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Showing posts with label wine consumption. Show all posts
Showing posts with label wine consumption. Show all posts

Thursday, December 19, 2024

Cardiovascular Protection Tracks With Wine Intake, Now Provable With Urinary Marker

 But this is absolutely impossible! Previous research said; 'No benefit at all from alcohol'.

The latest here;

Cardiovascular Protection Tracks With Wine Intake, Now Provable With Urinary Marker

Biomarker of wine consumption believed to reduce misclassification and bias in study

A photo of glasses of red and white wine.

Key Takeaways

  • Drinking 12-35 glasses of wine a month was tied to a lower risk of combined heart failure, myocardial infarction, stroke, and cardiovascular death over a median 9 years of follow-up.
  • The study results support prior epidemiological research suggesting cardiovascular benefits with moderate wine drinking.
  • Tartaric acid was selected as a surrogate for wine intake, given the specificity of its dietary origin (grapes) and the scarcity in the consumption of its alternative dietary sources.

Moderate wine consumption maintained its association with cardiovascular benefit when self-reports were taken out of the equation, the large PREDIMED trial showed.

Using urinary tartaric acid as an objective biomarker measuring wine consumption, light to moderate wine intake was tied to a lower risk of long-term cardiovascular disease (CVD) -- combined heart failure, myocardial infarction, stroke, and CVD death -- in an older Mediterranean population, reported Ramon Estruch, MD, PhD, of the University of Barcelona, and colleagues.

Compared with people with the lowest tartaric acid level (<1 μg/ mL), those with levels in the 12-35 μg/mL range (equivalent to drinking 12-35 glasses of wine per month) seemed to have some cardiovascular protection over a median 9 years of follow-up (HR 0.50, 95% CI 0.27-0.95).

"These findings suggest that the bioactive compounds present in wine may play a role in lowering the risk of CVD," the authors wrote in the European Heart Journal.

However, they also showed that any cardiovascular benefit was weaker with tartaric acid levels in the 3-12 μg/mL range (3-12 glasses per month; HR 0.62, 95% CI 0.38-1.00) -- and not observed at all with the lowest (1-3 μg/mL, equivalent to 1-3 glasses of wine per month) and highest (>35 μg/mL, equivalent to 1.25 glasses per day) tartaric acid concentrations.

These results are in line with prior epidemiological research suggesting cardiovascular benefit with moderate wine drinking. Unlike these older studies, however, Estruch and colleagues had sought a surrogate for wine consumption for their study because they wanted to reduce the potential for misclassification and bias typically encountered in observational studies of alcohol and health outcomes.

"The implications of this study are far-reaching, particularly in the context of nutritional epidemiology and public health recommendations," wrote Giovanni de Gaetano, MD, PhD, of IRCCS NEUROMED in Pozzilli, Italy, and colleagues in an accompanying editorial.

"The use of an objective biomarker such as urinary tartaric acid represents a significant methodological advancement in alcohol research. It offers a more accurate and reliable measure of wine consumption, which could help resolve some of the ongoing debates about the health effects of alcohol," they added. "Humans, for various reasons, are often not truthful and tend to either deny or under-report their alcohol intake."

"Moreover, the findings suggest that wine consumption in real-life conditions, unaffected by the often artificial influences of a clinical trial setting, might have a more beneficial impact on cardiovascular health than previously thought," they noted.

For the study, tartaric acid was selected as a surrogate for wine intake given its stability of concentration, specificity of its dietary origin (grapes), the high sensitivity of the analytical method, and the scarcity in the consumption of its alternative dietary sources. "Thus, tartaric acid emerges as a valuable short-term biomarker (several days to a week) for assessing wine consumption, provided that the intake of grapes and their derivatives is excluded," Estruch's team explained.

The editorialists also highlighted that changes in urinary tartaric acid levels over time may have an association with cardiovascular risk. "Participants with tartaric acid levels >3 µg/mL at baseline, who experienced an increase over 1 year, had a 59% lower risk of CVD compared with those whose levels decreased during the same period. This dynamic association suggests that not only the baseline level of wine consumption but also changes over time may influence CVD risk," de Gaetano's group wrote.

The publication of the PREDIMED analysis coincided with a new report from the National Academies of Sciences, Engineering, and Medicine that found that the weight of the literature leans toward moderate alcohol drinkers (defined as two drinks a day for men and one a day for women) having lower risks of cardiovascular disease, cancer, weight changes, neurocognition, and other outcomes.

PREDIMED was the landmark trial that showed in 2013 that the Mediterranean diet conferred more cardiovascular benefit versus advice to reduce dietary fat alone. Although the study has since been retracted and republished due to the discovery of protocol violations, its updated results were essentially unchanged after re-analysis.

