葡萄酒增加冠狀動脈疾病女性病患的心跳速率變異

By Laurie Barclay, MD

　　Feb. 16, 2005 - 根據一項發表於2月號心臟期刊的斷面試驗結果顯示，喝葡萄酒，而不是啤酒或是烈酒，會增加女性冠狀動脈疾病（CHD）病患的心跳速率變異。
　　
　　瑞典Stockholm Karolinska機構I. Janszky表示，流行病學數據顯示，飲用少許酒精性飲料，特別是葡萄酒，與CHD發病率與死亡率下降有關；HRV是心跳速率波動的程度，被認為是自主神經系統活性一種可靠、非侵襲性指標；HRV的下降已經被發現可以預測健康人、以及急性冠狀動脈事件後病患的CHD發病率與死亡率。
　　
　　研究人員收納了102位急性心肌梗塞後存活住院、或是接受經皮穿璧冠狀動脈成型術、冠狀動脈繞道手術的病患；受試者完成一份有關飲用啤酒、葡萄酒與烈酒的問卷，並且她們接受院外的24小時的心電圖（ECG）檢查；ECG檢查項目包括總能量、高頻能量、低頻能量與超低頻能量。
　　
　　在多變項分析模式中，飲用葡萄酒與時間及頻率區段的HRV增加正相關，而且這個關係與臨床共同變相之間沒有關聯；舉例來說，飲用葡萄酒的女性受試者，在整個紀錄的所有5分鐘片段之間，正常與正常間隔的標準偏差平均值為3.89，而不喝葡萄酒的女性受試者為3.59（P＝.014）；然而，啤酒與烈酒的總攝取量，及酒精總攝取量與任何HRV參數的變化之間並沒有關聯。
　　
　　該項試驗的限制，包括採用自行報告的酒精攝取量、觀察性試驗設計、可能會因為多元不飽和脂肪酸或是其他變項造成殘餘干擾、樣品數目太小，以致於無法偵測出HRV與啤酒或是烈酒攝取量、或是酒精總攝取量之間的關連、某些女性因為其疾病嚴重性的反應而停止飲酒、以及無法得知對男性或是重度酗酒者的影響。
　　
　　研究人員表示，喝葡萄酒，而不是烈酒或是啤酒，正面地且獨立地與女性CHD患者的HRV有關；這些結果可能使我們對飲酒與CHD之間的關係更加瞭解。
　　
　　Ansgarius基金會、Belven基金會、Swedish心臟與肺臟基金會、公共衛生委員會與Stockholm的Expo－95郡議會、瑞典醫學研究議會、與Stockholm的Vardal基金會贊助這項試驗；研究人員表示，並沒有任何的利益衝突。

Wine Increases Heart Rate Variability in Women With Coronary Heart Disease

By Laurie Barclay, MD


Feb. 16, 2005 — Drinking wine, but not beer or spirits, increases heart rate variability (HRV) in women with coronary heart disease (CHD), according to the results of a cross-sectional study published in the February issue of Heart.

"Compelling epidemiological evidence suggests that moderate intake of alcoholic beverages, especially wine, is associated with lower risk of [CHD] morbidity and mortality," write I. Janszky, from the Karolinska Institute in Stockholm, Sweden, and colleagues. "HRV, the amount of fluctuation of the beat to beat differences, is known to be a reliable, noninvasive marker of autonomic nervous system activity. Decrease in HRV has been found to predict CHD morbidity and mortality in apparently healthy populations and in patients after an acute coronary event."

The investigators enrolled 102 women who survived hospitalization for acute myocardial infarction or underwent a revascularization procedure, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting. These women completed a standardized questionnaire regarding self-reported consumption of beer, wine, and spirits, and they underwent ambulatory 24-hour electrocardiogram (ECG) during normal activities. ECG outcome measures included total power, high frequency power, low frequency power, and very low frequency power.

Wine consumption was positively associated with increased HRV in both time and frequency domains, and this association was independent of other clinical covariates. In the multivariate model, for example, mean of the standard deviations of all normal to normal intervals for all five-minute segments of the entire recording was 3.89 for wine drinkers and 3.59 for women who did not drink wine (P = .014). However, intake of beer or spirits and the total amount of alcohol consumed did not correlate significantly with any of the HRV parameters.

Study limitations include the use of self-reported assessment of alcohol intake, observational design, possible residual confounding by polyunsaturated fatty acids or other variables, insufficient sample size to detect an association between HRV and consumption of beer or spirits or total amount of alcohol, the possibility that some women stopped drinking in response to the severity of their illness, and inability to generalize the findings to men or to heavier alcohol consumption.

"Intake of wine, but not of spirits or beer, is positively and independently associated with HRV in women with CHD," the authors write. "These results may contribute to the understanding of the complex relation between alcohol consumption and CHD."

The Ansgarius Foundation, the Belvén Foundation, the Swedish Heart and Lung Foundation, the Public Health Committee and Expo-95 of Stockholm County Council, the Swedish Medical Research Council, and the Vardal Foundation in Stockholm supported this study. The authors report no conflicts of interest.

Heart. 2005;91:314-318

Reviewed by Gary D. Vogin, MD