Red Wine May Boost Heart Health in Type 2 Diabetes Patients

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http://www.medpagetoday.com/Endocrinology/Diabetes/54055?xid=nl_mpt_DHE_2015-10-13&eun=g424561d0r
Ending the day with a glass of Malbec or Merlot -- or any other red wine for that matter -- may be good for the heart, and this may be especially true for people with type 2 diabetes, according to a long-term randomized trial.
The trial included patients with well controlled type 2 diabetes who were largely non-drinkers prior to enrollment, and who agreed to drink either a 5-oz glass of red wine, white wine, or mineral water with dinner each night for 2 years. After that time period, the red wine group showed significantly better outcomes compared to the water group for several cardiometabolic outcomes, such as HDL cholesterol levels (P<0.001), apolipoprotein A1 levels (P=0.05), and the ratio of total cholesterol to HDL cholesterol (P=0.039), reported Iris Shai, RD, PhD, of Ben-Gurion University in Be'er Sheva, Israel, and colleagues.

Moderate white wine consumption also appeared to reduce cardiovascular and metabolic risk, but to a lesser extent than red wine, they wrote in the Annals of Internal Medicine.
"Red wine was found to be superior in improving overall metabolic profiles, mainly by modestly improving the lipid profile, by increasing good (HDL) cholesterol and apolipoprotein A1, while decreasing the ratio between total cholesterol and HDL cholesterol," Shai wrote in an email to MedPage Today.
Previous studies have suggested a link between moderate alcohol consumption and lower heart disease risk and mortality in adults without diabetes, but Shai noted that it has not been clear if this apparent protection extends to patients with the disease.
A total of 224 patients were included in the CASCADE (CArdiovaSCulAr Diabetes & Ethanol) trial, and 94% of these participants had follow-up data at 1 year, while 87% had follow-up data at 2 years.
In an attempt to achieve a comparatively healthy diet among participants during the study, they were instructed in the basics of the Mediterranean diet and asked to follow it. They were not asked to restrict calories.

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Primary outcomes included lipid and glycemic control measures. Genotyping for the alcohol metabolism alleles ADH1B*1 and ADH1B*2 was also conducted. Blood pressure, lever biomarkers, medication, symptoms, and quality of life were measured at various times.
After 2 years, the red wine group showed significantly better outcomes compared to the water group for several cardiometabolic outcomes:

• An increase in HDL cholesterol levels by 0.05 mmol/L, 2.0 mg/dL (95% CI 0.04-0.06 mmol/L, 1.6-2.2 mg/dL)
• An increase in apolipoprotein A1 levels by 0.03 g/L (95% CI 0.03-0.06 g/L)
• A decrease in total cholesterol-HDL cholesterol ratio by 0.27 (95% CI - 0.52 to -0.01)

The corresponding lipid changes in the white wine group were not significantly different from those in the water group, the authors reported.
Although some glucose metabolism components improved after 2 years in both the red and white wine groups, only white wine significantly decreased fasting plasma glucose level by 1.0 mmol/L ( -17.2 mg/dL, 95% CI - 1.60 to -0.3 mmol/L, P=0.004) and HOMA-IR score by 1.2 (95% CI -2.1 to - 0.2, P=0.019), compared with the water group.
Of 203 study participants with available DNA samples, 35.6% were homozygous for the wild-type C allele ADH1B*1 (slow ethanol metabolizers), and 21.3% were homozygous for ADH1B*2 (fast ethanol metabolizers).

"As expected in the water group, changes in biomarkers did not differ across genetic ADH1B variants," the researchers wrote. "In the combined red and white wine group, however, the improvements in glycemic control were mostly achieved among carriers of ADH1B*1."
These carriers had favorable significant changes compared with carriers of ADH1B*2 homozygote.
Study limitations included the unavoidable lack of blinding among the interventions groups and the use of fasting insulin and glucose to measure insulin resistance. And because only wine was consumed in the study, the findings cannot be extrapolated to consumption of beer and spirits.
Shai said that even though previous observational studies have suggested that moderate alcohol consumption has a beneficial effect on cardiometabolic risk in patients with diabetes, clinical recommendations for this in patients who are non-drinkers remain controversial.
She noted that in patients with type 2 diabetes for whom alcohol consumption is not contraindicated, moderate wine intake -- especially red wine -- may be a beneficial addition to a healthy diet.

The study was funded by the European Foundation for the Study of Diabetes.
Shai and co-authors disclosed no relevant relationships with industry.