In Opa’s family, there
is a high risk of cardiovascular disease. Opa himself has cardiovascular disease and had life-saving
bypass surgery almost 20 years ago. At 85, he has outlived all of his 10 siblings many of whom did not survive beyond middle age.
After the bypass surgery, Opa was prescribed the
beta-blocker Sotalol to control blood pressure and the statin Lipitor to
control cholesterol. Although he took these medications faithfully for more
than 15 years, both his blood pressure and LDL cholesterol levels
remained high. Opa was also diagnosed with non-alcoholic fatty liver disease
(NAFLD) which was attributed to his diet. Four years ago, Opa decided that the side-effects of Lipitor, particularly muscle pain and fatigue, were no longer tolerable. And, against his doctor's advice, he stopped using all prescribed medications.
Opa hardly eats any meat, but he
does love cheese, cream, milk and butter. So when he discontinued the meds,
I suggested that we start drinking red wine with rich meals to help lower cholesterol (and also because I happen to like red wine). He agreed even though
he didn't particularly like wine and almost never drank alcohol.
Like many others, I have known for a long time
that moderate drinking of red wine and other alcoholic beverages is associated with a reduced risk of heart disease. But I didn’t know how much cardio protection wine offers until today.
According to the British Medical Journal, 30 grams of alcohol a day may
cause an estimated reduction of 24.7% in risk of coronary heart disease ("standard" drinks of a 5 oz glass of wine, a 12 oz can of beer, and a 1.5 oz shot of hard liquor each contain about 14 grams of alcohol).
Findings published in the American Heart Association journal showed that “drinking 1 to 2 drinks per day, 3 to 4 days per week
decreased the risk of having a heart attack by as much as 32%... and was found
to be associated with an approximately 20% reduction in the risk for ischemic
stroke and may even be beneficial in preventing subsequent strokes.”
In regard to mortality by all causes, the American Heart Association published a 2010 review showing that moderate alcohol consumption reduces the risk of mortality by all causes by 20%. (It should go without saying, but I'll mention anyway that high levels of alcohol consumption show the opposite effect.)
But what about statins?
Statins also reduce mortality. According to a recent Cochrane
review, statins reduce risk of mortality by all causes by 0.76%. Across studies, for every group of 100 patients
who did not take statins, 5.17 died within a few years, and for every group of
100 patients who took statins, 4.41 died within a few years. This positive effect, although small, is greater than the findings yielded in the previous Cochrane review which showed a 0.07% reduction in mortality.
Also noteworthy is that some 15% -
20% of patients using statins experience side effects; muscle aches, fatigue, liver toxicity, and memory loss are
among the most recognized to date.
And beta-blockers?
The Journal
of the American Medical Association (Jama) released a media statement in October
of 2012 with this headline: Beta-Blocker Use Not Associated with Lower Risk of
Cardiovascular Events. Although beta-blockers have been the standard treatment
for coronary artery disease, the 2012 review showed that “beta-blocker
use was not associated with a lower event rate of cardiovascular events at
44-month follow-up, even among patients with prior history of MI [myocardial infarction]. Further
research is warranted to identify subgroups that benefit from beta-blocker
therapy and the optimal duration of beta-blocker therapy.”
So did Opa make the right decision when he switched to wine?
Beta blockers have not been shown to have any long term cardioprotective effects. Statins have been shown to reduce the rate of mortality by nearly 1% but also have unpleasant (and sometimes dangerous) side-effects. And two drinks of red wine (or other alcoholic beverage) a few times a week have been shown to reduce the risk of mortality by 20%, the risk of heart attack by 32%, and the risk of stroke by 20%. Plus side-effects are generally pleasant. So, based on the research, it's safe to say yes, Opa made the right decision. It'a slso safe to say that he made the right decision based on the results of his check-up.
As I think I mentioned in a previous post, Opa recently returned to his doctor for a complete physical (read: he finally said yes after numerous suggestions over the past few years). Results were as follows:
· blood pressure 120/80 (normal)
· LDL cholesterol 2.1 (considered to be in the ideal range for people at risk of heart disease)
· liver function normal (confirmed by blood tests and ultrasound)
Opa’s doctor was amazed (as was I!) and wondered what might account for these results. He smiled when I suggested that it might be the red wine. His advice to Opa? “While I can’t prescribe red wine, I suggest that you just keep doing what you’re doing.”
I didn't mention it to the doctor, but I can't help but think that, in Opa's case, the dementia might also be a cardio protective factor. Or maybe not the dementia per se but its meditation-like, "living in the present" effects, coupled perhaps with our calm, low-stress home environment.
Studies consistently show the health benefits of meditation. Most striking is a 2009 study from the Medical College of Wisconsin in Milwaukee presented to the American Heart Association. Findings from the 9-year study showed that participants with coronary heart disease who practiced meditation had 47% lower rates of heart attack, stroke, and mortality by all causes compared to nonmeditating controls.
Although Opa would never have been interested in meditation or concepts like "living in the present" in younger days, I don't think this research would surprise him today. In fact, if you ask him what the secret to good health is, he will invariably respond with this:
He might also want to add: "And maybe drink a little red wine."
