Imagine sitting down with a non-drinking, 55-year-old male patient with high cholesterol, high blood pressure, and a pack-a-day smoking habit. You check the chart and find that his father died of an acute myocardial infarction at age 62. It is time to talk him into lowering his risk for cardiovascular disease.

But before you can say, “statins,” your patient interrupts to tell you he’s been reading about high cholesterol on the internet. He wants you to explain just what all those web sites mean when they talk about the “French Paradox.” He is probably not talking about Parisians’ simultaneous adoration of Monet and Jerry Lewis.

He really wants to know about the growing body of data—first noticed in French people with high-fat diets—suggesting that red wine consumption can help lower the risk of cardiovascular disease. He asks if he should start having a few drinks each day to lower his risk factors.

Indeed, data have shown that 1–2 drinks per day might cut heart disease patients’ relative risk of death from cardiac causes by up to 30%. And the same amount of daily alcohol intake may lower the risk of ischemic stroke by 70%.

The data have lead some, including David Whitten, MD, a consultant for the Wine Institute in Fort Worth, TX, to begin urging physicians everywhere to push daily alcohol intake as a way to lower the risks associated with cardiovascular disease. According to Dr. Whitten, moderate daily alcohol consumption carries all of the benefits of cholesterol-lowering drugs with fewer side-effects and a lower cost.

Physicians interested in the potential role of wine in reducing heart disease risk recently gathered in (where else?) Napa Valley, CA, for the First International Wine and Heart Health Summit, sponsored by Banner Health Arizona, the Robert Mondavi Winery, and Desert Cardiology of Tucson.

One retrospective study presented at the conference showed a 14% risk of further cardiac events in non-drinkers who had undergone angioplasty, but just a 3% risk in similar patients who were classified as light-to-moderate drinkers.

“It is time to openly advocate the consumption of wine as a daily health habit among the vast majority of our population,” Dr. Whitten said.

No doubt, this is a doctor’s order that will go over better with many patients than the usual, “cut the bacon double-cheeseburgers and quit smoking.”

But some conference participants said that recommendation goes too far. They cite the lack of prospective, controlled research definitively supporting claims that wine consumption—or any alcohol consumption, for that matter—improves outcomes in people with cardiovascular disease or its risk factors. And while few recommend that light or moderate drinkers should stop, they worry that advocating alcohol consumption in people who avoid drinking could lead to more problems than it solves.

Tedd M. Goldfinger, DO, is director of the Wine and Heart Health Initiative at the Desert Heart Foundation in Tucson, AZ. According to Dr. Goldfinger, existing data “clearly support” that moderate consumption of any alcoholic beverage can raise high-density lipoprotein (HDL), inhibit platelet aggregation, and possibly even improve vascular endothelial functioning. Any or all of these would mean good news for at-risk patients.

“Whether society is prepared to handle that is another story,” he says. “We should not recommend that cardiac patients who are light or moderate drinkers stop drinking. But it is a big stretch to start telling people that they need to drink.”

According to Dr. Goldfinger, clinicians should proceed cautiously with patients who avoid alcohol. Many adult patients who abstain do so because past experience has taught them that alcohol spells trouble in their lives. Others abstain for religious or moral reasons.

Physicians considering adding a drink or two per day to a patient’s regimen should first evaluate him or her for a history of alcohol or drug problems, a propensity toward impulsivity, and a predilection for abusive behavior and rule such patients out, he says.

“Nondrinkers are best left alone,” says Arthur Klatsky, MD, a senior cardiology consultant at Kaiser Permanente Medical Center in Oakland, Calif. and a leading researcher on alcohol consumption and cardiovascular health. But he acknowledges that problem drinking because of doctor’s orders is “a hypothetical risk.”

“I have yet to see the heavy drinker who took it up to protect the heart,” he says. While evidence of alcohol’s potential to protect against cardiac events may be mounting, much of the data remain correlational and most of the studies retrospective. That may lower the status of moderate alcohol consumption when compared to well-established interventions like lowering blood pressure, preventing diabetes, improving diet, and prescribing exercise.

“There are no controlled experiments, and without that you don’t have the gold standard. [Drinking alcohol] is not in the first tier of things people should do” to lower the risk of cardiovascular events, Dr. Klatsky says. Rather, patients should be encouraged to go with the proven interventions first and to include one drink a day for women and two a day for men as secondary measure.

Still, that begs more questions: Is red wine superior to other forms of alcohol, as some have claimed? Does one need to uncork an expensive bottle of ’84 to maximize the heart-healthy effects, or is a pint of Ripple just as good?

“Wine is wine. It doesn’t matter how much you spend on it,” Dr. Goldfinger says. Cheap wine, which tends to be younger, may even prove superior because it contains more of the polyphenols thought to improve endothelial function. And the type of drink shouldn’t matter much either. Increased HDL and inhibited platelet aggregation all seem to be consequences of ethanol metabolism, meaning that any drink would do the trick.

Dr. Goldfinger noted that his group in Tucson is starting two new protocols this summer, one looking at the effects of wine on endothelial function and another looking prospectively at the impact of moderate wine consumption on cardiac events in patients with coronary artery disease. After the results from these studies and others are in, clinicians may be able to upgrade moderate alcohol consumption on their list of heart-healthy interventions. “Over the next decade, we will start to see some fairly serious data,” he said.