Can French paradox hypothesis explain the observed different trends of mortality from ischemic heart disease and stroke in Western europe?

The incidence and mortality of cardiovascular disease (CVD) in France is relatively low despite the traditionally high intake of saturated fat.[12] The “French paradox” has been postulated to be related to the widespread consumption of wine.[23] However, this French paradox is being questioned and the results from the MONICA studies showed that France is not lowest among populations for CVD.[45] Thus, France would not be an exception, but would follow that geographic gradient. Although numerous epidemiologic studies have provided evidence for a French exception,[6] some studies have not found any difference between beer, wine and spirits in their relation to CVD or CVD risk factors.[78] Gronbaek et al. showed a strong association between light and moderate wine drinking and decreased mortality from CVD and other causes, whereas a similar intake of alcohol from spirits led to increased risk.[9] This difference has been attributed to prospective substances other than alcohol, e.g. antioxidants such as flavonoids, which are abundant in red wine.[101112]

We performed a time series analysis in which special attention was paid to cohort patterns.[13] We studied mortality trends of ischemic heart disease (IHD) and stroke in birth cohorts born between 1860 and 1939 in seven low-mortality European countries; i.e. Denmark, Finland, France, the Netherlands, Norway, Sweden and England and Wales. The IHD mortality increased between the 1950s and 1970s in all countries for both men and women, except for France with relatively less peak and more stable mortality trend compared with other countries [Figure 1]. For stroke, the France mortality was similar to other countries first, but started to decline much faster than other countries [Figure 2]. This French advantage would be repeated in the future too.[141516]

Figure 1

Mortality trends from ischemic heart disease in period of 1950-1999, by sex and country

Figure 2

Mortality trends from stroke in period of 1950-1999, by sex and country

It seems that our results support the French paradox; however, the question still remains: Is this difference due to French paradox or other factors?