Mediterranean diet with wine consumption associated with lower mortality and cardiovascular disease riskMediterranean diet with moderate wine linked to lower heart risks

This analysis synthesizes data from two distinct cohorts to evaluate the impact of the Mediterranean diet (MedDiet) and concurrent wine consumption on cardiovascular outcomes. The first cohort, PREDIMED, consisted of 7447 high-risk participants. The second cohort, the SUN project, comprised a larger, younger Spanish population totaling 23,133 individuals. The primary objective was to determine if the addition of wine to the MedDiet influenced major cardiovascular disease (CVD) and all-cause mortality.

The study design involved comparing good compliers of the MedDiet against poor compliers. In the PREDIMED cohort, participants were further categorized by their wine consumption habits: those who consumed wine versus those who did not. The follow-up period for CVD in the PREDIMED group was 4.8 years, while all-cause mortality was tracked for 17 years. In the SUN project, the follow-up for all-cause mortality was significantly longer at 22 years.

Regarding primary outcomes for cardiovascular disease in the PREDIMED cohort, good compliers who excluded wine showed a reduced risk compared to poor compliers (HR 0.84; 95% CI 0.61-1.15). However, when wine was included as part of the MedDiet, the reduction in risk for CVD was more pronounced among good compliers (HR 0.55; 95% CI 0.36-0.83). In the SUN cohort, no significant associations were observed between MedDiet compliance, wine consumption, and cardiovascular disease.

Secondary outcomes focused on all-cause mortality. In the PREDIMED group, good compliers who excluded wine showed a reduced risk of death (HR 0.77; 95% CI 0.68-0.87). This reduction was even more pronounced among those who included wine in their MedDiet (HR 0.67; 95% CI 0.57-0.78). In the SUN cohort, all-cause mortality for good compliers excluding wine showed a reduced risk (HR 0.94; 95% CI 0.71-1.26), while those including wine showed a reduction of HR 0.54 (95% CI 0.28-1.04). When pooling the cohorts, wine consumption within the MedDiet was associated with lower mortality (P =.01).

Safety and tolerability data were not reported for either cohort, meaning specific adverse event rates or discontinuation figures are unavailable. The study notes that while PREDIMED was an RCT, the specific analysis regarding the impact of wine on outcomes included observational components, which limits the ability to claim direct causality. Methodological limitations include non-significant associations and interactions in certain analyses, which necessitate caution when interpreting the data. Additionally, it is noted that a reduced risk for death was not present in PREDIMED participants who consumed three or more glasses of wine per day. These nuances suggest that the benefits may be specific to moderate consumption rather than high intake.

Clinically, these findings suggest that moderate wine consumption as part of a Mediterranean diet may be associated with lower mortality and CVD risk in high-risk populations. However, the lack of significant associations in the SUN cohort and the specific exclusion of heavy drinkers from the primary benefit in PREDIMED indicate that the results are nuanced. Questions remain regarding the exact dose-response relationship and the long-term impact on younger populations where the association was less clear.