Long-term wine consumption is related to cardiovascular mortality and life expectancy independently of moderate alcohol intake: the Zutphen Study

A burden of proof study on alcohol consumption and ischemic heart disease

Cohort and case-control data have suggested an association between low to moderate alcohol consumption and decreased risk of ischemic heart disease (IHD), yet results from Mendelian randomization (MR) studies designed to reduce bias have shown either no or a harmful association. Here we conducted an updated systematic review and re-evaluated existing cohort, case-control, and MR data using the burden of proof meta-analytical framework. Cohort and case-control data show low to moderate alcohol consumption is associated with decreased IHD risk - specifically, intake is inversely related to IHD and myocardial infarction morbidity in both sexes and IHD mortality in males - while pooled MR data show no association, confirming that self-reported versus genetically predicted alcohol use data yield conflicting findings about the alcohol-IHD relationship. Our results highlight the need to advance MR methodologies and emulate randomized trials using large observational databases to obtain more definitive answers to this critical public health question.

Long-Term Consumption of 6 Different Beverages and Cardiovascular Disease-Related Mortality: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

The relationship between beverage consumption and risk of cardiovascular disease has been extensively examined in cross-sectional studies. However, limited studies have investigated beverage consumption as a longer-term habitual behavior, which is important owing to potential cumulative harmful or beneficial cardiovascular effects. We examined the association between the long-term consumption of 6 types of beverages (sugar-sweetened or artificially sweetened beverages, tea, coffee, fruit juice, energy drinks, and alcohol) and cardiovascular mortality, by considering sex differences. We conducted a systematic search of MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus databases from 2010 to December 2023. Of 8049 studies identified, 20 studies were included for meta-analysis. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with the use of a random-effects model. We found that long-term coffee consumption was related to reduced cardiovascular disease-related mortality in males (pooled HR: 0.63; 95% CI: 0.46, 0.87; P = 0.005) but not in females (HR: 0.78; 95% CI: 0.60, 1.02; P = 0.07). Long-term higher intake of tea was associated with lower risk of cardiovascular disease-related mortality in all adults (pooled HR: 0.81; 95% CI: 0.72, 0.92; P ≤ 0.001). Higher alcohol intake was linked to higher stroke in both males (pooled HR: 1.44; 95% CI: 1.06, 1.94; P = 0.02) and females (pooled HR: 2.26; 95% CI: 1.34, 3.81; P = 0.002). Higher sugar-sweetened beverage intake was in relation to higher cardiovascular disease-related mortality (pooled HR: 1.31; 95% CI: 1.16, 1.46; P ≤ 0.0001). We concluded that long-term habitual coffee consumption is beneficial for males, and tea consumption is beneficial for all adults. Long-term high alcohol and sugar-sweetened beverage consumption increased risk of cardiovascular disease-related mortality for both males and females. However, we were unable to draw conclusions on the potential benefit or harm of the long-term consumption of fruit juice and energy drinks on cardiovascular disease-related mortality owing to the limited number of studies available. This review was registered at PROSPERO as CRD42020214679.

Effect of the Mediterranean diet in cardiovascular prevention

The Mediterranean diet is the best evidence-based model for cardiovascular prevention. In addition to 2 major randomized secondary prevention trials (Lyon Heart and CORDIOPREV) and 1 primary prevention trial (PREDIMED) that have demonstrated these benefits, there is an unprecedented body of high-quality prospective epidemiological evidence supporting these beneficial effects. The key elements of this traditional pattern are the abundant use of extra-virgin olive oil and high consumption of foods of natural plant-based origin (fruits, vegetables, nuts, and legumes) and fish, along with a reduction in processed meats, red meats, and ultraprocessed products. Moderate consumption of wine, preferably red wine, with meals is an essential element of this traditional pattern. Although removing wine consumption from the Mediterranean diet has been associated with a reduction in its preventive efficacy, doubts have recently arisen about the possible adverse effect of even low or moderate intake of any alcoholic beverages. A new large Spanish trial, UNATI, which will begin in June 2024, will randomize 10 000 drinkers aged 50 to 75 years to abstention or moderate consumption. UNATI aims to answer these doubts with the best possible evidence.

High Adherence to a Mediterranean Alcohol-Drinking Pattern and Mediterranean Diet Can Mitigate the Harmful Effect of Alcohol on Mortality Risk

BACKGROUND

Alcohol is a psychoactive substance with deleterious effects on human health and mortality. This study aims to investigate the joint associations between the Mediterranean Diet (MedDiet), alcohol- consumption patterns and mortality from the following: all causes, cardiovascular, neoplastic, the digestive system, and other causes.

METHODS

A sample of 3411 alcohol consumers aged ≥18 years was selected from two prospective cohort studies: the MICOL and NUTRIHEP Study. Cohorts were enrolled in 2005-2006, and followed up until December 2022, capturing data on alcohol consumption, diet, and mortality. Adherence to the MedDiet was measured by the relative Mediterranean score (rMED), and alcohol consumption by the Mediterranean Alcohol-drinking Pattern index (MADP). Statistical analyses included flexible parametric survival models and subdistribution hazard ratios, to consider different causes of death.

RESULTS

a significant increase in digestive-system (SHR 2.77, 95% CI 1.16; 63) and cancer mortality risk (SHR 2.25, 95% CI 1.08; 4.70) was observed among individuals with low adherence to the MADP. Low adherence to the Mediterranean pattern of alcohol consumption, combined with low adherence to the MedDiet, was associated with higher overall mortality (HR 2.29, 95% CI 1.04, 5.04), and, in particular, with higher mortality from digestive system diseases (SHR 4.38, 95% CI 1.22, 15.8).

CONCLUSIONS

This study suggests that deleterious effects of alcohol on mortality vary, depending on alcohol consumption patterns and dietary context. Higher adherence to the MedDiet appears to mitigate the adverse effects of moderate alcohol consumption, particularly for wine drinkers.

