies at home and abroad, finding that although there is no consistent view in the current relevant studies, most research results suggest that small to moderate alcohol consumption may benefit cardiovascular health, especially in middle-aged and elderly people with pre-existing atherosclerosis and cardiovascular disease. It may provide ideas for developing lifestyle intervention guidelines for cardiovascular disease prevention and control in the future.

Key words: Cardiovascular system, Alcohol drinking, Alcoholic beverages, Binge drinking, "J" curve effect, Wine, Dissent and disputes

任金霞,骆雷鸣. 饮酒对心血管系统影响的双向效应争论中的共识与分歧[J]. 中国全科医学, 2022, 25(30): 3747-3754. DOI: 10.12114/j.issn.1007-9572.2022.0299.
Jinxia REN,Leiming LUO. Consensus and Disagreement in the Debate on the Bidirectional Effects of Alcohol Consumption on the Cardiovascular System[J]. Chinese General Practice, 2022, 25(30): 3747-3754. DOI: 10.12114/j.issn.1007-9572.2022.0299.

参考文献 55

[1]	ANDERSON P. The impact of alcoholic beverages on human health[J]. Nutrients，2021，13(12):4417. DOI：10.3390/nu13124417.
[2]	NUTT D, HAYES A, FONVILLE L，et al. Alcohol and the brain[J]. Nutrients，2021，13(11):3938. DOI：10.3390/nu13113938.
[3]	XI B, VEERANKI S P, ZHAO M，et al. Relationship of alcohol consumption to all-cause，cardiovascular，and cancer-related mortality in US adults[J]. J Am Coll Cardiol，2017，70(8):913-922. DOI：10.1016/j.jacc.2017.06.054.
[4]	VAN DE LUITGAARDEN I A T, SCHRIEKS I C, KIENEKER L M，et al. Urinary ethyl glucuronide as measure of alcohol consumption and risk of cardiovascular disease：a population-based cohort study[J]. J Am Heart Assoc，2020，9(7):e014324. DOI：10.1161/JAHA.119.014324.
[5]	CÍFKOVÁ R, KRAJCOVIECHOVÁ A. Alcohol and cardiovascular disease：position paper of the Czech society of cardiology[J]. Cent Eur J Public Health，2019，27 Suppl:S6-9. DOI：10.21101/cejph.a5998.
[6]	YAN J J, THOMSON J K, ZHAO W W，et al. Role of stress kinase JNK in binge alcohol-evoked atrial arrhythmia[J]. J Am Coll Cardiol，2018，71(13):1459-1470. DOI：10.1016/j.jacc.2018.01.060.
[7]	FERNÁNDEZ-SOLÀ J. Cardiovascular risks and benefits of moderate and heavy alcohol consumption[J]. Nat Rev Cardiol，2015，12(10):576-587. DOI：10.1038/nrcardio.2015.91.
[8]	POPOVA S, DOZET D, SHIELD K，et al. Alcohol's impact on the fetus[J]. Nutrients，2021，13(10):3452. DOI：10.3390/nu13103452.
[9]	RUMGAY H, MURPHY N, FERRARI P，et al. Alcohol and cancer：epidemiology and biological mechanisms[J]. Nutrients，2021，13(9):3173. DOI：10.3390/nu13093173.
[10]	OKARU A O, LACHENMEIER D W. Margin of exposure analyses and overall toxic effects of alcohol with special consideration of carcinogenicity[J]. Nutrients，2021，13(11):3785. DOI：10.3390/nu13113785.
[11]	POHL K, MOODLEY P, DHANDA A D. Alcohol's impact on the gut and liver[J]. Nutrients，2021，13(9):3170. DOI：10.3390/nu13093170.
[12]	CHIKRITZHS T, LIVINGSTON M. Alcohol and the risk of injury[J]. Nutrients，2021，13(8):2777. DOI：10.3390/nu13082777.
[13]	FONG M, SCOTT S, ALBANI V，et al. 'Joining the dots’：individual，sociocultural and environmental links between alcohol consumption，dietary intake and body weight-a narrative review[J]. Nutrients，2021，13(9):2927. DOI：10.3390/nu13092927.
