Summary

In a study of risk factors for Raynaud's phenomenon, smoking was without significant influence in women, but increased the likelihood of the condition in men. Heavy drinking made the condition more likely in women, but not in men. In fact, moderate drinking in men was linked to a lessened likelihood of Raynaud's.

Introduction

Raynaud's phenomenon (commonly called just "Raynaud's") occurs when the arteries to fingers and toes go into what's termed vasospasm. They constrict dramatically, temporarily limiting the blood supply. Over time, the vessels may thicken slightly, further limiting blood flow. The result is the skin turns pale and dusky. When the spasms subside blood returns to the area, and the tissue reddens before returning to a normal color.

Raynaud's is reported to occur in between 4% and 9% of women, and in 3% to 6% of men. Causes listed usually include exposure to cold, smoking, heavy alcohol consumption, and heredity. Information on the causes, however, has been somewhat contradictory, perhaps because it's been obtained from small studies or surveys. Boston scientists decided to investigate a larger collective of subjects with Raynaud's, in order to better define the relationship between cause and effect. Their findings are published in the American Journal of Medicine, and we summarize them here.

What was done

Participants in the Framingham Heart Study provided the subjects for this study. As the use of vibrating tools like road drills is associated with the disorder, only people who hadn't used them were included. Raynaud's patients were identified using a well-tested questionnaire having 100% sensitivity and specificity.¹

Smoking status was recorded as "never smoked", "past smoker", or "current smoker". The average number of cigarettes daily was also recorded. Alcohol consumption was determined by self-report of the number of drinks per week over the previous year, for beer, white wine, red wine, and liquor, separately. Consumption was considered none, moderate, or heavy, using conversion to ounces of absolute alcohol, with less than one ounce per week as "none", 1 to 3½ ounces (women) or 7 ounces (men) as "moderate drinking", and over 3½ ounces (women) or 7 ounces (men) as "heavy drinking".

Other information gathered included: age, body mass index (BMI), antihypertensive medications, cardiovascular disease, and menopausal and hormonal status.

What was found

There were 1840 women and 1602 men in the study; 6.1% of the women and 4.2% of the men had Raynaud's. Surprisingly, over 36% of the women and 45% of the men with the condition stated that it had begun after age 50.

There was no relationship between smoking and Raynaud's in women. However, there was an increased risk in men who smoked (or had smoked), with a degree of 'dose-dependency' - i.e. somewhat less risk in those smoking fewer cigarettes a day.

Heavy alcohol consumption in women was linked to increased Raynaud's prevalence, compared with nondrinkers and moderate drinkers. White wine, beer, and liquor were linked to this higher risk of Raynaud's, but not red wine, which was associated with a lower risk. It should be noted that women who drank red wine were actually more likely to be heavy drinkers than non-red wine drinkers.

In men, there was a J-shaped relationship between alcohol use and Raynaud's. Moderate consumption in men was linked with the lowest risk, while no drinking and heavy drinking carried higher risks. As with women, red wine was linked to a lower risk than the other drinks.

What the findings mean

Risk factors for Raynaud's phenomenon showed clear gender differences in this study. In women, smoking was without significant influence, whereas heavy drinking made the condition more likely. In men, on the other hand, current smoking was associated with increased odds of Raynaud's, while heavy alcohol consumption was not, and moderate alcohol use was linked to a reduced likelihood of the condition.

The red wine effect is seen by the authors of the study as being consistent with earlier reports linking red wine consumption to reductions in cardiovascular disease. The finding in this analysis may indicate that Raynaud's is a similar physiological response as those leading to cardiovascular disease, and the 'active' ingredient in red wine (resveratrol?) is protective against both responses. Certainly the attention being directed to resveratrol might be widened to include clinical studies of possible benefits of the agent in people with Raynaud's phenomenon.