Long-Term Health Outcomes of Regular, Moderate Red Wine Consumption

Studies that are conducted to assess alcohol's long-term health outcomes generally report the results as a pooled analysis across all types of alcohol. Questions have been raised regarding potential health differences between types of alcohol, such as beer, wine, or spirits. While these three share the same alcohol in the form of ethanol, they differ in the other compounds they contain that are particular to each type of alcohol, specifically the polyphenols in red wine. The generalizability of pooled results may be limited due to the differences in health outcomes that may exist between different types of alcohol and lead to overall conclusions that differ from the subset analysis by type of alcohol that is often reported in the data tables of an article. The objective of this systematic review was to specifically address the assessment of the long-term health outcomes of regular, moderate, red wine consumption. PubMed was searched from 1987 through June 2023. Studies were included if they met all the following criteria: adult participants, red wine consumption and its frequency (close to daily), volume in moderation (1 glass/day for women, 2 glasses/day for men), and measurement of long-term (> 2 years) health outcomes. Nonclinical animal studies, or studies with an endpoint as a marker or biomarker, without a health outcome, of short duration (< 2 years), small size (< 25 subjects), a focus on binge drinking, no wine analysis performed, review articles, meta-analysis, or editorial/commentary were excluded. A total of 74 studies met the inclusion/exclusion criteria. Of these, 27 (36%) evaluated cancer outcomes, 14 (19%) evaluated cardiovascular outcomes, 10 (14%) evaluated mortality, 7 (9%) evaluated weight gain, 5 (7%) evaluated dementia, and the remaining 11 evaluated a variety of health outcomes. There were no studies that demonstrated an association between red wine consumption and negative health outcomes. Forty-seven studies demonstrated an association between red wine consumption and positive health outcomes, whereas 26 studies were neutral, and one had mixed results where women had a positive health outcome and men were neutral. All studies on mortality and dementia showed positive health outcomes. From this systematic review of the literature, there is no evidence of an association between moderate red wine consumption and negative health outcomes. Across the various outcomes assessed, a beneficial effect of moderate red wine consumption was consistently seen for mortality and dementia, along with certain cancers (e.g., non-Hodgkin lymphoma) and cardiovascular conditions (e.g., metabolic syndrome). For other health outcomes, the association was neutral, i.e., neither harmful nor beneficial. This review is not intended to encourage red wine consumption for health outcomes but rather to avoid discouraging moderate red wine consumption based on misunderstanding or misinterpretation of the red wine data due to the reporting of pooled data across all types of alcohol.

Alcohol consumption and epigenetic age acceleration in young adults

Alcohol is a widely consumed substance in the United States, however its effect on aging remains understudied. In this study of young adults, we examined whether cumulative alcohol consumption, i.e., alcohol years of beer, liquor, wine, and total alcohol, and recent binge drinking, were associated with four measures of age-related epigenetic changes via blood DNA methylation. A random subset of study participants in the Coronary Artery Risk Development in Young Adults Study underwent DNA methylation profiling using the Illumina MethylationEPIC Beadchip. Participants with alcohol consumption and methylation data at examination years 15 (n = 1,030) and 20 (n = 945) were included. Liquor and total alcohol consumption were associated with a 0.31-year (P = 0.002) and a 0.12-year (P = 0.013) greater GrimAge acceleration (GAA) per additional five alcohol years, while beer and wine consumption observed marginal (P = 0.075) and no associations (P = 0.359) with GAA, respectively. Any recent binge drinking and the number of days of binge drinking were associated with a 1.38-year (P < 0.001) and a 0.15-year (P < 0.001) higher GAA, respectively. We observed statistical interactions between cumulative beer (P < 0.001) and total alcohol (P = 0.004) consumption with chronological age, with younger participants exhibiting a higher average in GAA compared to older participants. No associations were observed with the other measures of epigenetic aging. These results suggest cumulative liquor and total alcohol consumption and recent binge drinking may alter age-related epigenetic changes as captured by GAA. With the increasing aging population and widespread consumption of alcohol, these findings may have potential implications for lifestyle modification to promote healthy aging.

Mediterranean Alcohol-Drinking Patterns and All-Cause Mortality in Women More Than 55 Years Old and Men More Than 50 Years Old in the "Seguimiento Universidad de Navarra" (SUN) Cohort

BACKGROUND

Most of the available epidemiological evidence on alcohol and chronic disease agrees on recommending alcohol abstention to young people, but some controversy exists about the most appropriate recommendation for alcohol abstention for people of older ages. A growing body of evidence suggests that the pattern of alcohol consumption is likely to be a strong effect modifier. The Mediterranean Alcohol Drinking Pattern (MADP) represents a score integrating several dimensions of drinking patterns (moderation, preference for red wine, drinking with meals, and avoiding binge drinking). Our aim was to clarify this issue and provide more precise recommendations on alcohol consumption.

METHODS

We prospectively followed-up 2226 participants (men older than 50 years and women older than 55 years at baseline) in the Seguimiento Universidad de Navarra (SUN) cohort. We classified participants into three categories of adherence to the MADP score (low, moderate, and high), and we added a fourth category for abstainers. Cox regression models estimated multivariable-adjusted hazard ratios (HR) of all-cause death and 95% confidence intervals (CI) using low MADP adherence as the reference category.

RESULTS

The strongest reduction in risk of mortality was observed for those with high adherence to the MADP, with an HR of 0.54 (95% CI: 0.37-0.80). The moderate adherence group (HR = 0.65, 95% CI: 0.44-0.96) and the abstention group (HR = 0.60, 95% CI: 0.36-0.98) also exhibited lower risks of mortality than the low MADP adherence group.

CONCLUSIONS

based on the available evidence, a public health message can be provided to people older than 50 years as follows: among those who drink alcohol, high adherence to the MADP score could substantially reduce their risk of all-cause mortality.

