The Effect of Moderate Wine Intake on Carotid Atherosclerosis in Type 2 Diabetes, A 2-year Intervention Study - The 63rd Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery 12-13 April 2016, David Intercontinental Hotel, Tel-Aviv, Israel

Rachel Golan ¹ Ilana Harman-Boehm ² Dan Schwarzfuchs ³ Ilan Shelef ² Yftach Gepner ¹ Shula Witkow ¹ Idit F Liberty ² Benjamin Sarusi ³ Uta Ceglarek ⁴ Michael Stumvoll ⁴ Matthias Blüher ⁴ Joachim Thiery ⁴ Meir J Stampfer ⁵ Assaf Rudich ¹ Iris Shai ¹ Yaakov Henkin ²

¹Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva
²Soroka University Medical Center, Soroka University Medical Center, Beer Sheva
³Nuclear Research Center Negev, Nuclear Research Center Negev, Dimona
⁴Department of Medicine, University of Leipzig, Leipzig
⁵Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard School of Public Health, Boston, MA

Background: Carotid atherosclerosis risk is higher in persons with type 2 diabetes mellitus (T2DM). Interventions to halt the progression of carotid atherosclerosis is needed.

Objective: To assess the effect of initiating moderate alcohol intake on carotid atherosclerosis in persons with T2DM.

Design: 2-year RCT (CASCADE [CArdiovaSCulAr Diabetes & Ethanol] trial).

Setting: Ben-Gurion University of the Negev–Soroka Medical Center and Nuclear Research Center Negev, Israel.

Patients: Alcohol-abstaining adults with well-controlled T2DM.

Intervention: Patients were randomly assigned to 150 mL of mineral water, white wine, or red wine with dinner for 2 years. Wines and mineral water were provided. All groups followed a Mediterranean diet without caloric restriction. We assessed carotid-total-plaque-volume (carotid-TPV) and vessel-wall-volume (VWV) using three-dimensional-ultrasound.

Results: Two-year repeated, high-quality, paired carotid images were available from 174 participants (age=59 years; 67% men; HbA1C=6.8%). Mean TPV did not increase in the entire cohort (mean change = -1.3 mm³±17.1), or in individual intervention groups (red wine-1.31±17.6, white wine 1.17±16.9, mineral water -1.38±17.0; p>0.05). Baseline detectable plaque was found in 55% of the participants. In multivariate regression models, among those with detectable TPV, adjusted for baseline TPV, age, statin use, intervention group and 2-year changes in BMI, higher baseline TPV (beta=-0.32, p=0.005) and decreased Apo(B/Apo(A) ratio (beta=0.34, p=0.003) were independently associated with greater regression in TPV. Data on VWV were available from 160 participants. After 2 years, no significant changes were observed in VWV (619.7mm³vs. 610.9mm³ after 2-years, p=0.09) with no differences between intervention groups (p>0.05). 2-year changes in systolic-blood-pressure remained an independent predictor of greater regression in VWV (beta=0.187, p=0.029) adjusting for intervention-group, baseline VWV, age, statin use and 2-year changes in BMI.

Conclusions: Initiation of moderate wine consumption, as part of a healthy diet, among patients with T2DM may contribute to plaque regression, possibly through improved lipids and blood pressure.