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From French Paradox to plaque regression

Observational data suggests that moderate wine consumption could be heart healthy. This follow-up to a study we covered in a previous NERD puts this hypothesis to the test.

Study under review: Effect of wine on carotid atherosclerosis in type 2 diabetes: a 2-year randomized controlled trial.

Introduction

Heart disease is the leading cause of death worldwide. In the early 1990s, researchers analyzed[1] the relationship between heart disease mortality and a defined cholesterol-saturated fat index in 40 countries. A strong association between increased cholesterol-saturated fat intake and increased death rates from heart disease was observed for nearly all countries. Yet, despite having one of the highest cholesterol-saturated fat indexes, France had a heart disease death rate similar to countries with half of their cholesterol-saturated fat index level.

This observation was called the French Paradox[2]: how do the French eat a diet rich in saturated fat and maintain a low rate of heart disease mortality? An early explanation[3] was that moderate wine consumption was the reason for this paradox, even though excessive alcohol intake is associated with increased cardiovascular mortality[4]. Observational data[5] have demonstrated a J-shaped curve for the relationship between alcohol consumption and heart disease, meaning that the greatest benefits appear with a small amount of alcohol.

Recent research[6] has shown that modest alcohol consumption beneficially affects several established risk factors for heart disease, including insulin resistance, inflammation, and blood lipids. This is especially relevant for people with type 2 diabetes, as the disease itself is a major risk factor[7] for heart disease and strongly associated with the other heart disease risk factors mentioned above.

Study Deep Dives #15, Volume 2, “Wine and dine with diabetes” discussed a two-year randomized controlled trial[8] investigating the effects of wine consumption on glucose metabolism, insulin sensitivity, and blood lipids in people with type 2 diabetes. The study reported moderate benefits on all parameters depending on the type of wine (red vs. white) and genetic factors.

The study under review is a second publication of the same cohort of participants with diabetes. This time, the researchers report on how drinking wine affects the development of atherosclerosis using ultrasound. Specifically, the researchers used a three-dimensional ultrasound of the carotid artery, which can provide a sensitive and non-invasive[9] measurement of arterial plaque volume.

Some evidence suggests that modest alcohol consumption benefits cardiovascular health by affecting several known risk factors. A previous Study Deep Dives article discussed a randomized controlled trial reporting benefits for insulin sensitivity and blood lipids in a cohort of participants with type 2 diabetes after drinking wine for two years. The study under review is a second publication on this cohort, this time reporting on the extent of atherosclerosis assessed through ultrasound imaging.

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Other Articles in Issue #42 (April 2018)