Does voluntary health insurance improve health and longevity? Evidence from European OECD countries

The financing structure of the healthcare system and, particularly, the voluntary health insurance (VHI) constituent, has been a vital pillar in improving the overall quality of life. Consequently, this study aims to shed light on the effect of VHI on the population's health and longevity in a sample of 26 European OECD countries. The methodology employed covers both hierarchical clustering and the novel dynamic panel threshold technique. First, the descriptive cluster analysis unveils a delimitation of the countries into four main groups with respect to a broad set of health status indicators. Second, the estimates show that VHI is a significant determinant of health and longevity. More specifically, we find that the relationship between variables is characterized by a threshold effect, whose estimated value is roughly 6.3% of the total healthcare financing. Also, the heterogeneity analysis unveils consistent differences regarding the impact of VHI on health and longevity for the supplementary and complementary types of VHI. Overall, results are strongly robust, the signs and the significance of the coefficients being preserved in the presence of several additional control factors. From a policy perspective, the study's findings can be used nationwide to stimulate regulatory policies to encourage the achievement of a satisfactory level of private health insurance.

Alcohol Consumption and Cardiovascular Health

BACKGROUND

Studies evaluating alcohol consumption and cardiovascular diseases have shown inconsistent results.

METHODS

We performed a systematic review of peer-reviewed publications from an extensive query of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception to March 2022 for all studies that reported the association between alcohol consumption in terms of quantity (daily or weekly amounts) and type of beverage (wine, beer or spirit) and cardiovascular disease events.

RESULTS

The study population included a total of 1,579,435 individuals based on 56 cohorts from several countries. We found that moderate wine consumption defined as 1-4 drinks per week was associated with a reduction in risk for cardiovascular mortality when compared with beer or spirits. However, higher risk for cardiovascular disease mortality was typically seen with heavier daily or weekly alcohol consumption across all types of beverages.

CONCLUSIONS

It is possible that the observational studies may overestimate the benefits of alcohol for cardiovascular disease outcomes. Although moderate wine consumption is probably associated with low cardiovascular disease events, there are many confounding factors, in particular, lifestyle, genetic, and socioeconomic associations with wine drinking, which likely explain much of the association with wine and reduced cardiovascular disease events. Further prospective study of alcohol and all-cause mortality, including cancer, is needed.

Alcohol and Cardiovascular Diseases—Do the Consumption Pattern and Dose Make the Difference?

Excessive consumption of alcohol is not only a social problem, but it also significantly increases the morbidity and mortality rates of many societies. A correlation has been demonstrated between alcohol consumption and increased mortality from cancer, accidents and injuries, liver cirrhosis and other causes. Alcohol abuse increases the incidence of hemorrhagic stroke and the risk of ischemic stroke, induces serious arrhythmias, adversely affects blood pressure and damages the heart muscle. The dose and way of drinking alcohol play a crucial role in assessing whether this drink allows people to maintain health or whether it is a great health and social threat. The beneficial effects of low and moderate doses of alcohol on the occurrence of cardiovascular diseases have been shown in many population studies and meta-analyses in which the effect of U-shaped or J-shaped curves relating alcohol intake to cardiovascular mortality was observed, especially in ischemic heart disease. However, due to the fact that alcohol consumption is associated with many health hazards, it is not recommended to consume it as a preventive action of cardiovascular diseases. Moreover, recent studies suggest that association of low-to-moderate alcohol consumption with the reduction in cardiovascular risk is a result of lifestyle changes and that any reduction in alcohol consumption is in fact beneficial in terms of general health.

Alcohol, Drinking Pattern, and Chronic Disease

This review discusses the inconsistent recommendations on alcohol consumption and its association with chronic disease, highlighting the need for an evidence-based consensus. Alcohol is an addictive substance consumed worldwide, especially in European countries. Recommendations on alcohol consumption are controversial. On one hand, many nonrandomized studies defend that moderate consumption has a beneficial cardiovascular effect or a lower risk of all-cause mortality. On the other hand, alcohol is associated with an increased risk of cancer, neurological diseases, or injuries, among others. For years, efforts have been made to answer the question regarding the safe amount of alcohol intake, but controversies remain. Observational studies advocate moderate alcohol consumption following a Mediterranean pattern (red wine with meals avoiding binge drinking) as the best option for current drinkers. However, agencies such as the IARC recommend abstention from alcohol as it is a potent carcinogen. In this context, more randomized trial with larger sample size and hard clinical endpoints should be conducted to clarify the available evidence and provide clinicians with support for their clinical practice.

[Stroke prevention]

Prevention is essential to stroke management because of the high risk of recurrence. Stroke incidence is increased by known risk factors, which can be prevented. Cardiovascular prevention after stroke or TIA also includes aetiology-specific treatment, when it is known. Endovascular treatment is not indicated as a first-line treatment for atheromatous cervical or intracranial stenosis. Endovascular or surgical treatment is not indicated as first-line treatment for cervical arterial dissection because of its minor risk of stroke recurrence.

Is a Meal without Wine Good for Health?

Hippocrates, the father of medicine, had said: "Wine is a thing wonderfully appropriate to man if, in health as in disease, it is administered with appropriate and just measure according to the individual constitution." Wine has always accompanied humanity, for religion or for health. Christians and Jews need wine for the liturgy. For Plato, wine was an indispensable element in society and the most important in the symposium. In this second part of the banquet, mixed with water, the wine gave the word. If the French paradox made a lot of ink flow; it was the wine that was originally responsible for it. Many researchers have tried to study alcohol and polyphenols in wine, in order to solve the mystery. Beyond its cardiovascular effects, there are also effects on longevity, metabolism, cancer prevention, and neuroprotection, and the list goes on. The purpose of this work is to make an analysis of the current knowledge on the subject. Indeed, if the paradigm of antioxidants is seductive, it is perhaps by their prooxidant effect that the polyphenols act, by an epigenetic process mediated by nrf2. Wine is a preserve of antioxidants for the winter and it is by this property that the wine acts, in an alcoholic solution. A wine without alcohol is pure heresy. Wine is the elixir that by design, over millennials, has acted as a pharmacopeia that enabled man to heal and prosper on the planet. From Alvise Cornaro to Serge Renaud, nutrition was the key to health and longevity, whether the Cretan or Okinawa diet, it is the small dose of alcohol (wine or sake) that allows the bioavailability of polyphenols. Moderate drinking gives a protection for diseases and a longevity potential. In conclusion, let us drink fewer, but drink better, to live older.

