Tag Archives: heart attack

The Effect of Wine Consumption on Repeat Cardiovascular Events after Heart Attack

Posted on January 2, 2013 by Becca| 7 Comments

 

We’ve all seen the reports suggesting that wine consumption, particular red wine, is beneficial for many aspects of one’s health, with the most studied probably being wine’s affect on cardiovascular health.  Studies have shown that red wine consumption may have cardiovascular health benefits by way of cardioprotective properties.  Of course, there are other studies that suggest there is no link between red wine consumption and cardiovascular health benefits; however, when in consumed in moderation, there does appear to be something going on.

Most of the studies to date have examined animals or people with or without cardiac disease risk factors prior to any adverse events occurring.  According to

By Patrick J. Lynch (1999), modified by Christian 2003 (Yale University - School of medicine) [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons

By Patrick J. Lynch (1999), modified by Christian 2003 (Yale University – School of medicine) [CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], via Wikimedia Commons

the authors of the short study presented today, very few studies have examined the effect of red wine consumption on people who have recently experienced a cardiac event and how their risk changes with continued red wine consumption post cardiac event.

Methods

A total of 11,323 Italian participants were enrolled in this study.  Questions regarding demographics, cardiovascular risk factors, medications, dietary habits, and medical history were answered.  After cardiac events, participants were given advice and instructions on how they should eat and/or drink and general lifestyle changes.

Participants were followed over time at clinic visits to update information on any lifestyle and health changes.  Clinic visits were 0.5, 1.5, and 3.5 years after the initial cardiac event.  Heart attack was considered the initial cardiac event.

Daily wine intake was determined and consumers were separated into the following categories: 1) never/almost never; 2) up to 0.5L per day (0.1-3.3 glasses); 3) between 0.5L and 1L per day (3.4-6.8 glasses); and 4) greater than 1L per day (greater than 6.8 glasses).

Photo by isante_magazine: http://farm5.staticflickr.com/4086/5057195715_74f63d6cca.jpg

Photo by isante_magazine: http://farm5.staticflickr.com/4086/5057195715_74f63d6cca.jpg

Results

  • 85.4% of participants were male and 14.6% were female.
  • After heart attack, those participants drinking higher amounts of wine tended to be younger, more likely have lower systolic blood pressure, able to perform an exercise stress test, current smoker and less likely to have had more than one heart attack, diabetes, or hypertension.
  • Wine consumption as associated with consumption of butter, cheese, coffee, and oils and negatively associated with consumption of fish, fruit, vegetables, and olive oil.
  • During the first 6 months after heart attack, the proportion on non-drinkers increased.
    • 21.6% of wine drinkers reported giving up drinking after heart attack.
    • 24% of those drinking less than 0.5L and 15% of those drinking greater than 0.5L stopped drinking wine completely.
    • For those drinking greater than 0.5L of wine per day, 80% of them reduced their wine consumption by 6 months after heart attack.
    • Only a small number of participants increased wine consumption after heart attack.
  • After 37,021 person-years after the initial heart attack, there were 1168 cardiovascular events including 671 deaths related to cardiovascular events, 456 heart attacks (nonfatal), and 119 strokes (nonfatal).
  • The rate of new cardiovascular events was lower in participants who consumed higher levels of wine.
    • The rate of new cardiovascular events was lowest in participants who consumed moderate levels of wine (up to 0.5L per day).
  • The risk of new cardiovascular events decreased by 13% for those consuming up to 0.5L of wine per day compared with nondrinkers.
  • No significant differences between wine consumption and cardiovascular events were found when other confounding factors were included (i.e. sex and compliance with advised treatment).
  • Pharmacological treatments did not affect the results of the study.
  • After the long-term follow up (between 5.7 and 7.3 years) and 60,022 person-years, 1659 participants had died (1400 men and 259 women).
  • Wine consumption up to 0.5L and more than 0.5L per day was associated with a lower risk of death than nondrinkers.

