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VII. TYPE OF ALCOHOL CONSUMPTION7idiopathic dilated cardiomyopathy of unknown etiology.Myocytic hypertrophy, interstitial fibrosis, and disorganizationof mitochondria with large glycogen-containingvacuoles may be observed. Further research is required todefine the pathophysiology and therapeutic strategies toprevent this type of myocardial damage.V. ALCOHOL AND ABNORMAL HEARTRHYTHMS AND ABNORMALELECTROCARDIOGRAMSAlcohol is a major cause of atrial fibrillation, which is themost common abnormal heart rhythm encountered inmedical practice. This serious arrhythmia requires patientsto be treated with oral anticoagulants to prevent stroke.Moderate alcohol consumption can cause atrial fibrillation.(See the chapter Atrial Fibrillation). In some patients atrialor ventricular premature beats and palpitations may occur.Alcohol consumption for several years can cause theelectrocardiogram to show abnormal findings such as milddeformities of the ST segment and T waves.VI. ALCOHOL AND COAGULATIONFACTORS AND STROKEAlcohol consumption is associated with an increasedincidence of hemorrhagic stroke. Alcohol consumptionalters coagulation factors as outlined above in the analysisof the Framingham study.VII. TYPE OF ALCOHOL CONSUMPTIONA. Red Wine versus White WineMild alcohol consumption causes a modest reduction incardiovascular events. There has been considerable controversy,however, regarding what type of alcoholic beveragesprovides the greatest cardioprotection. Studies of theFrench population indicate that wine, particularly redwine, offers greater protection. Studies in the UK andother countries indicate that beer is as good or even slightlybetter. Studies in the United States indicate that spirits areas good as wine.In human volunteers a high-fat diet has been shown toinduce endothelial dysfunction while red wine counteractsit. Reportedly, the acute administration of red wine reducesthe increase in nuclear factor kB (NF-kB) responsible forpromoting the expression of several inflammatory genesresulting from a high-fat meal. This effect was notobserved for vodka.The French, who eat rich food and drink more heavilythan many other nationalities, have a much lower rate ofheart disease events, the so-called French paradox (see thechapters Atherosclerosis/Atherothrombosis and HeartAttacks). Their high consumption of red wine appears tobe the source of their cardioprotection. However, geneticfactors may also be involved.There appears to be significant differences between redand white wine. Red wine has a much higher content ofthe powerful antioxidants called polyphenols than whitewine. These polyphenols appear to mop up oxygen freeradicals that damage the arterial wall and may help toprevent damage caused by diabetes. French winemakershave recently increased levels of polyphenols in white wineby altering the wine-making process. They have done thisby using white grapes that have a high polyphenol contentand added more of the skins in which polyphenols areheavily concentrated. They softened the grapes for six daysand the mixture was heated. This straw-yellow winecontains polyphenol levels four times higher than normal.Unfortunately, a controlled clinical trial to study the resultsof this new process is unlikely to take place.B. French Red Wine versus GermanWhite WineInvestigative study: Because endothelial type nitric oxide(NO) synthase exerts vasoprotective effects and red wineconsumption has been associated with a reduction ofcardiovascular disease but without molecular basis,Wallerath et al. studied the effect of red wine onendothelial-type nitric oxide synthase (eNOS) expressionand eNOS activity in human endothelial cells.Methods: In the method used in this study, humanendothelial cells were treated with red wine and eNOSmessenger ribonucleic acid (mRNA) was measured byRNase protection assay and other techniques.Results: The results showed that incubation ofendothelial cells with red wines from France upregulatedeNOS mRNA and protein expression. In contrast, redwines from Germany showed little or no effect on eNOSexpression. No significant difference in eNOS mRNAexpression could be detected between ‘‘en barrique’’(matured in oak barrels) and ‘‘non-barrique’’ (maturedin steel attacks) produced French red wines. Endothelialcells treated with French red wines produced up to threetimes more bioactive NO than did control cells. Frenchred wines increased the activity of the eNOS promoter, andthe eNOS mRNA stability was also increased by red wine.