Moderate alcohol consumption is associated with lower chronic disease burden expressed in disability-adjusted life years: a prospective cohort study

The relation of alcohol consumption with disease burden remains debated partly due to opposite associations with cardiovascular disease (CVD) and cancer. The relation of alcohol consumption with disease burden expressed in disability-adjusted life years (DALYs) summarizes opposing associations of alcohol consumption on chronic diseases. This study aimed to investigate the association of alcohol consumption with chronic disease burden expressed in DALYs based on individual-participant data. The study was a prospective study among 33,066 men and women from the EPIC-NL cohort. At baseline, alcohol consumption was assessed with a validated food-frequency questionnaire. Participants were followed for occurrence of and mortality from chronic diseases and DALYs were calculated. After 12.4 years follow-up, 6647 disease incidences and 1482 deaths were documented, resulting in 68,225 healthy years of life lost (6225 DALYs). Moderate drinkers (women 5–14.9 g/day, men 5–29.9 g/day) had a lower chronic disease burden (mean DALYs −0.27; 95% CI −0.43; −0.11) than light drinkers (0–4.9 g/day), driven by a lower disease burden due to CVD (−0.18: −0.29; −0.06) but not cancer (−0.05: −0.16; 0.06). The associations were most pronounced among older participants (≥50 years; −0.32; −0.53; −0.10) and not observed among younger women (−0.08; −0.43; 0.35), albeit non-significant (p_interaction > 0.14). Substantial drinking (women 15–29.9 g/day, men 30–59.9 g/day) compared to light drinking was not associated with chronic disease burden. Our results show that moderate compared to light alcohol consumption was associated with living approximately 3 months longer in good health. These results were mainly observed among older participants and not seen among younger women.

Alterations in microRNA expression associated with alcohol consumption in rectal cancer subjects

Purpose

Alcohol consumption has been purported to influence many diseases. MicroRNAs (miRNAs) may be influenced by compounds found in alcohol. In this investigation, we test the hypothesis that total alcohol, beer, wine, and hard liquor influence miRNA expression.

Methods

We studied 1447 colorectal (CR) cancer cases with normal CR mucosa and carcinoma miRNA expression data along with alcohol consumption data. We analyzed long-term and long-term and current (LTC) alcohol use for beer, liquor, and wine with miRNA expression between paired carcinoma and normal colon and rectal tissues, adjusting for multiple comparisons using the positive false discovery rate q-value. MiRNAs associated significantly with alcohol were examined with all-cause mortality (ACM). MiRNAs associated significantly with ACM were examined with RNA-Seq data.

Results

Expression of 84 miRNAs was associated significantly with LTC wine use in normal rectal mucosa. Higher expression of two of these miRNAs significantly worsened ACM: hsa-miR-210 (Hazard Ratio [HR] 1.12, 95% CI (1.03, 1.21), p-value = 0.004), and hsa-miR-92a-1-5p (HR 1.20, 95% CI (1.04, 1.38), p-value = 0.013). These miRNAs were downregulated across levels of LTC wine consumption.

Conclusions

Our results suggest that wine influences miRNA expression in rectal cancer, supporting the hypothesis that components in alcohol influence miRNA expression.

Electronic supplementary material

The online version of this article (doi:10.1007/s10552-017-0882-2) contains supplementary material, which is available to authorized users.

Factors That May Enhance Longevity: A Literature Review and a Comprehensive Update for Aesthetic Surgeons

INTRODUCTION

After surgery, the plastic surgeon is very often questioned about how to maintain the result and more frequently how to slow down the aging process. However, this type of knowledge is not commonly delivered during medical education or at least needs an update. This review could be used as a guide to help plastic surgeons to manage these frequent postoperative consultations. The aim of this literature review was to focus discussion on specific positive factors, identified to have a significant impact on human longevity.

MATERIALS AND METHODS

A literature review was performed using the automated computerized PubMed search, with the keywords "human longevity." Only papers written in the English language were included. References were screened to identify further relevant articles. Experimental studies based on microorganisms and animals, works published in non-indexed journals, case reports, letters, and viewpoints were excluded.

RESULTS

One hundred and twenty-four articles reporting factors influencing human longevity were analyzed for data extraction. A total of 59 articles reporting only positive factors were included. Fourteen factors seemed to have a positive impact on longevity: caloric restriction, active effort and sports, happiness, vitamins, vegetarian or Mediterranean diet, oriental practices, socioeconomic status, genetics, sexual activity, sleep, moderate wine consumption, religion, and education.

CONCLUSION

While some factors with a positive impact on longevity are clearly identified and should be integrated in the postoperative process, further studies are still needed to be able to slow down the aging process.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Association of Smoking, Alcohol, and Obesity with Cardiovascular Death and Ischemic Stroke in Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study and Cardiovascular Health Study (CHS)

Atrial fibrillation (AF) is associated with an increased risk of ischemic stroke and cardiovascular (CV) death. Whether modifiable lifestyle risk factors are associated with these CV outcomes in AF is unknown. Among Atherosclerosis Risk in Communities (ARIC) study and Cardiovascular Health Study (CHS) participants with incident AF, we estimated the risk of composite endpoint of ischemic stroke or CV death associated with candidate modifiable risk factor (smoking, heavy alcohol consumption, or high body mass index [BMI]), and computed the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) of incorporating each factor into the CHA₂DS₂-VASc. Among 1222 ARIC (mean age: 63.4) and 756 CHS (mean age: 79.1) participants with incident AF, during mean follow-up of 6.9 years and 5.7 years, there were 332 and 335 composite events respectively. Compared with never smokers, current smokers had a higher incidence of the composite endpoint in ARIC [HR: 1.65 (1.21–2.26)] but not in CHS [HR: 1.05 (0.69–1.61)]. In ARIC, the addition of current smoking did not improve risk prediction over and above the CHA₂DS₂-VASc. No significant associations were observed with alcohol consumption or BMI with CVD outcomes in AF patients from either cohort. Smoking is associated with an increased risk of ischemic stroke or CV death in ARIC, which comprised mostly middle-aged to young-old (65–74 years), but not in CHS, which comprised mostly middle-old or oldest-old (≥75 years) adults with AF. However, addition of smoking to the CHA₂DS₂-VASc score did not improve risk prediction of these outcomes.

