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Gianni Testino, Valentino Patussi, Emanuele Scafato, Ornella Ancarani, Paolo Borro, Alcohol, Cardiovascular Disease and Cancer, Alcohol and Alcoholism, Volume 48, Issue 5, September/October 2013, Pages 627–628, https://doi.org/10.1093/alcalc/agt064
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We have read the excellent paper by Chiva-Blanch et al. (2013). The Authors affirm that moderate alcohol consumption (30 g/day for men and 15 g/day for women), expecially in the form of wine and beer, has cardioprotective effects through different mechanisms. Moreover, they report that three or more drinks per day may increase the risk of hypertention, stroke and breast cancer.
Recently, the International Agency for Cancer Research (IARC—WHO: World Health Organization) (IARC, 2010, 2012) has demonstrated sufficient evidence in humans for the carcinogenicity of alcohol consumption. Alcohol consumption causes cancers of the oral cavity, pharynx, larynx, oesophagus, colorectum, liver (hepatocellular carcinoma) and female breast. Also, an association has been observed between alcohol consumption and cancer of the pancreas.
There is sufficient evidence in humans for the carcinogenicity of acetaldehyde associated with the consumption of alcoholic beverages. Acetaldehyde associated with the consumption of alcoholic beverages causes cancer of the oesophagus and of the upper aerodigestive tract combined.
There is sufficient evidence in experimental animals for the carcinogenicity of ethanol. There is sufficient evidence in experimental animals for the carcinogenicity of acetaldehyde.
Therefore:
alcohol consumption is carcinogenic to humans (group 1),
ethanol in alcoholic beverages is carcinogenic to humans (group 1),
acetaldehyde associated with the consumption of alcoholic beverages is carcinogenic to humans (group 1).
It is well known that light drinking (up to 1 drink/day) increases the risk of cancer of oral cavity and pharynx, oesophagus and female breast (Bagnardi et al., 2013). Previously, Allen et al. (2009) have systematically surveyed >1 million women who between 1996 and 2001 attended breast cancer screening clinics in the United Kingdom. They found that after 7 years of follow-up, even light to moderate levels of alcohol consumption were predictive of an increased risk of several common cancers, including those of breast, rectum, liver, oesophagus and oropharynx.
Moreover, drinking alcohol is well known to be positively associated with the development of hypertension, arrhythmias and haemorrhagic stroke.
Alcohol consumption is linearly related to increased blood pressure, arrhythmias (mainly atrial fibrillation) and haemorrhagic stroke (Higashiyama et al., 2013).
Goldberg underlines how the data on alcohol and cardiovascular disease are still correlative, whereas the toxic effects of alcohol are well established. Perhaps that is why some studies show a reduction in cardiovascular disease, but not overall mortality, in patients who drink alcoholic beverages (Goldberg, 2003). In the era of evidence-based medicine, controlled clinical trials are required to introduce new therapies into a clinic (Goldberg, 2003).
For all these reasons, in Australia, the National Heart Foundation (National Heart Foundation of Australia, 2010) explicitly advises against the consumption of red wine and other type of alcoholic drinks for the preventing or treatment of heart disease and WHO suggests that a greater reduction in death from ischaemic heart disease can be more effectively obtained by being physically active and eating a healthier diet than by drinking a low dose of alcohol (WHO, 2012).
More recently, Lachenmeier et al. (2012) have revealed how alcoholic beverages are multicomponent mixtures containing several carcinogenic compunds. Fifteen known and suspected human carcinogens (ethanol, acetaldehyde, acrylamide, aflatoxins, arsenic, benzene, cadmium, ethyl carbamate, formaldehyde, furan, lead, 4-methylimidazole, N-nitrosodimethylamine, ochratoxin A and safrole) occurring in alcoholic beverages were identified. The Margin of Exposure (MOE) approach was used for comparative risk assessment. MOE compares a toxicological threshold with the exposure. MOEs above 10,000 are judged as low priority for risk management action. The lowest MOES were found for ethanol (3.1 for ore standard drink per day).
Therefore, in our opinion, medical professionalism includes the responsibility to advice general population that there is no level of ‘moderate and regular’ consumption that can be considered safe (Testino, 2008; Testino et al., 2012). In particular, we agree with Coltart et al. (2011) ‘medical professionalism includes the responsibility to speak out, to lead, and to voice advocacy. It is every clinician's responsibility to address alcohol harm, both on a daily basis with individual patients and in the wider context of health harms and inequalities at the population levels. The voice of doctors is valuated and trusted within societies, and therefore, we call on all doctors to show effective leadership by holding ministries of health accountable for their lack of action in the face of such robust evidence’.
In conclusion, according to Goldberg, with respect to the prevention of cardiovascular disease, since a number of preventive measures, such as exercise, smoking cessation and lowering of cholesterol levels and blood pressure, do not have undesirable effects of alcohol. In particular, the substitution of one disease for another is not a medical and ethical advance (Goldberg, 2003).