Examining the French paradox: a systematic review of red wine consumption and cardiovascular risk

The French paradox, characterized by a lower prevalence of coronary heart disease (CHD) despite a diet rich in saturated fats, challenges conventional beliefs linking saturated fat intake to CHD risk. Despite high saturated fat consumption, the French exhibit lower CHD rates, sparking interest in the potential cardiovascular benefits of red wine (RW), a staple of the Mediterranean diet rich in polyphenols like resveratrol.

The objective of this systematic review is to examine the potential advantages of RW and its components in enhancing cardiovascular health among patients with CHD.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a thorough search of PubMed, Cochrane, ScienceDirect, and Google Scholar was conducted to identify relevant studies published from inception to July 2024. Eligible studies investigating the association between RW consumption and cardiovascular risk factors/outcomes within the French paradox context were included. Data extraction and eligibility criteria ensured methodological rigor.

Of the 812 studies initially screened, 36 met the inclusion criteria in accordance with the PRISMA guidelines. Among these, 28 reported positive effects of RW on cardiovascular parameters, including improvements in lipid profiles, reductions in inflammatory markers, enhanced endothelial function, and modulation of gut microbiota. Two studies identified adverse effects, while six found no significant associations. Collectively, these findings suggest that moderate RW consumption - attributable primarily to its polyphenolic compounds such as resveratrol - may confer cardioprotective benefits, particularly in patients with CHD.

This review supports the French paradox by highlighting that moderate RW consumption may improve cardiovascular health through lipid modulation, endothelial function, and anti-inflammatory effects - mainly due to its polyphenols rather than alcohol. However, individual responses and lifestyle factors may influence outcomes, warranting further research.