SIRT1: role in cardiovascular biology

SIRT1 (silent information regulator two protein) is a type III protein deacetylase that regulates a variety of important metabolic and physiologic processes including stress resistance, metabolism, apoptosis and energy balance. It reverses cholesterol transport and reduces risk for development of atherosclerosis and cardiovascular disease. The following review highlights the potential role of SIRT1 on cardiovascular biology and function.

The impact of moderate wine consumption on health

Wine is a traditional beverage that has been associated with both healthy and harmful effects. Conceptions like the so-called "French paradox" or the beneficial impact of the Mediterranean diet suggest benefit. Wine has a complex composition, which is affected by whether it is red or white or by other variables, like the variety of grapes or others. Alcohol and phenolic compounds have been attributed a participation in the benefits ascribed to wine. The case of alcohol has been extensively studied, but the key question is whether wine offers additional benefits. Resveratrol, a non-flavonoid compound, and quercetin, a flavonol, have received particular attention. There is much experimental work confirming a beneficial balance for both substances, particularly resveratrol, in various organs and systems. The pharmacological dosages used in many of those experiments have shed doubt, however, on the clinical translation of those findings. Clinical studies are limited by their observational nature as well as for the difficulties to abstract the benefits of wine from other confounders. Notwithstanding the doubts, there is reasonable unanimity in beneficial effects of moderate wine consumption in cardiovascular disease, diabetes, osteoporosis, maybe neurological diseases, and longevity. Observations are less enthusiastic in what refers to cancer. While considering these limitations, clinicians may spread the message that the balance of moderate wine consumption seems beneficial.

Lifestyle risk factors and residual life expectancy at age 40: a German cohort study

BACKGROUND

Cigarette smoking, adiposity, unhealthy diet, heavy alcohol drinking and physical inactivity together are associated with about half of premature deaths in Western populations. The aim of this study was to estimate their individual and combined impacts on residual life expectancy (RLE).

METHODS

Lifestyle and mortality data from the EPIC-Heidelberg cohort, comprising 22,469 German adults ≥40 years and free of diabetes, cardiovascular disease and cancer at recruitment (1994-1998), were analyzed with multivariable Gompertz proportional hazards models to predict lifetime survival probabilities given specific baseline status of lifestyle risk factors. The life table method was then used to estimate the RLEs.

RESULTS

For 40-year-old adults, the most significant loss of RLE was associated with smoking (9.4 [95% confidence interval: 8.3, 10.6] years for male and 7.3 [6.0, 8.9] years for female heavy smokers [>10 cigarettes/day]; 5.3 [3.6, 7.1] years for men and 5.0 [3.2, 6.6] years for women smoking ≤10 cigarettes/day). Other lifestyle risk factors associated with major losses of RLE were low body mass index (BMI <22.5 kg/m(2), 3.5 [1.8, 5.1] years for men; 2.1 [0.5, 3.6] years for women), obesity (BMI ≥30, 3.1 [1.9, 4.4] years for men; 3.2 [1.8, 5.1] years for women), heavy alcohol drinking (>4 drinks/day, 3.1 [1.9, 4.0] years for men), and high processed/red meat consumption (≥120 g/day, 2.4 [1.0, 3.9] years for women). The obesity-associated loss of RLE was stronger in male never smokers, while the loss of RLE associated with low BMI was stronger in current smokers. The loss of RLE associated with low leisure time physical activity was moderate for women (1.1 [0.05, 2.1] years) and negligible for men (0.4 [-0.3, 1.2] years). The combined loss of RLE for heavy smoking, obesity, heavy alcohol drinking and high processed/red meat consumption, versus never smoking, optimal BMI (22.5 to 24.9), no/light alcohol drinking and low processed/red meat consumption, was 17.0 years for men and 13.9 years for women.

CONCLUSIONS

Promoting healthy lifestyles, particularly no cigarette smoking and maintaining healthy body weight, should be the core component of public health approaches to reducing premature deaths in Germany and similar affluent societies.

Mediterranean alcohol-drinking pattern and mortality in the SUN (Seguimiento Universidad de Navarra) Project: a prospective cohort study

Moderate alcohol intake has been related to lower mortality. However, alcohol use includes other dimensions beyond the amount of alcohol consumed. These aspects have not been sufficiently studied as a comprehensive entity. We aimed to test the relationship between an overall alcohol-drinking pattern and all-cause mortality. In a Mediterranean cohort study, we followed 18 394 Spanish participants up to 12 years. A validated 136-item FFQ was used to assess baseline alcohol intake. We developed a score assessing simultaneously seven aspects of alcohol consumption to capture the conformity to a traditional Mediterranean alcohol-drinking pattern (MADP). It positively scored moderate alcohol intake, alcohol intake spread out over the week, low spirit consumption, wine preference, red wine consumption, wine consumed during meals and avoidance of binge drinking. During the follow-up, 206 deaths were identified. For each 2-point increment in a 0-9 score of adherence to the MADP, we observed a 25% relative risk reduction in mortality (95% CI 11, 38%). Within each category of alcohol intake, a higher adherence to the MADP was associated with lower mortality. Abstainers (excluded from the calculations of the MADP) exhibited higher mortality (hazard ratio 1·82, 95% CI 1·14, 2·90) than participants highly adherent to the MADP. In conclusion, better adherence to an overall healthy alcohol-drinking pattern was associated with reduced mortality when compared with abstention or departure from this pattern. This reduction goes beyond the inverse association usually observed for moderate alcohol drinking. Even moderate drinkers can benefit from the advice to follow a traditional MADP.

