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The debate over whether moderate alcohol consumption can offer health benefits has never been more combustible. In the past month, a federal committee of respected scientists issued a detailed report finding with “moderate certainty” that people who drink alcohol in moderation have lower all-cause mortality than those who abstain.
But just two weeks later, U.S. Surgeon General Vivek Murthy issued an advisory calling for alcoholic beverages to carry cancer warnings, arguing that Americans are uneducated about potential links between alcohol and seven types of cancer.
A key part of this debate are the dozens of studies that have been conducted in recent decades on alcohol, cardiovascular disease and cancer. Moderate alcohol consumption has been linked repeatedly to lower rates of cardiovascular disease. It has also been linked to higher rates of certain cancers. But because cardiovascular diseases are still the number one cause of death in the United States—702,880 Americans died of heart disease and 165,393 died of stroke in 2022, per the Centers for Disease Control and Prevention, compared to 608,371 deaths from all forms of cancer—moderate wine consumption is linked to a lower rate of mortality.
But anti-alcohol advocates have questioned those studies on cardiovascular disease and alcohol. They claim the studies are flawed, particularly because most studies rely on patients self-reporting their drinking habits. What’s more, they argue that many non-drinkers in studies are former drinkers who quit after becoming ill.
Now a study from Spain pushes back on those criticisms by using an innovative method to determine how much patients are drinking. They found that wine’s connection to better heart health is still strong.
Verifying Wine Consumption
The study, published Dec. 18, 2024, in the European Heart Journal, was conducted by a team of researchers at the University of Barcelona and other Spanish institutions. They analyzed data collected from 1,232 people with an average age of 68 as part of the PREDIMED trial, a large, randomized controlled study focused on the Mediterranean diet’s ability to prevent cardiovascular disease in older people.
One limitation of alcohol and health research is that it usually relies on people self-reporting their eating and drinking habits. But for this study, the researchers measured alcohol consumption using the amount of tartaric acid in subjects’ urine. By using an objective biological indicator, the researchers could be certain about the amount that people drank—and therefore draw stronger conclusions about the link between wine and the risk of heart disease.
Comparing the subjects’ urinary tartaric acid concentration with the occurrence of heart problems—heart attack, stroke, heart failure and death from heart issues—over a follow-up period of 9 years, the researchers found that light-to-moderate wine drinking correlated with a lower risk of cardiovascular disease, especially heart attacks. The researchers hypothesize in their report that “the bioactive compounds present in wine,” especially polyphenols, “may play a role in lowering the risk of cardiovascular disease.”
Researchers observed a significant reduction in risk in people who drank between 3 and 35 glasses of wine per month, as measured by the concentration of tartaric acid in their urine. The reduction was slightly greater in people who drank between 12 and 35 glasses per month compared to people who drank between 3 and 12 glasses per month. People who drank less than 3 or more than 35 glasses per month did not experience a significant risk reduction.
Carefully Adjusting for Confounding Factors
The authors note that “wine was not the only source of alcohol intake in PREDIMED participants, and exposure to 3 to 35 glasses of wine per month may reflect a higher total amount of alcohol.” More study is needed to determine how other types of alcohol, in conjunction with wine, may impact heart health.
The authors caution that their study looked at an older Mediterranean population at high risk of cardiovascular disease, so their results may not apply to other groups. When they looked specifically at the data for female participants, the statistical association was weaker than with men. The researchers say this effect could be explained by the lower number of cardiovascular events among women in the study cohort.
Though the study is observational, meaning it can’t establish causation, the researchers carefully controlled for a number of variables, including age, sex, smoking, education and physical activity. The researchers emphasize that point in their text. “The observed association between wine consumption and a lower incidence of cardiovascular events in the group with moderate levels of tartaric acid in their urine should be solely attributed to their wine consumption.”
Strong Confirmation of a Link Between Wine and a Healthy Heart
The European Heart Journal published an editorial alongside the study by three researchers at the European Neurological Institute in Pozzilli, Italy, who were not involved in the study. In the editorial, the scientists say the study “provides compelling evidence for [moderate wine consumption’s] association with lower cardiovascular disease risk.”
The authors point out that even after putting better controls in place, the evidence of a link between wine and a healthy heart is strong. While a randomized controlled trial on the health effects of moderate wine consumption remains elusive, alcohol studies have never been better. “The most important biases, such as exclusion of former drinkers from the reference group, participant selection and lifestyle-related confounding factors, have been accounted for in order to achieve more accurate and reliable results.”
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