A drink a day may keep heart disease at bay
Studies show moderate drinking helpful to diabetics
For people with Type 2 diabetes, a drink a day may keep the cardiologist away. There is new evidence that moderate alcohol consumption can provide protection against heart disease in both men and women with diabetes.
Results recently published in the American Heart Association journal Circulation show strong protection for people with diabetes who take a half or whole drink of beer, wine, or spirits a day.1,2
Depending on which statistics you believe, 69% to 80% of all people with diabetes die of heart disease — so the race to find cardio protective therapies has long been a priority.
And while most researchers in the field stop short of considering alcohol as a therapeutic agent or recommending that patients start drinking as a way to protect their hearts, the recent large population-based studies show the once rigid prohibition against drinking for people with diabetes is falling by the wayside.
Alcohol consumption "should not be routinely discouraged" among women with diabetes, wrote the authors of a Harvard population-based analysis derived from the long-running Nurses’ Health Study.
The authors of a similar study derived from data in the Physicians’ Health Study provided similar results.
"This certainly goes contrary to the conventional wisdom that drinking is harmful to people with diabetes," says J. Michael Gaziano, MD, MPH, a cardiologist and epidemiologist at Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School, both in Boston.
Gaziano’s study showed a 40% reduced risk of cardiac disease in men with diabetes who were moderate drinkers, and his Harvard colleagues found women who drank moderately reduced their risk by about 50%.
The results parallel a University of Wisconsin study published last year.3 The Wisconsin Epidemiologic Study of Diabetic Retinopathy, based on nearly 1,000 participants, concluded that diabetes patients who consumed one or two drinks a day were up to 80% less likely to die of heart disease.
"We’re not sure what mechanism is at work here; it is my strong suspicion that it is something in the alcohol itself that causes the lipid lowering," says Gaziano.
Neither Harvard team found any difference in coronary heart disease levels among people with diabetes who were beer or wine drinkers and those who preferred whisky or gin, he adds.
"There’s no doubt that alcohol lowers HDL [high-density lipoprotein] substantially," says Gaziano. Given the high rate of heart disease among people with diabetes, he says, every HDL point is a step in the right direction toward preventing heart attacks and stroke.
"There are only three things that raise HDL cholesterol: exercise, alcohol, and hormone replacement among women. The more of those factors you can get, the lower the risk of heart disease," says Gaziano.
The key word in both studies is "moderation," since overconsumption of alcohol has numerous well-documented deleterious effects, Gaziano notes.
"We don’t say drinking is safe and wonderful for everybody," he says. "This is a matter for patient/physician discussion. But it is a matter that should be discussed and probably will be brought up by patients."
The Alexandria, VA-based American Diabetes Association has no formal position on alcohol consumption for people with diabetes, and patients should never be encouraged to start drinking for health benefits, says Marion Parrott, MD, the ADA’s vice president for clinical affairs.
"We haven’t defined moderate,’ yet, but most of the studies define it as one beer, 1.5 ounces of liquor, or one 4-ounce glass of wine," she says. "I would never encourage a patient to start drinking because of those studies."
"I don’t advocate that we recommend people take up drinking," Gaziano adds. "But as a general policy, physicians and other clinicians should discuss alcohol consumption with their patients and define a safe intake."
He also warns that people who have been alcoholics, those with a family history of alcoholism, and people with liver disease should not drink. He also says that those who are occasional drinkers or nondrinkers should not increase their alcohol consumption or start drinking based on the results of his study.
The biggest caveat, say both Gaziano and Parrott, is that alcohol is a high-calorie food with little or no nutritional value.
"Patients have to keep track of those calories, and they should also realize that alcohol can cause hypoglycemia and plan meals and medications accordingly," Parrot says.
Numerous studies have shown the "French Paradox" or that drinking moderate amounts of red wine with meals offsets a rich, high-fat diet. That effect is most widely attributed to the powerful antioxidant flavonoids in the grape skins used in red wine.
References
- Ajani U, Gaziano J, Lotufo P, et al. Alcohol consumption and risk of coronary heart disease by diabetes status. Circulation 2000; 102:500-505.
- Solomon CG, Hu FB, Stampfer MJ, et al. Moderate alcohol consumption and risk of coronary heart disease among women with Type 2 diabetes mellitus. Circulation 2000; 102:494-499.
- Valmadrid T, Klein R, Moss S, et al. Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus. JAMA 1999; 282:239-246.
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