Advice on Lifestyle Changes (Diet, Red Wine and Physical Activity) Does Not Affect Internal Carotid and Middle Cerebral Artery Blood Flow Velocity in Patients with Carotid Arteriosclerosis in a Randomized Controlled Trial

Abstract

Background: A Mediterranean diet, with and without small daily amounts of red wine, and physical activity reduce the risk of cerebrovascular disease and improve cognition. An increase in cerebral blood flow may be the underlying mechanism. Under normal conditions, cerebral blood flow velocity changes in the internal carotid arteries and in large basal cerebral arteries correlate closely with cerebral blood flow changes, as the diameter of these vessels hardly changes and only the smaller vessels downstream change their diameter. Methods: A prospective randomized controlled trial was performed in 108 patients with carotid atherosclerosis (mean age 64 years, 67% men, 66% on statin therapy). Half of them were advised to follow a polyphenol-rich modified Mediterranean diet including 1-2 tomatoes, 3-5 walnuts and a bar of dark chocolate (25 g) a day and to perform moderate physical exercise for 30 min/day (lifestyle changes). Within these two groups, half of the patients were randomized either to avoid any alcohol or to drink 100 ml of red wine (women) or 200 ml of red wine (men) daily. Bilateral middle cerebral and internal carotid blood flow velocity (peak systolic, peak end-diastolic and mean) was measured at baseline and after 4 and 20 weeks using colour-coded duplex ultrasound. Insonation depth and insonation angle were used to identically place the sample volume during follow-up investigations. A general linear model with Tukey-Kramer adjustment for multiple comparisons was used to assess the primary end points. For the analysis we used the mean values of the right and left artery. Results: Neither lifestyle changes nor red wine had an effect on peak systolic, peak end-diastolic or mean cerebral blood flow velocity. Conclusions: Advice on lifestyle changes, including a modified polyphenol-rich Mediterranean diet, a glass of red wine daily and physical exercise, did not affect middle cerebral and internal carotid blood flow velocity in our patient group with carotid atherosclerosis. An increase in cerebral blood flow is thus unlikely to be the cause of the reduced risk of cerebrovascular disease and improved cognitive functioning described in the literature. One possible explanation for the fact that blood flow velocity was not affected by red wine, diet and physical activity advice is that two thirds of our patients were already on statin therapy. Statins increase cerebral blood flow and vasomotor reactivity via nitric oxide.

Effects of Auricular Point Acupressure with Lifestyle Interventions on Cerebrovascular Function among Adults with High Stroke Risk: A Randomized Controlled Study

“…Interestingly, for participants who only received lifestyle interventions in our study, the kinematic indices such as V max and V min as well as CVHP score at week 2 were a little lower than those at the baseline, and the dynamic indices such as Rv and CP were a little higher, which revealed that the cerebrovascular hemodynamic function was not much improved in the lifestyle intervention alone group. Tis outcome is consistent with some studies, which similarly found that the advice on lifestyle changes did not afect cerebral blood fow velocity in patients with carotid arteriosclerosis [32]. Nevertheless, some other studies have demonstrated that lifestyle interventions play a positive role in stroke prevention [33,34].…”

Wine: An Aspiring Agent in Promoting Longevity and Preventing Chronic Diseases

“…In patients with carotid atherosclerosis, the combination of a polyphenol-rich Mediterranean diet and moderate daily physical activity (30 min/day) with moderate red wine consumption (100 mL for women and 200 mL for men) for 20 weeks did not affect the middle cerebral and internal carotid blood flow velocity [ 27 ]. The absence of significant improvement may be due to the fact that 66% of the study population was on statin therapy [ 27 ]. However, in the same patient population, these lifestyle changes (healthy diet plus red wine, and exercise) for 20 weeks did improve the LDL/HDL ratio of the participants [ 28 ].…”

Health Effects of Red Wine Consumption: A Narrative Review of an Issue That Still Deserves Debate

“…In young healthy individuals, low blood concentrations of ET following RW intake had an acute depressant effect on left ventricular (LV) performance, but an increase in some indices of right ventricular function [65], suggesting that low ET doses may impair LV function. A lifestyle modification intervention (including RW consumption) did not affect the blood flow velocity of the internal carotid or middle cerebral artery in patients with carotid atherosclerosis [76]. Most of the enrolled patients were receiving statin therapy, however, which could have hidden the beneficial effects on blood flow velocity and thus affected the study results.…”