Is it merely a myth that alcoholic beverages such as red wine can be cardioprotective?

It has been suggested that although the negative impact of alcohol consumption varies from person to person, on a global level the adverse effect of alcohol on cardiovascular disease outweighs any protective effect by between two- and three-fold. This is inaccurate. There is a proven positive relationship between alcohol consumption and cardiovascular disease that is acknowledged by the World Health Organization. For example, moderate alcohol consumption reduces the risk of cardiovascular disease by approximately 25%, such that alcohol consumption per se accounts for -4.7% of the total cardiovascular disease burden in Australia. Correspondingly, cardiovascular disease accounted for 34% of the total number of deaths in Australia in 2008, and 18% of the overall burden of disease in Australia in 2003, with coronary heart disease and stroke contributing over 80% of this burden. Australia is not substantially different from other developed countries having similar demographics to, and the same leading causes of burden as, other high-income developed countries. This article examines the suggestions and evidence surrounding the relationship between light-to-moderate alcohol consumption and benefits to human health.

Bioavailability of wine-derived phenolic compounds in humans: a review

Phenolic compounds are produced in the seeds and skins of grapes, and are transferred into wine during the fermentation process. Phenolic compounds can also be imparted into wine from maturation and storage in oak wood barrels after fermentation. The consumption of wine, an alcoholic beverage, has been observed in epidemiological studies to reduce the risk of cardiovascular disease and certain cancers, as well as diabetes and dementia, in a J-shaped relationship between amount consumed and level of risk. The bioactivity of wine primarily observed in vitro and ex vivo, may result from wine's relatively high content of phenolic compounds, which is similar to that observed in fruits and vegetables; a Mediterranean fruit and vegetable rich-diet is also associated with a reduced risk of cardiovascular disease and cancers. If the wine-derived phenolic compounds or their active metabolites are not absorbed in sufficient amounts and in a readily available form for cells, however, then they are less likely to have any significant in vivo activity. This review considers and discusses the available data to date on the bioavailability of the different wine-derived phenolic compounds in humans.

Wine consumption and 20-year mortality among late-life moderate drinkers

OBJECTIVE

This study examined level of wine consumption and total mortality among 802 older adults ages 55-65 at baseline, controlling for key sociodemographic, behavioral, and health status factors. Despite a growing consensus that moderate alcohol consumption is associated with reduced total mortality, whether wine consumption provides an additional, unique protective effect is unresolved.

METHOD

Participants were categorized in three subsamples: abstainers, high-wine-consumption moderate drinkers, and low-wine-consumption moderate drinkers. Alcohol consumption, sociodemographic factors, health behavior, and health problems were assessed at baseline; total mortality was indexed across an ensuing 20-year period.

RESULTS

After adjusting for all covariates, both high-wine-consumption and low-wine-consumption moderate drinkers showed reduced mortality risks compared with abstainers. Further, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine were older, were more likely to be male, reported more health problems, were more likely to be tobacco smokers, scored lower on socioeconomic status, and (statistical trend) reported engaging in less physical activity. Controlling only for overall ethanol consumption, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine showed a substantially increased 20-year mortality risk of 85%. However, after controlling for all covariates, the initial mortality difference associated with wine consumption was no longer significant.

CONCLUSIONS

Among older adults who are moderate drinkers, the apparent unique effects of wine on longevity may be explained by confounding factors correlated with wine consumption.

Are sirtuins viable targets for improving healthspan and lifespan?

Although the increased lifespan of our populations illustrates the success of modern medicine, the risk of developing many diseases increases exponentially with old age. Caloric restriction is known to retard ageing and delay functional decline as well as the onset of disease in most organisms. Studies have implicated the sirtuins (SIRT1-SIRT7) as mediators of key effects of caloric restriction during ageing. Two unrelated molecules that have been shown to increase SIRT1 activity in some settings, resveratrol and SRT1720, are excellent protectors against metabolic stress in mammals, making SIRT1 a potentially appealing target for therapeutic interventions. This Review covers the current status and controversies surrounding the potential of sirtuins as novel pharmacological targets, with a focus on SIRT1.

Blood pressure, smoking and alcohol use, association with vascular dementia

The success of the ageing global population brings with it a growth in the number of dementia sufferers. Older adults are at highest risk of dementia and are likely to manifest both vascular and Alzheimer's pathology. Blood pressure also changes with ageing and there is evidence linking high blood pressure in midlife to an increased risk of later dementia. Data from later life is sparser. A number of intervention trials have been carried out with antihypertensives and have shown mixed results with regard to cognitive and dementia outcomes (both dementia overall and of vascular and Alzheimer's types). Meta-analyses have in general not found an association between blood pressure lowering and reduced dementia incidence, although the number of cases reported in the placebo controlled trials is invariably lower in the actively treated group. Systematic reviews and meta-analyses have also been published with regard to smoking and alcohol use and incident dementia. Despite mixed reports, overall smoking was associated with an increased risk of later dementia and alcohol with a 'U' or 'J' shaped relationship. Following the systematic reviews subsequent publications tend to report similar findings. The literature in this area suffers from differing populations, lengths of follow up and assessments of both risk factor and outcome. However, at present, maintenance of cognitive function would seem to be best served by treating cardiovascular risk factors in accordance with current guidelines, controlling blood pressure, reducing smoking and if consuming alcohol doing so in moderation. This review will concentrate on the prevention of dementia and attempt to provide an overview of the evidence relating to vascular related dementia and the potential risk factors of hypertension, alcohol use and smoking behaviour.