[14]	REHM J, ROVIRA P, LLAMOSAS-FALCÓN L，et al. Dose-response relationships between levels of alcohol use and risks of mortality or disease，for all people，by age，sex，and specific risk factors[J]. Nutrients，2021，13(8):2652. DOI：10.3390/nu13082652.
[15]	RUMGAY H, SHIELD K, CHARVAT H，et al. Global burden of cancer in 2020 attributable to alcohol consumption：a population-based study[J]. Lancet Oncol，2021，22(8):1071-1080. DOI：10.1016/S1470-2045(21)00279-5.
[16]	ROERECKE M. Alcohol's impact on the cardiovascular system[J]. Nutrients，2021，13(10):3419. DOI：10.3390/nu13103419.
[17]	DUDLEY R, MARO A. Human evolution and dietary ethanol[J]. Nutrients，2021，13(7):2419. DOI：10.3390/nu13072419.
[18]	WHITMAN I R, AGARWAL V, NAH G，et al. Alcohol abuse and cardiac disease[J]. J Am Coll Cardiol，2017，69(1):13-24. DOI：10.1016/j.jacc.2016.10.048.
[19]	BELL S, DASKALOPOULOU M, RAPSOMANIKI E，et al. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases：population based cohort study using linked health records[J]. BMJ，2017，356:j909. DOI：10.1136/bmj.j909.
[20]	O'KEEFE E L, DINICOLANTONIO J J, O'KEEFE J H，et al. Alcohol and CV health：Jekyll and Hyde J-curves[J]. Prog Cardiovasc Dis，2018，61(1):68-75. DOI：10.1016/j.pcad.2018.02.001.
[21]	SPIEGELMAN D, LOVATO L C, KHUDYAKOV P，et al. The Moderate Alcohol and Cardiovascular Health Trial （MACH15）：design and methods for a randomized trial of moderate alcohol consumption and cardiometabolic risk[J]. Eur J Prev Cardiol，2020，27(18):1967-1982. DOI：10.1177/2047487320912376.
[22]	DI CASTELNUOVO A, COSTANZO S, BAGNARDI V，et al. Alcohol dosing and total mortality in men and women：an updated meta-analysis of 34 prospective studies[J]. Arch Intern Med，2006，166(22):2437-2445. DOI：10.1001/archinte.166.22.2437.
[23]	CHIVA-BLANCH G, BADIMON L. Benefits and risks of moderate alcohol consumption on cardiovascular disease：current findings and controversies[J]. Nutrients，2019，12(1):E108. DOI：10.3390/nu12010108.
[24]	MAUGERI A, HLINOMAZ O, AGODI A，et al. Is drinking alcohol really linked to cardiovascular health? Evidence from the kardiovize 2030 project[J]. Nutrients，2020，12(9):E2848. DOI：10.3390/nu12092848.
[25]	MANOLIS T A, MANOLIS A A, MANOLIS A S. Cardiovascular effects of alcohol：a double-edged sword/how to remain at the nadir point of the J-curve? [J]. Alcohol，2019，76:117-129. DOI：10.1016/j.alcohol.2018.08.011.
[26]	OPPENHEIMER G M, BAYER R. Is moderate drinking protective against heart disease? The science，politics and history of a public health conundrum[J]. Milbank Q，2020，98(1):39-56. DOI：10.1111/1468-0009.12437.
[27]	HOLMES M V, DALE C E, ZUCCOLO L，et al. Association between alcohol and cardiovascular disease：Mendelian randomisation analysis based on individual participant data[J]. BMJ，2014，349:g4164. DOI：10.1136/bmj.g4164.
[28]	MILLWOOD I Y, WALTERS R G, MEI X W，et al. Conventional and genetic evidence on alcohol and vascular disease aetiology：a prospective study of 500 000 men and women in China[J]. Lancet，2019，393(10183):1831-1842. DOI：10.1016/S0140-6736(18)31772-0.
