Spożycie niewielkich ilości alkoholu działa kardioprotekcyjnie – czy na pewno ?

Sierpień 27, 2014  |  Udostępnij  | 

Od lat, na podstawie wyników wielu badań obserwacyjnych, uznaje się, że spożycie umiarkowanej ilości alkoholu ma działanie kardioprotekcyjne. Wykres opisujący ryzyko zdarzeń sercowo-naczyniowych w zależności od liczby przyjmowanych tygodniowo jednostek etanolu tworzy tak zwaną krzywą J – ryzyko rośnie wraz ze wzrostem liczby spożytych jednostek, ale wcale nie jest najmniejsze w przypadku abstynentów. Sytuacja ta może wydawać się dziwna, jeśli przeanalizuje się oddziaływanie tego związku na organizm człowieka. Światowe statystyki plasują alkohol na piątym miejscu wśród wiodących czynników ryzyka zgonu i niepełnosprawności – jest on główną (obok chorób wirusowych) przyczyną marskości wątroby, uznanym czynnikiem ryzyka wielu nowotworów oraz najczęstszym powodem wypadków i urazów. Nic więc dziwnego, że znaleźli się naukowcy chcący jeszcze dokładniej przyjrzeć się wpływowi etanolu na układ sercowo-naczyniowy.

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W artykule[1] opublikowanym na łamach British Medical Journal możemy przeczytać o rezultatach ich wyjątkowo pomysłowego eksperymentu z zastosowaniem metod biologii molekularnej. Na wstępie naukowcy biorący udział w projekcie uzyskali dostęp do rejestrów wcześniej przeprowadzonych badań, w których mapowano polimorfizm genu ADH1B kodującego dehydrogenazę alkoholową, enzym odpowiedzialny za metabolizowanie alkoholu etylowego. Łącznie potrzebne informacje uzyskano dla ponad 260 tys. osób, spośród których 48% stanowiły kobiety. Średni wiek w badanej populacji wynosił 58 lat. Jak wykazano, posiadacze mutacji rs1229984 tego genu (tzw. allel A) są wyjątkowo podatni na działanie etanolu – spożycie już niewielkiej ilości przypłacają zawrotami głowy i nudnościami, co sprawia, że statystycznie piją mniej. Nosiciele allelu A i osoby z innym wariantem genu ADH1B były porównywane pod względem występowania choroby wieńcowej wraz jej następstwami, udarów mózgu oraz cukrzycy typu 2. Według przeprowadzonych ankiet osoby obciążone złą tolerancją alkoholu spożywały statystycznie 17,2% mniej jednostek alkoholu w tygodniu, niż to miało miejsce w przypadku osób z niezaburzoną reakcją na etanol, a ponadto istotnie częściej podawały całkowitą abstynencję. Jednocześnie nosiciele allelu A mieli statystycznie lepszy profil czynników ryzyka sercowo-naczyniowego – rzadziej cierpieli na nadciśnienie tętnicze, otyłość czy hipercholesterolemię (statystycznie niższe poziomy LDL). Po podsumowaniu zebranych danych okazało się, że miało to swoje przełożenie na zmniejszenie ryzyka rozwoju choroby niedokrwiennej serca i udaru niedokrwiennego mózgu, ale nie wpłynęło istotnie na rozwój cukrzycy typu 2. Co ważne nie zaobserwowano tak zwanej krzywiej J – wśród osób badanych, im mniejsza ilość spożywanego tygodniowo alkoholu, tym statystycznie mniejsze ryzyko zdarzeń sercowo-naczyniowych, z najniższym ryzykiem w przypadku całkowitej abstynencji.

Przedstawione wyniki przeczą dotychczasowym ustaleniom pochodzącym z badań obserwacyjnych, które to przez lata utwierdzały kardiologów w poglądzie, iż przysłowiowy „kieliszek wina do kolacji” może mieć efekt prozdrowotny. Wydaje się więc, że przynajmniej chorych z najwyższym ryzykiem sercowo-naczyniowym powinniśmy zachęcać do redukcji spożycia alkoholu (nawet jeśli już piją niewiele), a docelowo do całkowitej abstynencji.

1. Holmes MV et al., Associationbetweenalcoholandcardiovasculardisease:Mendelianrandomizationanalysisbasedonindividual participantdata. BMJ. 2014 Jul 10;349:g4164


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