Atherosclerotic plaques, which represent the morphological correlate of vessel clotting and heart attacks, develop over a period of years to decades. The underlying disease is believed to be represented by a chronic inflammatory process of the vessel wall. This process leads to an invasion of inflammatory cells and an accumulation of lipids (cholesterol) within the walls of blood vessels. Subsequently, numerous cytokines and growth factors are secreted, which facilitate the development and progression of atherosclerotic lesions by promoting the migration and proliferation of vascular cells, influencing the expression of relevant genes, and by controlling the vessel´s tone. In addition, pathogenic factors cause a condition of oxidative stress which leads to the liberation of harmful reactive oxygen species. With time, plaques become “unstable” and are thus prone to rupture, which then results in intraluminal blood clotting, myocardial infarction, and death.
The polyphenolic compounds that are particularly found in red wine, exert a number of advantageous properties that help counteract the complex process of atherosclerosis (Table). More specifically, red wine polyphenols modulate cholesterol levels, inhibit lipid oxidation, beneficially modulate the expression of genes (particularly endothelial nitric oxide synthase), exert antioxidant effects, promote vessel relaxation, counteract blood clotting (thrombogenicity), and inhibit specific cellular events such as activation of growth factor receptors in vascular cells (particularly platelet-derived growth factor). The latter effect is particularly important for the prevention of plaque development and progression, as inhibition of these factors was previously shown to efficiently reduce atherosclerosis and the risk for heart attacks in research models and humans. In summary, the phenolic compounds that are found in red wine, interfere with well characterized molecular mechanisms at all stages of atherogenesis.