[29]	KNOX J, SCODES J, WITKIEWITZ K，et al. Reduction in World Health Organization risk drinking levels and cardiovascular disease[J]. Alcohol Clin Exp Res，2020，44(8):1625-1635. DOI：10.1111/acer.14386.
[30]	MOISSL A P, DELGADO G E, KRÄMER B K，et al. Alcohol consumption and mortality：the Ludwigshafen Risk and Cardiovascular Health （LURIC） study[J]. Atherosclerosis，2021，335:119-125. DOI：10.1016/j.atherosclerosis.2021.08.014.
[31]	YUSUF S, JOSEPH P, RANGARAJAN S，et al. Modifiable risk factors，cardiovascular disease，and mortality in 155 722 individuals from 21 high-income，middle-income，and low-income countries （PURE）：a prospective cohort study[J]. Lancet，2020，395(10226):795-808. DOI：10.1016/S0140-6736(19)32008-2.
[32]	LANKESTER J, ZANETTI D, INGELSSON E，et al. Alcohol use and cardiometabolic risk in the UK Biobank：a Mendelian randomization study[J]. PLoS One，2021，16(8):e0255801. DOI：10.1371/journal.pone.0255801.
[33]	ROSOFF D B, DAVEY SMITH G, MEHTA N，et al. Evaluating the relationship between alcohol consumption，tobacco use，and cardiovascular disease：a multivariable Mendelian randomization study[J]. PLoS Med，2020，17(12):e1003410. DOI：10.1371/journal.pmed.1003410.
[34]	JACKSON C L, HU F B, KAWACHI I，et al. Black-White differences in the relationship between alcohol drinking patterns and mortality among US men and women[J]. Am J Public Health，2015，105(Suppl 3):S534-543. DOI：10.2105/AJPH.2015.302615.
[35]	SCHOOLING C M, SUN W J, HO S Y，et al. Moderate alcohol use and mortality from ischaemic heart disease：a prospective study in older Chinese people[J]. PLoS One，2008，3(6):e2370. DOI：10.1371/journal.pone.0002370.
[36]	YUSUF S, HAWKEN S, OUNPUU S，et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries （the INTERHEART study）：case-control study[J]. Lancet，2004，364(9438):937-952. DOI：10.1016/S0140-6736(04)17018-9.
[37]	JANKHOTKAEW J, BUNDHAMCHAROEN K, SUPHANCHAIMAT R，et al. Associations between alcohol consumption trajectory and deaths due to cancer，cardiovascular diseases and all-cause mortality：a 30-year follow-up cohort study in Thailand[J]. BMJ Open，2020，10(12):e038198. DOI：10.1136/bmjopen-2020-038198.
[38]	MOSTOFSKY E, CHAHAL H S, MUKAMAL K J，et al. Alcohol and immediate risk of cardiovascular events：a systematic review and dose-response meta-analysis[J]. Circulation，2016，133(10):979-987. DOI：10.1161/CIRCULATIONAHA.115.019743.
[39]	KEYS A, MENOTTI A, KARVONEN M J，et al. The diet and 15-year death rate in the seven countries study[J]. Am J Epidemiol，1986，124(6):903-915. DOI：10.1093/oxfordjournals.aje.a114480.
[40]	SCHWINGSHACKL L, MORZE J, HOFFMANN G. Mediterranean diet and health status：active ingredients and pharmacological mechanisms[J]. Br J Pharmacol，2020，177(6):1241-1257. DOI：10.1111/bph.14778.
[41]	DINU M, PAGLIAI G, CASINI A，et al. Mediterranean diet and multiple health outcomes：an umbrella review of meta-analysis of observational studies and randomised trials[J]. Eur J Clin Nutr，2018，72(1):30-43. DOI：10.1038/ejcn.2017.58.