Estruch's group performed a case-cohort nested study within the nearly 7,500-person PREDIMED trial. The scope of the present analysis was limited to the 685 participants with incident cases of CVD and a random subcohort of 625 participants (including 78 overlapping cases). Average age was 68 years, and 53% were women.

PREDIMED participants had their wine consumption measured through validated food frequency questionnaires. They also underwent assessment of urinary tartaric acid levels at baseline and after 1 year of intervention.

The investigators found a strong correlation between urinary tartaric acid levels and self-reported wine consumption.

People with higher tartaric acid levels were more likely to be men, current smokers, have higher levels of physical activity, and have greater consumption of meat.

The study authors acknowledged that their results may not be generalizable to populations beyond the older, Mediterranean PREDIMED cohort. Given the observational design of the study, residual confounding cannot be excluded, despite their efforts at statistical adjustment.

It remains unclear why wine would provide cardiovascular benefits, they said, though polyphenols have been theorized to play at least one major role.

"Polyphenols have been demonstrated to exert a variety of health benefits that could confer cardioprotective properties to wine, such as anti-inflammatory properties," they wrote. "Therefore, multiple mechanisms may explain the cardioprotective properties of polyphenols."

  • author['full_name']

    Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

PREDIMED was funded by the Instituto de Salud Carlos III, an agency of the Spanish government.

The present analyses were also supported by the Organización Interprofesional del Vino de España and Fundación para la Investigación del Vino y la Nutrición.

Estruch's disclosures included grants from the Spanish Fundación Dieta Mediterránea and Cerveza y Salud; and personal fees from Brewers of Europe, the Fundación Cerveza y Salud, Pernaud-Ricard, Instituto Cervantes, Lilly Laboratories, and the Wine and Culinary International Forum.

de Gaetano is a member of the International Scientific Forum on Alcohol Research and the Accademia Italiana della Vite e del Vino.

Primary Source

European Heart Journal

Source Reference: Domínguez-López I, et al "Urinary tartaric acid as a biomarker of wine consumption and cardiovascular risk: The PREDIMED trial" Eur Heart J 2024; DOI: 10.1093/eurheartj/ehae804.

Secondary Source

European Heart Journal

Source Reference: de Gaetano G, et al "Wine consumption and cardiovascular health: The unresolved French paradox and the promise of objective biomarkers" Eur Heart J 2024; DOI: 10.1093/eurheartj/ehae726.

Wednesday, June 28, 2023

Study reveals that wine consumption has an inverse relationship to cardiovascular mortality

The key line in here is: moderate wine consumption is good for cardiac health.

This is absolutely not possible according to this earlier research: 

Here is what your doctor will use, no thinking required:

Safest level of alcohol consumption is none, worldwide study shows

The latest here:

Study reveals that wine consumption has an inverse relationship to cardiovascular mortality

In a recent study published in the Nutrients Journal, researchers aimed to understand the association between wine consumption and cardiovascular mortality, cardiovascular disease (CVD), and coronary heart disease (CHD).

The researchers performed a systematic review and meta-analysis using longitudinal studies, including cohort and case-control studies retrieved from multiple databases, which they searched from their inception to March 2023.

Study: Association between Wine Consumption with Cardiovascular Disease and Cardiovascular Mortality: A Systematic Review and Meta-Analysis. Image Credit: Alefat/Shutterstock.comStudy: Association between Wine Consumption with Cardiovascular Disease and Cardiovascular Mortality: A Systematic Review and Meta-Analysis. Image Credit: Alefat/Shutterstock.com

Background

Cardiovascular diseases account for a high proportion of deaths on a global scale, with CVD-related deaths surging to nearly 18 million in 2017, in which ischemic heart disease (IHD) caused almost half of the deaths. 

A previous meta-analysis suggested a J-shaped relationship between wine consumption and cardiovascular events and that moderate wine intake promoted better cardiovascular health.

A positive effect of wine on CVDs was first reported in 1979, wherein researchers also asserted that different wine components exert protective effects against pathologies, such as coronary heart diseases, CHD-associated mortality, and cancers, such as oral cancer.

Moreover, studies have suggested that de-alcoholized wines (in the absence of ethanol) are protective against thrombosis as they conserve antioxidant effects.

Light to moderate alcohol consumption positively affects general health; for instance, it acts on high-density lipoprotein cholesterol to prevent atherosclerosis, lowers the incidence of IHD, and helps with the prognosis of people at higher risk of coronary complications leading to myocardial infarction.

