EVIDENCE-BASED ANSWER
YES. Moderate daily red wine consumption decreases cardiovascular risk compared with either abstinence or heavy and binge drinking (strength of recommendation [SOR]: B, meta-analysis of prospective cohort and case-control studies); however, not enough evidence exists to determine whether wine reduces cardiovascular risk more than other alcoholic beverages.
A high dietary intake of flavonoids, contained in red wine and other food products, correlates with decreased mortality from coronary heart disease (CHD) (SOR: B, meta-analysis of prospective cohort studies).
Heavy alcohol drinking is associated with an increased risk of stroke, but data are lacking for low and moderate levels of wine consumption. (SOR: B, meta-analysis of prospective cohort and case-control studies).
Evidence summary
A 2-part meta-analysis of 26 studies enrolling men, women, or both, showed a significant inverse association between red wine consumption and fatal and nonfatal cardiovascular events. The first part, encompassing 13 studies (5 prospective cohort and 8 case-control studies with a total of 209,418 participants), compared moderate wine drinkers with non-drinkers and heavy or binge drinkers. Moderate drinkers consumed an average of 1 to 2 drinks per day.1 This meta-analysis, and other studies described in this summary, defined a drink as 130 mL of wine with 12% ethanol content.
For all 13 studies combined, moderate wine drinking significantly reduced cardiovascular events at 2 to 24 years of follow-up compared with no drinking and heavy drinking (relative risk [RR]=0.68; 95% confidence interval [CI], 0.59-0.77). A pool of the 7 studies that enrolled both male and female participants also found that wine drinking significantly reduced cardiovascular events (RR=0.53; 95% CI, 0.42-0.68). However, pooled results from the 6 studies with exclusively male participants found no difference in cardiovascular events with wine consumption (RR=0.87; 95% CI, 0.68-1.12). Beer drinking, which was also evaluated, produced statistically significant risk reductions in studies of both men and women; the effect was smaller in men-only studies.1
CV risk decreases with increased wine intake—to a point
The second part of the meta-analysis, 7 prospective cohort and 3 case-control studies with a total of 176,042 participants, found an apparent J-shaped dose-response relationship between wine intake and cardiovascular risk reduction. Daily consumption ranged from 0 to 1738 mL, although most participants had 0 to 3 drinks (390 mL) per day. Data from the 7 prospective studies illustrated a progressive decrease in cardiovascular risk as wine intake increased to 150 mL per day. Consuming larger amounts of wine (as much as 750 mL per day) showed a trend toward further cardiovascular risk reduction, but the trend wasn’t statistically significant.1
High flavonoid intake is associated with lower CHD mortality
A meta-analysis of 7 prospective cohort studies including 105,000 men and women 30 to 84 years of age indicated that a high dietary intake of flavonoids (present in larger amounts in red wine, chocolate, tea, and other foods) correlated with reduced CHD mortality. Participants whose flavonoid consumption was in the highest third had significantly less CHD mortality than participants in the bottom third (RR=0.80; 95% CI, 0.69-0.93; P<.001). The meta-analysis couldn’t determine whether the flavonoid content of red wine confers additional cardiovascular benefit beyond that of alcohol alone.2