Results

According to the authors, the results of this study suggest that moderate wine consumption was associated with a new cardiovascular event after a prior heart attack.  However, once changing in drinking habits and other confounding factors were taken into consideration, this association was no longer significant.  The authors noted that since they were not able to include the highest level of alcohol consumption (greater than 1L per day) due to too few participants actually consuming that much on a regular basis, there could have been some weakening in power of the analysis.

If you don’t take the confounding factors into consideration, the results suggest that there is a negative association between moderate wine consumption and

By Alex Proimos (Flickr: The Stethoscope) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

By Alex Proimos (Flickr: The Stethoscope) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

cardiovascular events and death due to new cardiovascular events.  According to the authors, those Italian individuals with prior cardiovascular history may have reduced risk of repeat events if they consume moderate amounts of wine.

Taking confounding factors into consideration is very important, so I’m not sure why the authors would still focus on the positive results they found prior to taking these results into consideration.  The fact of the matter is that confounding factors are important, and if including them in the model result in insignificant results, well then that should be the result you present.  There were other factors that were not taken into consideration that limited the study, including data on physical activity and other types of alcohol consumed by participants.  Both of these could have significant impacts on the results of the study.

The authors concluded by saying that light to moderate wine consumption was not associated with increased risks of cardiovascular events or cardiovascular-related deaths, which is a result I can get on board with based on the statistics.  While it is true wine consumption did not increase the risk of further cardiovascular events, it is not clear whether or not wine consumption actually decreases this risk.  The study should be repeated with more confounding factors taken into consideration.  Also, the study should be repeated in other locations, since the dietary habits of Italians and people from other corners of the world are different and thereby the cardiovascular risks will likely be different.

I’d love to hear what you all think of this study.  Please feel free to leave your comments!

Source: Levantesi, G., Marfisi, R., Mozaffarian, D., Franzosi, M.G., Maggioni, A., Nicolosi, G.L., Schweiger, C., Siletta, M., Tavazzi, L., Tognoni, G., and Marchioli, R. 2011. Wine consumption and risk of cardiovascular events after myocardial infarction: Results from the GISSI-Prevenzione trial. International Journal of Cardiology, doi: 10.1016/j.ijcard.2011.06.053.

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Resveratrol Supplements Shown to Decrease Cardiovascular Disease Risk in the First Long-Term Clinical Research Trial

Posted on August 9, 2012 by Becca| 2 Comments

We’ve all seen evidence time and time again that red wine is good for your health when consumed in moderation.  Scientists have even broken it down to the molecules, and have found that certain compounds are likely most responsible for the increased health benefits of red wine, with the polyphenol resveratrol being the most widely studied.  Resveratrol (and red wine in general) has been shown to benefit many different health issues, including (but certainly not limited to) diabetes, osteoporosis, dementia, and cardiovascular health.  We’ve seen short-term studied in laboratory settings, rodents, and some humans, however, what we seem to be missing are long term clinical research trials confirming what scientists have already found in the laboratory.

http://supplementsbase.com/wp-content/
uploads/Resveratrol-Supplements-300×199.jpg

The goal of the short study presented today was to examine the effects of a dietary resveratrol-enriched grape supplement on the inflammatory and fibrinolytic status of patients that were at high risk for cardiovascular disease and who were currently undergoing medical treatment for the prevention of those types diseases.

Methods

This study was a randomized, triple-blinded, placebo-controlled clinical trial with three “parallel arms” (a.k.a. treatments).  The three treatments were a grape extract containing 8mg of resveratrol, a grape extract containing similar polyphenolic content but without resveratrol, and a placebo control (maltodextrin).

Patients currently undergoing cardiovascular disease prevention at the Morales Meseguer University Hospital Cardiology Service in Murcia, Spain were recruited for this study.  To be considered for this study, patients had to be between 18 and 80 years old, have diabetes mellitus or hypercholesterolemia in addition to another cardiovascular disease risk factor including arterial hypertension, tobacco smoking (active), or obesity/overweight.  Patients were not allowed to participate in the study if they were pregnant, outside the age requirement, having documented cardiovascular disease or cerebrovascular disease, regularly intaking food supplements (particularly ones containing antioxidants), or if they had an infectious disease, neoplastic disease, or any other known chronic pathological disease.