Prevalence of sexual activity and associated factors in hypertensive males and females in China: a cross-sectional study

Background

Hypertension is an important factor contributing to sexual dysfunction. The number of people with hypertension is increasing in China, but research into sexual life, which has implications for quality of life, is limited. We aimed to compare sexual activity and the influence of daily behaviors and sexual domain of hypertensive males and females in south China.

Methods

A cross-sectional study was conducted at the health care center of a university-affiliated hospital from 2007 to 2008. We enrolled 502 subjects with hypertension (225 males, 48.79 ± 7.39 years old; 277 females, 48.26 ± 6.93 years old) and 173 with normotension (82 males, 45.69 ± 6.58 years old; 91 females, 46.14 ± 7.03 years old), all sexually active. All subjects completed a self-administered questionnaire on sexual activity before a routine physical check-up. Data were collected on sociodemographic and clinical characteristics, use of cigarettes and intake of beverages (including alcohol).

Results

Hypertensive and normotensive subjects differed in frequency of orgasms and of sexual satisfaction, as well as duration of sexual activity. For hypertensive men, low frequency of sexual activity, orgasms and satisfaction were associated with unemployed or retired status than physical labor work (odds ratio [OR] 0.28 [95% confidence interval (95% CI) 0.12–0.69], 0.32 [0.12–0.86], 0.33 [0.19–0.88], respectively; p < 0.05), and long sexual duration was associated with never drinking alcohol than heavy drinking (OR 4.49 [1.28–6.41]). For hypertensive women, low frequency and duration of sexual activity and low satisfaction were associated with never drinking tea than heavy tea drinking (OR 0.42 [0.18–0.96], 0.49 [0.24–0.98], 0.29 [0.14–0.64], respectively; p < 0.05). Medication use and electrocardiography results were not associated with sexual activity for hypertensive patients.

Conclusions

For hypertensive people in China, lifestyle factors are associated with sexual dysfunction, which differs by the sex of the person. Further research needs to examine serum hormone levels to validate the result.

Self-rated health and physician-rated health as independent predictors of mortality in elderly men

BACKGROUND

When assessing health status, physicians may focus on objective symptoms and diagnoses, whereas individuals may focus more on subjective symptoms, functional limitations and quality of life.

METHODS

In the Zutphen Elderly Study, 710 community-living men (aged 64-84 years) were followed until death for 15 years. Self-rated health was assessed through a single-item question. Physician-rated health was estimated on a Likert scale by physicians after medical history assessment and physical examination. Both health ratings were categorised into three groups. All-cause, cardiovascular and cancer mortality rates were analysed in Cox proportional-hazards models.

RESULTS

There were 352 (49.6%) men who felt healthy and 225 (31.7%) men with a good physician-rated health. During 15 years of follow-up 503 of 710 men (70.8%) died, of whom 229 (45.5%) from cardiovascular causes and 144 (28.6%) from cancer. Self-rated and physician-rated health both predicted independently all-cause mortality (hazard ratios [HR] for worst vs. best health category: 1.72; 95% confidence interval [CI]: 1.26-2.33, and 1.77; 95% CI: 1.36-2.29; respectively; P-values of <0.005). When self-rated and physician-rated health were discordant, mortality risk was highest when physicians had a less favourable view on the health status than the participant. Self-rated health predicted independently cancer mortality (HR 2.41), whereas physician-rated health cardiovascular mortality (HR 2.13).

CONCLUSION

Self-rated and physician-rated health status predicted both all-cause mortality, and showed a differential pattern for cancer and cardiovascular diseases mortality.

Alcohol and the heart: to abstain or not to abstain?

Alcohol has been consumed by most societies over the last 7000 years. Abraham Lincoln said "It has long been recognized that the problems with alcohol relate not to the use of a bad thing, but to the abuse of a good thing." Light to moderate alcohol consumption reduces the incidence of coronary heart disease (CHD), ischemic stroke, peripheral arterial disease, CHD mortality, and all-cause mortality, especially in the western populations. However, heavy alcohol consumption is detrimental causing cardiomyopathy, cardiac arrhythmias, hepatic cirrhosis, pancreatitis, and hemorrhagic stroke. In this article, we review the effects of alcohol on CHD, individual cardiovascular risk factors, cardiomyopathy, and cardiac arrhythmias, including the most recent evidence of the effects of alcohol on CHD.

Direct and indirect pathways connecting cognitive ability with cardiovascular disease risk: socioeconomic status and multiple health behaviors

OBJECTIVE

To model and test direct and indirect pathways connecting general cognitive ability (g) with cardiovascular disease risk factors, via socioeconomic status (SES) and multiple health behaviors.

METHODS

A sample comprising participants in the Health and Lifestyle Survey, a prospective cohort study of a representative sample of U.K. adults in 1984/5 (n = 4939, 2426 males).

RESULTS

Two mediating latent variables were proposed that connected a latent cognitive trait (named g) with a latent trait of cardiovascular disease (CVD) risk: multiple health behaviors (defined by smoking, physical inactivity, and weekly saturated fat intake) and SES (defined by educational attainment, occupational social class, and income). In males and females, SES mediated the association between g and CVD risk, but the mediation was moderated by years of age. A direct effect from g to CVD risk was also significant, but this was restricted to older males. Multiple health behaviors offered no explanatory power, because they were not influenced by g.

CONCLUSIONS

SES may connect g with CVD risk in males, but not systematically across the life course. Moderated mediation is a novel way to illustrate that direct and indirect pathways can vary as a function of age. Explanations that emphasize g or SES are not mutually exclusive; there are direct and indirect contributions to CVD risk from each source, and these vary across the life course.

