Non-linear models for the relation between cardiovascular risk factors and intake of wine, beer and spirits

It is generally accepted that moderate consumption of alcohol is associated with a reduced risk of coronary heart disease (CHD). It is not clear however whether this benefit is derived through the consumption of a specific beverage type, for example, wine. In this paper the associations between known CHD risk factors and different beverage types are investigated using a novel approach with non-linear modelling. Two types of model are proposed which are designed to detect differential effects of beverage type. These may be viewed as extensions of Box and Tidwell's power-linear model. The risk factors high density lipoprotein cholesterol, fibrinogen and systolic blood pressure are considered using data from a large longitudinal study of British civil servants (Whitehall II). The results for males suggest that gram for gram of alcohol, the effect of wine differs from that of beer and spirits, particularly for systolic blood pressure. In particular increasing wine consumption is associated with slightly more favourable levels of all three risk factors studied. For females there is evidence of a differential relationship only for systolic blood pressure. These findings are tentative but suggest that further research is required to clarify the similarities and differences between the results for males and females and to establish whether either of the models is the more appropriate. However, having clarified these issues, the apparent benefit of consuming wine instead of other alcoholic beverages may be relatively small.