There were a total of 75 patients in the study, with 34 men and 41 women.  These patients were randomly assigned to one of three treatment groups (as described above). 

The main factor of study was the change in high-sensitivity C-reactive protein (CRP) levels from baseline to the end of the study (12 months).  CRP rises in response to inflammation, thereby is a good indicator any disease that carries with it inflammation (which can be a large variety of diseases, including cardiovascular diseases).

Treatments were contained within a 370mg hard gelatin capsule which contained 350mg of the product (resveratrol, polyphenols, or placebo) plus 20mg of magnesium stearate and silicon dioxide.

The polyphenol content of the resveratrol and polyphenol treatments were: ~40mg procyanidins, ~25mg anthocyanins, ~1mg flavonols, and ~0.8mg hydroxcinamic acids.  For the resveratrol treatment, in addition to the polyphenols listed about, each capsule contained 8.1+/-0.5mg resveratrol and other derivatives in trace amounts (i.e. piceid and viniferins).

Participants were told to maintain their usual medication schedules and other lifestyle and diet choices throughout the duration of the study.  Participants consumed 1 capsule per day (taken in the morning) for the first 6 months and then 2 capsules per day for the following 6 months to determine if there are any dose-dependent effects.  Patients received 10 boxes of 60 capsules for the entire study.  Any unused capsules were sent back to the site by the patients at the end of the study.

Possible negative side effects were monitored throughout the study by questionnaires and telephone interviews.  Participants were asked to make note of any consumption of grape products (especially red wine) other than their treatment capsules, and also detailed records of their diet 3 days before blood draws.  Questionnaires were taken at 6 months and 12 months time.

Blood samples were collected at baseline, 6 months, and 12 months during the study.  Safety of the capsules were monitored by measuring hepatic, thyroid, and renal functions.

The following serum levels of inflammatory-related markers were measured: IL-6, IL-10, TNF-α, IL-18, sICAM-1, hs-GRP, adiponectin, and PAI-1.  (If you’d like more details on these inflammatory markers, just ask.)

Results

  • There were no significant differences in the inclusion characteristics of participants, except minor but insignificant differences were noticed for age, glucose, glycated hemoglobin.
  • Significant correlations were found between: hs-CRP and PAI-1, IL-6 and hs-CRP, TNF-αand hs-CRP, and adiponectin and sICAM-1 in all treatments.
  • The percentages of patients with greater than 3mg/L at baseline for the placebo group was 54%, for the grape extract with polyphenols only group was 32%, and finally for the grape extract with polyphenols plus resveratrol was 48%.
  • Placebo group:

o   The first 6 months showed a slight increase in IL-6 and was a significant increase by the end of the study.

o   IL-10 (anti-inflammatory) decreased after the 12 month study period.

o   The was a marginally significant (not quite statistically significant) increase in the IL-6/IL-10 ratio (pro-inflammatory) after 12 months.

o   Other inflammatory markers were not significantly different.

o   The percentage of patients with greater than 3mg/L hs-CRP values did not change from baseline to the end of the 12 month period.

  • Grape Extract Plus Polyphenols Only Group:

o   There were no significant changes in any inflammatory markers during the 12 month study period.

o   The percentage of patients with greater than 3mg/L hs-CRP values did not change from baseline to the end of the 12 month period.

  • Grape Extract Plus Polyphenols AND Resveratrol Group:

o   There was a decrease in hs-CRP (the main compound of interest).

§  hs-CRP decreased for 20 out of 25 patients.

