Background: The devastating effects of heavy alcohol drinking have been long time
recognized. In the last decades, potential benefits of modest red wine drinking were suggested.
In European countries in which red wide intake is not negligible (such as France), the association
between cholesterol and cardiovascular (CV) risk was less evident, suggesting the action of
some protective molecules in red wine or other foods and drinks.
Methods: This narrative review is based on the material searched for and obtained via PubMed
up to May 2016. The search terms we used were: “red wine, cardiovascular, alcohol” in combination
with “polyphenols, heart failure, infarction”.
Results: Epidemiological and mechanistic evidence of a J-shaped relationship between red
wine intake and CV risk further supported the “French paradox”. Specific components of red
wine both in vitro and in animal models were discovered. Polyphenols and especially resveratrol
largely contribute to CV prevention mainly through antioxidant properties. They exert
beneficial effects on endothelial dysfunction and hypertension, dyslipidemia, metabolic diseases,
thus reducing the risk of adverse CV events such as myocardial infarction ischemic
stroke and heart failure. Of interest, recent studies pointed out the role of ethanol itself as a potential
cardioprotective agent, but a clear epidemiological evidence is still missing. The aim of
this narrative review is to update current knowledge on the intracellular mechanism underlying
the cardioprotective effects of polyphenols and ethanol. Furthermore, we summarized the results
of epidemiological studies, emphasizing their methodological criticisms and the need for
randomized clinical trials able to clarify the potential role of red wine consumption in reducing
Conclusion: Caution in avowing underestimation of the global burden of alcohol-related diseases
was particularly used.