Excessive drinking, on the contrary, causes over 200 diseases, which makes it a leading cause of deaths globally, i.e., up to three million deaths annually. High-dose alcohol consumption also increases the risk of suicide, per psychiatrists. 

Alcohol interacts with multiple drugs, altering its metabolism or its own. Decreased alcohol metabolism could lead to increased blood alcohol levels. For example, a component in wine, resveratrol, interacts with certain drugs and modifies their metabolism.

Polyphenols of the non-flavonoid family present in red wine, like tannins, provide multiple cardiovascular health benefits. It is also anti-inflammatory, antioxidant, and antimutagenic. Nonetheless, all cardiologist agrees that light to moderate alcohol consumption has a positive effect on cardiovascular health, whereas excessive alcohol drinking elevates the risk of CHD mortality, cancers, etc. 

Mendelian randomization (MR) approaches analyzed the effects of alcohol consumption on CVDs from a genetic viewpoint and found a much-decreased risk of CHDs in carriers of the alcohol dehydrogenase 1B (ADH1B) gene when they consumed less alcohol.

Likewise, studies have shown a positive effect of wine intake on nonfatal CHD, and beer consumption poses a higher risk of a nonfatal stroke. Based on these observations, researchers have hypothesized that wine components might benefit health. 

Since studies have never stratified these effects by the type of alcohol, perhaps, the researchers assumed that all alcoholic beverages had similar beneficial effects on cardiac health. However, there is a lack of scientific evidence of which alcoholic beverages could be less harmful to CVDs.

About the study

In the present study, researchers explored the association between the incidence of CVD, cardiovascular mortality, and CHD (all cardiovascular events) and wine consumption and attempted to elucidate its nature.

First, they compared the impact of wine on participants who consumed wine against those who did not. Additionally, they analyzed whether the study design characteristics and participant traits like age and smoking affected this association.

This systematic review and meta-analysis included studies with subjects older than 18. The exposure and outcome of included studies were wine consumption and cardiovascular events, respectively. 

The team evaluated the risk of bias in cohort studies using the quality assessment tool devised by the United State's National Heart, Lung, and Blood Institute. They used another similar tool to assess the risk of bias in the case–control studies.

Finally, two independent reviewers graded the cumulative risk of bias for each study - as good, fair, or poor; and found that the overall risk of bias for each included study was 100%. 

In the meta-analysis, they included studies with a greater sample size. They computed the relative risk (RR) and odds ratios (OR) for the correlation between wine consumption and cardiovascular events and converted hazard ratios (HR) reported in some studies to RR.

The team also calculated the pooled RRs for the effect of wine consumption on the risk of CHD, CVD, and cardiovascular mortality using DerSimonian and Lair random effect models. Finally, the team used Egger's test to show publication bias evidence for the association between CVD and wine consumption.

Results

After an extensive search for research studies, the authors retrieved 7,042 articles from nine countries with 1,443,245 subjects and a cumulative follow-up period between four and 25 years. However, the final analytical set for this systematic review and meta-analysis comprised 25 and 22 studies, respectively. In addition, there were four case–control and 21 cohort studies.

Regarding cardiovascular events, seven, 13, and seven studies reported CVD, CHD, and cardiovascular mortality, respectively. Many studies did not report the quantity of wine consumed; thus, researchers could not determine its effect.

The current review and meta-analysis added to the previous evidence of an inverse association between the consumption of wine and three cardiovascular events evaluated in this study.

Importantly, participants' average age, the proportion of women, the follow-up duration, or smoking status did not affect this association. Accordingly, the pooled RRs for CHD, CVD, and cardiovascular mortality were 0.76, 0.83, and 0.73, respectively, all with 95% confidence intervals (CIs). 

Though the observed inverse association applied to red and white wine, the variations in the strength of this association were attributable to the different concentrations of some components. 

Red wine has phenolic compounds, such as gallic acid, catechin, and epicatechin (flavonols), which gives it antioxidant properties. They also reduce low-density lipoprotein (LDL) oxidation, thrombosis risk, plasma, and lipid peroxide.

Also, alcoholic components of wine reduce thrombosis risk and fibrinogen levels and induce collagen and platelet aggregation. Thus, higher consumption of red wine is more beneficial for combating CVDs than other alcoholic beverages.

Conclusions

The current study results confirmed the existing data that moderate wine consumption is good for cardiac health. However, researchers should interpret these findings with caution. Increasing wine consumption could harm patients susceptible to alcohol due to age, preexisting pathologies, or medications.

Based on the findings of this review, wine could be a part of other dietary recommendations. For instance, the Mediterranean diet includes wine and recommends its use for health benefits. However, studies must assess and delineate the effect of wine drinking by the type of wine.

Journal reference: