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Our blood vessels are not simply passive conduits, but are actively engaged in self-preserving defenses against the stresses they must put up with every millisecond. This is particularly true of arteries, vital carriers of blood laden with oxygen and nutrients to our tissues under high pressure and often amid punishing turbulence. As defenses inevitably will eventually falter, determined by genetic and lifestyle factors, atherosclerosis develops, risking heart attack, stroke and other complications, the by-far most common causes of disability and death in the developed world.
It is the innermost layer of the arterial wall, the intima or endothelium, that is the primary site of atherosclerosis. Deposits of noxious fats and inflammatory cells begin to be laid down long before detectable signs of the disease appear. Whether an infectious component contributes has not been settled. The normally smooth inner surface roughens. With more deposits, the passage is narrowed by the gradually accruing atheroma (plaques), restricting blood flow. The coup de grâce is clot formation, killing the tissue dependent upon the now-obstructed artery.

The complex of components in (especially red) wine plays many roles in helping the endothelium withstand its stresses. Understanding is still evolving. Acceptance by the reluctant remains at best incomplete. The scientific evidence that has accumulated, however, both epidemiological data and direct research, strongly confirms folk wisdom that the combined effects of moderate alcohol consumption and the compounds, mostly polyphenols, found predominantly in wine (derived largely from grape skins) are associated with a large reduction of cardiovascular risk in men and women of any age, as well as a significant reduction in susceptibility to diabetes, itself a distinct cardiovascular liability. Although sufficient bioavailability of polyphenols has been questioned, their effective activity has been clearly demonstrated.

The mechanisms are manifold. The balance of “good” and “bad” blood fats, especially cholesterol, and their state of oxidation are favorably influenced. Damaging oxidative reactions, inflammation and blood clotting are reduced. Blood vessel walls are encouraged to relax. The elaboration of nitric oxide, essential for arterial health, is stimulated. Other effects are under study, including those of the procyanidins and sirtuins. Life span may be extended.
It appears that these health benefits of moderate drinking add to those derived from a “healthy lifestyle”: not smoking, eschewing indolence, reasonable body weight, sensible diet. Having good genes helps more than a little.

Drinking is healthiest when regular and with meals. All excess is unhealthy; binge drinking is most dangerous. Abstinence would seem to be a health risk. Smoking may erase the benefits of moderate drinking or of other healthy practices. Reliable individual advice can be obtained only from one’s own physician knowledgeable in these matters. I still tend to think of wine as enriching life, not medicating it.