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Effect of moderate red wine intake on cardiac prognosis after recent acute myocardial infarction of subjects with type 2 diabetes mellitus
Summary: The authors state that oxidative stress and increased inflammation have been reported to be increased in subjects with diabetes and to be involved in the pathogenesis of cardiovascular complications after myocardial infarction (MI). It is well recognized that red wine has antioxidant and anti-inflammatory activities. The investigators examined the effects of moderate red wine intake on echocardiographic parameters of functional cardiac outcome in addition to inflammatory cytokines and nitrotyrosine (oxidative stress marker) in subjects with diabetes after a first uncomplicated MI. One hundred and fifteen subjects with diabetes who had sustained a first non-fatal MI were randomized to receive a moderate daily amount of red wine (intervention group) or advised to not consume any alcohol (control group). Echocardiographic parameters of ventricular dys-synchrony, circulating levels of nitrotyrosine, tumour necrosis factor-_ (TNF- _), interleukin-6 (IL-6), interleukin-18 (IL-18) and C-reactive protein (CRP) were investigated at baseline and 12 months after randomization.

Results showed that after 1 year of intervention, concentrations of nitrotyrosine (P < 0.01), CRP (P < 0.01), TNF-_ (P < 0.01), IL-6 (P < 0.01) and IL-18 (P < 0.01) were increased in the control group compared with the intervention group. In addition, myocardial performance index (P < 0.02) was higher, and transmitral Doppler flow (P < 0.05), pulmonary venous flow analysis (P < 0.02) and ejection fraction (P < 0.05) were lower, in the control group, indicating ventricular dys-synchrony. The concentrations of nitrotyrosine, CRP, TNF-_ and IL-6 were related to echocardiographic parameters of ventricular dys-synchrony.

The authors conclude that in subjects with diabetes, red wine consumption, taken with meals, significantly reduces oxidative stress and pro-inflammatory cytokines as well as improving cardiac function after MI. They conclude that moderate red wine intake with meals may have a beneficial effect in the prevention of cardiovascular complications after MI in subjects with diabetes.

Comments: This is an exciting paper as it describes results from a randomised clinical trial (albeit non-blinded) among diabetic patients who had suffered a recent MI. All subjects were advised to consume a Mediterranean-style diet and to take a one-hour (at least) walk three times a week. About one half of the subjects were advised, in addition, to consume one 4-ounce glass of red wine daily; the remaining subjects were apparently advised to not consume red wine or other alcoholic beverage (although the specific instructions given the participants is not clearly outlined).

After 12 months, the authors state that HDL-cholesterol was much higher in the red wine group and that the “analysis of food diaries” of the control group “did not show any evidence of alcohol intake.” Thus, it is likely that most of the subjects followed the advice given about alcohol, although

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detailed measurements of the degree of compliance with the instructions are not given. The paper states that the fruit and vegetable intake, intake of red meat and fish, and weight changes were not different between the groups, suggesting that changes seen were likely to be related to the wine consumed.

Many of the improvements in inflammatory markers and measurements of ventricular function reported for the red wine group are rather striking. It appears that most of the more favorable indices of inflammation in the red wine group began to appear by about 3 or 6 months, while indices of ventricular function were significantly better in the red wine group only at 9 or 12 months. A total of 8 patients died during the year of observation, too few to evaluate the effects of red wine on mortality.

A long-term blinded trial of administering wine or other alcohol to subjects to judge the effects on morbidity and mortality has been advocated for a long time, but not yet done. Even for secondary prevention (for recurrent MI or death), large-scale intervention studies have not been undertaken. This interesting trial shows that over one year, many measures of inflammation and of ventricular function were better among diabetic subjects who had suffered a MI who were advised to consume one glass of red wine daily than among those advised to not consume alcohol.

Lay Summary: This paper describes results from a randomized clinical trial among diabetic patients who had suffered a recent MI. All subjects were advised to consume a Mediterranean-style diet and to exercise, and one half were advised, in addition, to consume one 4-ounce glass of red wine daily. After 12 months, the subjects assigned to consume red wine showed much more favorable indices of inflammation, and better cardiac performance.

Article: Marfella R, Cacciapuoti F, Siniscalchi M, Sasso FC, Marchese F, Cinone F, et al. Effect of moderate red wine intake on cardiac prognosis after recent acute myocardial infarction of subjects with Type 2 diabetes mellitus. Diabet Med 2006;23:974–981.

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