The Relationship Between Alcohol Consumption and Vascular Complications and Mortality in Individuals With Type 2 Diabetes

Abstract

OBJECTIVEModerate alcohol consumption has been associated with a reduced risk of mortality and coronary artery disease. The relationship between cardiovascular health and alcohol use in type 2 diabetes is less clear. The current study assesses the effects of alcohol use among participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial. RESEARCH DESIGN AND METHODSThe effects of alcohol use were explored using Cox regression models, adjusted for potential confounders. The study end points were cardiovascular events (cardiovascular death, myocardial infarction, and stroke), microvascular complications (new or worsening nephropathy or retinopathy), and all-cause mortality. RESULTSDuring a median of 5 years of follow-up, 1,031 (9%) patients died, 1,147 (10%) experienced a cardiovascular event, and 1,136 (10%) experienced a microvascular complication. Compared with patients who reported no alcohol consumption, those who reported moderate consumption had fewer cardiovascular events (adjusted hazard ratio [aHR] 0.83; 95% CI 0.72-0.95; P = 0.008), less microvascular complications (aHR 0.85; 95% CI 0.73-0.99; P = 0.03), and lower all-cause mortality (aHR 0.87; 96% CI 0.75-1.00; P = 0.05). The benefits were particularly evident in participants who drank predominantly wine (cardiovascular events aHR 0.78, 95% CI 0.63-0.95, P = 0.01; all-cause mortality aHR 0.77, 95% CI 0.62-0.95, P = 0.02). Compared with patients who reported no alcohol consumption, those who reported heavy consumption had dose-dependent higher risks of cardiovascular events and all-cause mortality. CONCLUSIONSIn patients with type 2 diabetes, moderate alcohol use, particularly wine consumption, is associated with reduced risks of cardiovascular events and all-cause mortality.

Latent class analysis suggests four classes of persons with type 2 diabetes mellitus based on complications and comorbidities in Tianjin, China: a cross-sectional analysis

“…Moreover, current drinkers were more likely to have comorbidities and CVD -a finding that is probably debatable. Blomster provided evidence that patients with T2DM who drink alcohol moderately have a lower risk of CVD and microvascular complications compared with those who do not drink at all [34]. Temperate drinking appears to be a protective factor against diabetes.…”

The effects of alcohol on ambulatory blood pressure and other cardiovascular risk factors in type 2 diabetes

“…An alcohol-induced increase in HDL cholesterol together with the antithrombotic effects of decreased fibrinogen, anti-inflammatory effects and increased adinopectin have been invoked as the major conduits for this decrease in CAD risk [33]. A prospective study in participants with type 2 diabetes similarly observed a 17% decrease in cardiovascular events with the consumption of up to 2-3 standard drinks/day, with red wine the predominant alcoholic beverage associated with the decrease in CAD risk [13]. If alcohol as red wine in the dose range we utilized does not raise HDL cholesterol or reduce fibrinogen levels it brings into question whether such effects are also important in reducing CAD risk in type 2 diabetes.…”

“…In contrast, heavier alcohol intake, irrespective of beverage type, has been linked to increased blood pressure (BP) [7], triglycerides [8], homocysteine levels [9], arterial stiffness [10], and incidence of the metabolic syndrome [11]. Such contrasting influences may explain, at least in part, why there is a U-shaped relationship between alcohol consumption and incidence of coronary artery disease (CAD) [12], a pattern also seen in type 2 diabetes [13]. More information on the balance of effects of regular mild-to-moderate alcohol consumption on cardiovascular risk factors in type 2 diabetes is, therefore, of considerable public health interest.…”

Drinking pattern of wine and effects on human health: why should we drink moderately and with meals?

“…Moderate wine consumption is also related to a lower risk of diabetes mellitus 16,17 , cardiometabolic complications in diabetic patients 18,19 , and declining cognitive function 20,21 .…”