§  The percentage of patients with greater than 3mg/L hs-CRP values decreased from 48% at baseline to 30% at the end of the 12 month period.

o   TNF-α and PAI-1 decreased by the end of the study in the resveratrol group.

o   The IL-6/IL-10 ratio decreased, primarily due to an increase in IL-10 levels.

o   sICAM-1 decreased only marginally.

o   Adiponectin significantly increased after 6 months and only marginally increased by 12 months.

o   IL-18 decreased over time, though was not significant.

o   IL-6 did not change over time.

o   Correlations:

§  The decrease in hs-CRP was significantly correlated with the decrease in TNF-α.

§  The decrease in sICAM-1 significantly correlated with the decrease in IL-18.

§  The increase in adiponectin was significantly correlated with the decrease in sICAM-1.

  • Contents of the capsules were deemed safe due to no relevant changes occurring in markers for the hepatic, thyroid, or renal systems.
  • There were no adverse effects noted by any patient in the study.

Conclusions

The results of this study are the first of its kind, according to the authors, to demonstrate that a dietary supplementation of grape extract plus 8mg of resveratrol in capsule form significantly improves the inflammatory and fibrinolytic status of patients that are currently undergoing prevention for cardiovascular diseases.  The authors indicate that the most important finding was the decrease in hs-CRP levels by 26% after 1 year, in addition to a decrease in proinflammatory TNF-a and PAI-1.  As a reminder, CRP rises in response to inflammation, thereby is a good indicator any disease that carries with it inflammation (which can be a large variety of diseases, including cardiovascular diseases).  A decrease in this marker means that inflammation in the system is decreased; which is overall positive result in regards to cardiovascular and other systems health.  It does appear that the higher dose of 2 capsules per day is more effective in reducing the levels of these inflammatory markers, particularly of PAI-1.

It is important to note that the patients in this study were not asked to give up any of their other medications for cardiovascular disease prevention.  Therefore, according to the authors, there is a strong possibility that there is a synergistic effect going on between the statins in the cardiovascular medications and the resveratrol or other compounds in the supplement.  Previous studies have shown that pravastatin and resveratrol are more effective than statins alone in protecting against heart attack in hypercholesterolemic rats, so a synergistic effect in humans should not be ruled out.

The main limitation in this study is that the sample sizes were not very large.  Since participants had to be divided into three treatment groups, therefore the sample size per treatment group was very small.  As a result of this, those results that were found to be marginally significant or not significant may change if more patients were enrolled into the study.  The only way around this is to simply repeat the study with more patients per treatment group.

According to the authors, this is the very first long-term clinical trial examining the effects of a resveratrol supplement on the prevention of cardiovascular disease in humans.  I thought it was a very interesting study, however would certainly like to see it performed with more patients enrolled.  Also, I’d like to see the studied carried out for longer, if possible, in attempt to be able to predict future cardiovascular events in patients consuming resveratrol supplements versus placebo. 

Finally, I’d like to see this study performed using a wider range of demographics.  It was not clear the demographic breakdown of the participants, but with such a low number of subjects, it may have been difficult to analyze these factors regardless.  Would we see these same results in other countries that typically have different diets or lifestyles?  How do these results hold up to the typical American diet and lifestyle? 

What do you all think about this study?  Would you change it?  How so?  Please feel free to leave your comments below!

Source: Tomé-Carneiro, J., Gonzálvez, M., Larrosa, M., Yáñez-Gascón, M.J., Gracía-Almagro, F.J., Ruiz-Ros, J.A., García-Conesa, M.T., Tomás-Barberán, F.A., Espín, J.C. 2012. One-Year Consumption of a Grape Nutraceutical Containing Resveratrol Improves the Inflammatory and Fibrinolytic Status of Patients in Primary Prevention of Cardiovascular Disease. American Journal of Cardiology 110(3): 356-363.

DOI: 10.1016/j.amjcard.2012.03.030.

I am not a health professional, nor do I pretend to be. Please consult your doctor before altering your alcohol consumption habits. Do not consume alcohol if you are under the age of 21. Do not drink and drive. Enjoy responsibly!

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