[42]	RENAUD S, DE LORGERIL M. Wine，alcohol，platelets，and the French paradox for coronary heart disease[J]. Lancet，1992，339(8808):1523-1526. DOI：10.1016/0140-6736(92)91277-f.
[43]	LIBERALE L, BONAVENTURA A, MONTECUCCO F，et al. Impact of red wine consumption on cardiovascular health[J]. Curr Med Chem，2019，26(19):3542-3566. DOI：10.2174/0929867324666170518100606.
[44]	DITANO-VÁZQUEZ P, TORRES-PEÑA J D, GALEANO-VALLE F，et al. The fluid aspect of the Mediterranean diet in the prevention and management of cardiovascular disease and diabetes：the role of polyphenol content in moderate consumption of wine and olive oil[J]. Nutrients，2019，11(11):E2833. DOI：10.3390/nu11112833.
[45]	BAGETTA D, MARUCA A, LUPIA A，et al. Mediterranean products as promising source of multi-target agents in the treatment of metabolic syndrome[J]. Eur J Med Chem，2020，186:111903. DOI：10.1016/j.ejmech.2019.111903.
[46]	STEPHAN L S, ALMEIDA E D, MARKOSKI M M，et al. Red wine，resveratrol and atrial fibrillation[J]. Nutrients，2017，9(11):E1190. DOI：10.3390/nu9111190.
[47]	GEPNER Y, GOLAN R, HARMAN-BOEHM I，et al. Effects of initiating moderate alcohol intake on cardiometabolic risk in adults with type 2 diabetes：a 2-year randomized，controlled trial[J]. Ann Intern Med，2015，163(8):569-579. DOI：10.7326/M14-1650.
[48]	OSORIO-PAZ I, BRUNAUER R, ALAVEZ S. Beer and its non-alcoholic compounds in health and disease[J]. Crit Rev Food Sci Nutr，2020，60(20):3492-3505. DOI：10.1080/10408398.2019.1696278.
[49]	WOTHERSPOON A, ELSHAHAT S, MCALINDEN N，et al. Effect of moderate red wine versus vodka consumption on inflammatory markers related to cardiovascular disease risk：a randomized crossover study[J]. J Am Coll Nutr，2020，39(6):495-500. DOI：10.1080/07315724.2019.1695234.
[50]	MUKAMAL K J, STAMPFER M J, RIMM E B. Genetic instrumental variable analysis：time to call Mendelian randomization what it is. The example of alcohol and cardiovascular disease[J]. Eur J Epidemiol，2020，35(2):93-97. DOI：10.1007/s10654-019-00578-3.
[51]	KOZELA M, DORYNSKA A, BOBAK M，et al. Alcohol use disorder increases the risk of nonfatal and fatal cardiovascular disease：an 11-year follow-up of a Polish population-based cohort. The HAPIEE study[J]. Pol Arch Intern Med，2020，130(11):960-966. DOI：10.20452/pamw.15616.
[52]	MASIP J, GERMÀ LLUCH J R. Alcohol，health and cardiovascular disease[J]. Rev Clin Esp，2021，221(6):359-368. DOI：10.1016/j.rceng.2019.07.001.
[53]	MINZER S, LOSNO R A, CASAS R. The effect of alcohol on cardiovascular risk factors：is there new information? [J]. Nutrients，2020，12(4):E912. DOI：10.3390/nu12040912.
[54]	DE GAETANO G, COSTANZO S, DI CASTELNUOVO A，et al. Effects of moderate beer consumption on health and disease：a consensus document[J]. Nutr Metab Cardiovasc Dis，2016，26(6):443-467. DOI：10.1016/j.numecd.2016.03.007.
[55]	HASEEB S, ALEXANDER B, BARANCHUK A. Wine and cardiovascular health：a comprehensive review[J]. Circulation，2017，136(15):1434-1448. DOI：10.1161/CIRCULATIONAHA.117.030387.

饮酒对心血管系统影响的双向效应争论中的共识与分歧

Consensus and Disagreement in the Debate on the Bidirectional Effects of Alcohol Consumption on the Cardiovascular System

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