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Study using more reliable measure of wine consumption finds protective effect for low to moderate drinking in people at risk of cardiovascular disease

Preventive Cardiology

Drinking a small or moderate amount of wine lowers the risk of serious cardiovascular disease in people at a higher risk who are following a Mediterranean diet, according to research published in the European Heart Journal [1] today (Wednesday).

Previous studies on the effects of wine on cardiovascular health have produced inconsistent results. This may be in part because research often relies on people reporting how much wine they drink. Instead, in the new study, researchers measured the amount of a chemical, called tartaric acid, in participants’ urine. Researchers say this is an “objective and reliable measure” of wine consumption.

The research was led by Professor Ramon Estruch from the University of Barcelona and the Hospital Clinic Barcelona, Spain.

The new research is part of a larger Spanish study investigating the effect of a Mediterranean diet (high in olive oil, vegetables, fruit, nuts and fish, and low in sweet or processed food and drink) on people with a higher risk of developing cardiovascular disease. All the people taking part had no cardiovascular disease at the start of the study, but they either had type-2 diabetes, or they had a combination of cardiovascular disease risk factors such as smoking, high blood pressure, high cholesterol, being overweight and/or a family history of cardiovascular disease.

As well as completing questionnaires about what they ate and drank, participants gave urine samples at the beginning of the study and after a year of following a Mediterranean diet. Tartaric acid is a chemical naturally found in grapes and grape-derived products such as wine. Tartaric acid is excreted in urine, meaning it can be measured to show if someone has consumed wine and/or grapes in last five to six days.

To investigate the effect of drinking wine, researchers included a total of 1,232 participants. Participants were followed up for four to five years and during that time, there were 685 cases of cardiovascular disease (heart attack, coronary revascularisation, stroke or death from cardiovascular disease,) during the study.

They found that light-to-moderate wine consumption, defined as half to one glass of wine per day reduces the risk of developing a cardiovascular event by 50% in this group of people at high risk of cardiovascular disease who were following a Mediterranean diet. Light drinking (between one glass per week and less than half a glass per day) reduced cardiovascular risk by 38%. However, this protective effect disappears in people who drank more than one glass per day.

Professor Estruch said: “By measuring tartaric acid in the urine, alongside food and drink questionnaires, we have been able to make a more accurate measurement of wine consumption. We have found a much greater protective effect of wine than that observed in other studies. A reduction in risk of 50% is much higher than can be achieved with some drugs, such as statins.

“This study demonstrates the importance of moderate wine consumption within a healthy dietary pattern, such as the Mediterranean diet. Until now, we believed that 20% of the effects of the Mediterranean diet could be attributed to moderate wine consumption; however, in light of these results, the effect may be even greater.

“The participants in our study were older people at high risk of cardiovascular disease living in a Mediterranean country, so the results may not apply to other populations. Another key question is at what age moderate wine consumption could be considered 'acceptable’. Recent studies indicate that the protective effects of wine consumption are observed starting from the age of 35 to 40. It is also important to note that moderate consumption for women should always be half that of men, and it should be consumed with meals.”

In an accompanying editorial [2] Professor Giovanni de Gaetano from IRCCS NEUROMED, Pozzilli, Italy and colleagues said: “The relationship between alcohol consumption, particularly wine, and cardiovascular disease (CVD) risk remains a topic of ongoing debate despite decades of related research. Numerous studies have suggested that moderate wine consumption, often defined as one glass per day, preferably during meals, is associated with a reduced risk of total mortality and CVD. However, this apparent protective effect is clouded by persistent uncertainties. The paper by Inés Domínguez-López et al, published in this issue of the European Heart Journal, sheds new light on this complex relationship by introducing an objective biomarker – urinary tartaric acid – as a measure of wine consumption and provides compelling evidence for its association with lower CVD risk.

“The study by Domínguez-López et al represents an important step forward in our understanding of the complex relationship between wine consumption and cardiovascular health. By leveraging urinary tartaric acid as an objective biomarker, the authors provide robust evidence that moderate wine consumption is associated with lower CVD risk in a Mediterranean population at high cardiovascular risk. This work not only highlights the value of objective biomarkers in nutritional epidemiology but also supports the notion that light-to-moderate wine consumption may be part of a heart-healthy diet. However, the findings also remind us of the risks associated with higher levels of consumption, underscoring the importance of moderation.”

ENDS

 

Notes to editor

References:

[1] Urinary tartaric acid as a biomarker of wine consumption and cardiovascular risk: the PREDIMED trial’, by I. Domínguez-López et al., European Heart Journal,  https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehae804
[2] ‘Wine consumption and cardiovascular health: the unresolved French paradox and the
promise of objective biomarkers’, by G. de Gaetano, European Heart Journal,  https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehae726

 

 

Funding: Comisión Interministerial de Ciencia y Tecnología, CIBEROBN from the Instituto de Salud Carlos III from the Ministerio de Ciencia, Innovación y Universidades, National Institutes of Health (NIH), Agencia Estatal de Investigación/Fondo Europeo de Desarrollo Regional, European Union, Generalitat de Catalunya and FIVIN, and Interprofesional del vino de España—OIVE.

Note: The "Interprofessional Wine Organisation of Spain" is public-private entity that encompasses all sectors related to wine, from production and preparation to sale. The reagents used to determine the biomarkers of wine consumption were part-funded by a grant from this organisation.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Disclosures: E.R. reports grants, personal fees, non-financial support, and other from the California Walnut Commission while the study was carried out; grants, personal fees, non-financial support, and other from Alexion; and personal fees and other from Amarin, outside the submitted work. R.M.L.-R. reports personal fees from Cerveceros de España, UNIDECO, personal fees, and other from Adventia, Wine in Moderation, Ecoveritas S.A., outside the submitted work. R.E. reports grants from the Fundación Dieta Mediterránea (Spain), and Cerveza y Salud (Spain), and personal fees for given lectures from Brewers of Europe (Belgium), the Fundación Cerveza y Salud (Spain), Pernaud-Ricard (Mexico), Instituto Cervantes (Alburquerque, USA), Instituto Cervantes (Milan, Italy), Instituto Cervantes (Tokyo, Japan), Lilly Laboratories (Spain), and the Wine and Culinary International Forum (Spain), as well as non-financial support for the organization of a National Congress on Nutrition and feeding trials with products from Grand Fountain and Uriach Laboratories (Spain). The remaining authors have nothing to disclose.

 

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About the European Society of Cardiology 
The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

The European Heart Journal is the flagship journal of the European Society of Cardiology. It is published on behalf of the ESC by Oxford Journals, a division of Oxford University Press.