Prevention of cardiovascular risk by moderate alcohol consumption: epidemiologic evidence and plausible mechanisms

An inverse association between moderate alcohol intake and cardiovascular risk, in particular coronary disease and ischemic stroke, has been shown in many epidemiologic studies. In addition, several other diseases are also known to occur less frequently in moderate drinkers than in non-drinkers, whereas excess of drinking is invariably harmful. However, some concern has been recently raised about the possibility that at all dosages the harm of alcohol could overcome its beneficial effects. We present here the epidemiologic and mechanistic evidence to support the protective effect of moderate alcohol intake against cardiovascular disease and all-cause mortality.

Resveratrol, sirtuins, and the promise of a DR mimetic

Dietary restriction (DR) delays or prevents age-related diseases and extends lifespan in species ranging from yeast to primates. Although the applicability of this regimen to humans remains uncertain, a proportional response would add more healthy years to the average life than even a cure for cancer or heart disease. Because it is unlikely that many would be willing or able to maintain a DR lifestyle, there has been intense interest in mimicking its beneficial effects on health, and potentially longevity, with drugs. To date, such efforts have been hindered primarily by our lack of mechanistic understanding of how DR works. Sirtuins, NAD(+)-dependent deacetylases and ADP-ribosyltransferases that influence lifespan in lower organisms, have been proposed to be key mediators of DR, and based on this model, the sirtuin activator resveratrol has been proposed as a candidate DR mimetic. Indeed, resveratrol extends lifespan in yeast, worms, flies, and a short-lived species of fish. In rodents, resveratrol improves health, and prevents the early mortality associated with obesity, but its precise mechanism of action remains a subject of debate, and extension of normal lifespan has not been observed. This review summarizes recent work on resveratrol, sirtuins, and their potential to mimic beneficial effects of DR.

Dietary flavonol intake may lower stroke risk in men and women

Flavonols are strong antioxidants in plant foods and tea is a major dietary source. There is evidence from prospective cohort studies that tea and flavonols are inversely related to stroke incidence. We conducted a metaanalysis of prospective cohort studies to assess quantitatively the strength of the association between flavonol intake and stroke incidence. Prospective cohort studies with data from individuals free of cardiovascular diseases (CVD) or stroke at baseline were included in the metaanalysis. Persons were followed for between 6 and 28 y. Data from 6 cohorts involving 111,067 persons with at least 2155 nonfatal and fatal cases were pooled. A random effects model was used. In all studies included, adjustments were made for major CVD risk factors except for 2 that did not adjust for alcohol and energy intake. A high intake of flavonols compared with a low intake was inversely associated with nonfatal and fatal stroke with a pooled relative risk of 0.80 (95% CI: 0.65, 0.98). Visual inspection of Begg's funnel plot and Egger's test (P = 0.01) indicated potential publication bias. We conclude that flavonols may reduce stroke risk.

Alcohol consumption and non-Hodgkin lymphoma survival

INTRODUCTION

Epidemiological studies have shown that moderate alcohol drinkers have a lower death rate for all causes. Alcohol drinking has also been associated with reduced risk of non-Hodgkin lymphoma (NHL). Here, we examined the role of alcohol consumption on NHL survival by type of alcohol consumed and NHL subtype.

METHODS

A cohort of 575 female NHL incident cases diagnosed during 1996-2000 in Connecticut was followed-up for a median of 7.75 years. Demographic, clinical, and lifestyle information was collected at diagnosis. Survival analyses were conducted with Kaplan-Meier methods, and hazard ratios (HR) were estimated from Cox Proportional Hazards models.

RESULTS

Compared to never drinkers, wine drinkers experienced better overall survival (75% vs. 69% five-year survival rates, p-value for log-rank test = 0.030) and better disease free survival (70% vs. 67% five-year disease-free survival rates, p-value for log-rank test = 0.049). Analysis by NHL subtype shows that the favorable effect of wine consumption was mainly seen for patients diagnosed with diffuse large B-cell lymphoma (DLBCL) (wine drinkers for more than 25 years vs. never drinkers: HR = 0.36, 95% CI 0.14-0.94 for overall survival; HR = 0.38, 95% CI 0.16-0.94 for disease-free survival), and the adverse effect of liquor consumption was also observed among DLBCL patients (liquor drinkers vs. never drinkers: HR=2.49, 95% CI 1.26-4.93 for disease-free survival).

CONCLUSIONS

Our results suggest a moderate relationship between pre-diagnostic alcohol consumption and NHL survival, particularly for DLBCL. The results need to be replicated in larger studies.

IMPLICATIONS FOR CANCER SURVIVORS

Pre-diagnostic behaviors might impact the prognosis and survival of NHL patients.

Biochemical effects of SIRT1 activators

SIRT1 is the closest mammalian homologue of enzymes that extend life in lower organisms. Its role in mammals is incompletely understood, but includes modulation of at least 34 distinct targets through its nicotinamide adenine dinucleotide (NAD(+))-dependent deacetylase activity. Recent experiments using small molecule activators and genetically engineered mice have provided new insight into the role of this enzyme in mammalian biology and helped to highlight some of the potentially relevant targets. The most widely employed activator is resveratrol, a small polyphenol that improves insulin sensitivity and vascular function, boosts endurance, inhibits tumor formation, and ameliorates the early mortality associated with obesity in mice. Many of these effects are consistent with modulation of SIRT1 targets, such as PGC1alpha and NFkappaB, however, resveratrol can also activate AMPK, inhibit cyclooxygenases, and influence a variety of other enzymes. A novel activator, SRT1720, as well as various methods to manipulate NAD(+) metabolism, are emerging as alternative methods to increase SIRT1 activity, and in many cases recapitulate effects of resveratrol. At present, further studies are needed to more directly test the role of SIRT1 in mediating beneficial effects of resveratrol, to evaluate other strategies for SIRT1 activation, and to confirm the specific targets of SIRT1 that are relevant in vivo. These efforts are especially important in light of the fact that SIRT1 activators are entering clinical trials in humans, and "nutraceutical" formulations containing resveratrol are already widely available.