In a recent study published in nutrients Journal, researchers aimed to understand the relationship 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 studies and case-control studies, drawn from multiple databases they searched from their inception to March 2023.
survey: Association of 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 large proportion of deaths worldwide, with CVD-related deaths rising to nearly 18 million in 2017, with ischemic heart disease (CHD) accounting for almost half of all deaths.
A previous meta-analysis suggested a J-shaped relationship between wine consumption and cardiovascular events and that moderate wine intake promotes better cardiovascular health.
The positive effect of wine on cardiovascular disease was first reported in 1979, and researchers also claimed that various components of wine exert protective effects against pathologies such as coronary heart disease, CHD-related mortality, and cancer. such as oral cancer.
Additionally, studies have shown that de-alcoholized wines (in the absence of ethanol) protect against thrombosis because they retain their antioxidant effects.
Light to moderate alcohol consumption has a positive effect on general health; for example, it acts on high-density lipoprotein cholesterol to prevent atherosclerosis, reduces the incidence of CHD, and helps predict people at higher risk of coronary complications leading to myocardial infarction.
Binge drinking, on the other hand, causes over 200 diseases, making it the leading cause of death worldwide, i.e. up to three million deaths per year. Drinking high doses of alcohol also increases the risk of suicide, according to psychiatrists.
Alcohol interacts with many drugs, altering his or her own metabolism. Decreased alcohol metabolism can lead to increased blood alcohol levels. For example, a component in wine, resveratrol, interacts with certain drugs and changes their metabolism.
Polyphenols of the nonflavonoid family present in red wine, like tannins, provide multiple benefits for cardiovascular health. It is also anti-inflammatory, antioxidant and anti-mutagenic. However, all cardiologists agree that light to moderate alcohol consumption has a positive effect on cardiovascular health, while excessive alcohol use increases the risk of mortality from CHD, cancer, etc.
Mendelian randomization (MR) approaches analyzed the effects of alcohol consumption on CVD from a genetic perspective and found a significantly reduced risk of CHD in carriers of the alcohol dehydrogenase 1B (ADH1B) gene when they consumed less alcohol.
Similarly, studies have shown a positive effect of wine intake on non-fatal CHD, and beer consumption poses a higher risk of non-fatal stroke. Based on these observations, researchers hypothesized that components of wine may be beneficial to health.
Because the studies never stratified these effects by type of alcohol, the researchers may have assumed that all alcoholic beverages had similar beneficial effects on heart health. However, there is a lack of scientific evidence as to which alcoholic beverages may be less harmful for cardiovascular disease.
About the research
In the current study, researchers investigated the relationship between the incidence of CVD, cardiovascular mortality and CHD (all cardiovascular events) and wine consumption and tried to clarify its nature.
First, they compared the effects of wine on participants who consumed wine versus those who did not. They also analyzed whether study design features and participant characteristics such as age and smoking influenced this association.
This systematic review and meta-analysis included studies with individuals over 18 years of age. The exposure and outcome of the included studies were wine consumption and cardiovascular events, respectively.
The team assessed the risk of bias in cohort studies using the Quality Assessment Tool created by the United States National Heart, Lung, and Blood Institute. They used another similar tool to assess risk of bias in case-control studies.
Finally, two independent reviewers assessed 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 larger sample size. They calculated the relative risk (RR) and odds ratios (OR) for the correlation between wine consumption and cardiovascular events and the adjusted hazard ratios (HR) reported in some studies in RR.
The team also calculated 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 evidence of publication bias for the association between CVD and wine consumption.
Results
After an extensive research search, 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 analysis set for this systematic review and meta-analysis included 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 do not report the amount of wine consumed; thus, researchers cannot determine its effect.
The present review and meta-analysis added to previous evidence of an inverse association between wine consumption and three cardiovascular events assessed in this study.
Importantly, mean age of participants, proportion of women, length of follow-up, or smoking status did not influence 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 (CI).
Although the observed feedback applies to red and white wine, variations in the strength of this relationship are due to the different concentrations of some components.
Red wine has phenolic compounds, such as gallic acid, catechin and epicatechin (flavonols), which give it antioxidant properties. They also reduce the oxidation of low-density lipoprotein (LDL), the risk of thrombosis, plasma and lipid peroxide.
Also, the alcoholic components of wine reduce the risk of thrombosis and fibrinogen levels and induce collagen and platelet aggregation. Therefore, higher consumption of red wine is more beneficial for fighting cardiovascular disease than other alcoholic beverages.
Conclusions
The results of the current study confirmed existing evidence that moderate wine consumption is beneficial for heart health. However, researchers should interpret these findings with caution. Increasing wine consumption may harm patients susceptible to alcohol due to age, existing pathologies or medications.
Based on the results of this review, wine may be part of other dietary recommendations. For example, the Mediterranean diet includes wine and recommends its use for health benefits. However, studies need to assess and delineate the effect of wine drinking by wine type.