Doctors’ perception of red wine consumption and cardiovascular health

Abstract

Introduction

The consumption of red wine has historically been associated with a reduction in cardiovascular risk, with sometimes controversial scientific evidence.

Method

A survey was carried out via whatsapp dated 09/01/22 to a cohort of doctors from the province of Malaga, asking about possible healthy red wine consumption habits, differentiating: never, 3–4 glasses per week, 5–6 weekly drinks and 1 daily drink.

Results

184 physicians answered, with a mean age of 35 years ± 11.1, of which 84 (45.6%) were women, distributed in different specialties, the majority being Internal Medicine with 52 (28.2%). The most frequently chosen option was D (59.2%), followed by A (21.2%), C (14.7%) and B (5%).

Conclusions

More than half of the doctors surveyed recommended zero consumption, and only 20% indicated that a daily drink could be healthy in non-drinkers.

Resumen

Introducción

El consumo de vino tinto se ha relacionado históricamente con una reducción de riesgo cardiovascular, con una evidencia científica en ocasiones controvertida.

Método

Se ha realizado una encuesta via whatsapp con fecha 01/09/22 a una cohorte de médicos de la provincia de Málaga, preguntando sobre los posibles hábitos de consumo de vino tinto saludables, diferenciando: nunca, 3–4 copas semanales, 5–6 copas semanales y 1 copa diaria.

Resultados

Contestaron 184 facultativos, con media de edad de 35 años ± 11.1, de los cuales 84 (45.6%) fueron mujeres, distribuidos en diferentes especialidades, siendo la mayoritaria Medicina Interna con 52 (28.2%). La opción mayoritariamente elegida fue la D (59.2%), seguida de la A (21.2%), la C (14.7%) y la B (5%).

Conclusiones

Más de la mitad de los médicos encuestados recomendaron nulo consumo, y sólo el 20% indicaron que una copa diaria podría ser saludable en sujetos no abstemios.

Introduction

Wine has been present in Spanish culture for centuries, playing a leading role in leisure and recreational situations. Although it contributes to socialising, which can be considered a positive aspect, its consumption is not risk-free, and this will depend on the quantity, frequency, pattern of consumption and characteristics of the person, such as age, sex and certain health conditions. Recent data indicate that there is no safe minimum amount of alcohol intake and that alcohol consumption is associated with increased mortality from all causes, and specifically cancer.¹ These results necessitate that efforts be directed towards reducing alcohol consumption in the population. Against this backdrop, it is important to determine the factors that can facilitate or pose a barrier to preventive interventions on alcohol consumption,² as well as to take into account that physicians' perception of risk factors will influence such interventions.³

Notwithstanding, red wine consumption, compared to other alcoholic beverages, has shown some benefit in the prevention of cardiovascular disease.⁴ This effect is produced by increasing the level of high-density lipoprotein (HDL) cholesterol, reducing oxidative stress and even modulating the incidence of diabetes mellitus.^5–7 Molecules known as polyphenols, with antioxidant and anti-inflammatory properties, play an important role in this process.⁸ Furthermore, epidemiological studies and meta-analyses have shown a protective effect of red wine on ischaemic heart disease⁹ and stroke prevention, especially at low doses of less than 20 g/day.¹⁰ That said, it should be made clear that the relationship between alcohol consumption and cardiovascular risk is complex. Many of the papers included in systematic reviews and meta-analyses tend to include biases not usually considered, such as case selection bias, problems in the classification of categories or the disconnection between results and conclusions, or the fact of considering as non-consumers those who may have consumed in the past.¹¹ In addition, it has been pointed out that industry-funded studies tend to distort the research agenda and priorities.¹²

Objective

Since the evidence between wine consumption and cardiovascular health is controversial, we decided to find out the opinion on red wine consumption and its impact on cardiovascular health of a cohort of doctors from different specialties in the province of Malaga.

Material and methods

Study population

An individual survey was carried out on the different doctors via WhatsApp on 09/01/2022 with the following question: Regarding the current evidence of red wine consumption and cardiovascular health in the middle-aged population, indicate the option that is most relevant. Adjust to your opinion: a daily drink can be considered beneficial in non-abstainers; 5–6 drinks weekly can be considered beneficial in non-abstainers; 3–4 drinks weekly can be considered beneficial in non-abstainers; Its consumption is never considered beneficial, even if there is a “non-harmful” threshold.

Ethical aspects

All doctors consented to participate in the study, which followed the recommendations of the Declaration of Helsinki and the regulations on confidentiality and protection of personal data.

Results

A total of 184 physicians responded (100% of those surveyed), with a mean age of 35 ± 11 years, of whom 84 (45.6%) were women and 74 were resident internal physicians (41.2%). The different specialties are represented in the sample, of which the majority was internal medicine with 52 participants (28.2%), followed by primary care with 36 (19.5%); cardiology and neurology contributed 10 answers each. The rest of the specialties (endocrinology, nephrology, pulmonology, allergology, intensive care medicine, general surgery, ophthalmology, otorhinolaryngology, psychiatry, radiology) totalled 76 responses (Fig. 1). The option most chosen was d (109; 59.2%), followed by a (39; 21.1%), c (27; 14.6%) and b (9; 5%) (Fig. 2).

Figure 1.

Data breakdown by specialities.

Figure 2.

Survey to physicians in the province of Malaga (n = 184).

Discussion

The link between alcohol and cardiovascular disease arises from a study carried out in 1992 in France, in which it was found that the incidence of cardiovascular diseases and their associated mortality was lower compared to that of other similar countries in the environment, despite the inclusion of saturated fats in the diet of the French population. This situation became known as “the French paradox”.¹³ Historically, the idea has spread across broad sectors that moderate consumption of red wine (understood as a glass a day) can be beneficial. Probably, the fact that more than 50% of the doctors surveyed have chosen the option of not drinking corresponds to the security provided by the recommendation to abstain from the consumption of any type of alcohol.¹ The second most voted option, that of a daily drink, is the historically accepted one and is still valid today, according to our survey and the literature consulted, although it is emphasized that the lower the consumption, the better the general expectations of safety and health. Options b and c, the least voted for, would match this line of thinking better.

A study carried out in Uruguay among cardiologists revealed, through a survey of 298 physicians, that the widespread recommendation was moderate consumption, although the specialists acknowledged not having updated information on the matter and admitted the need to receive more training in this area of knowledge.¹⁴ In another survey carried out by the Argentine Federation of Cardiology to 745 doctors, most of whom were cardiologists (671), although there were also specialists in internal medicine, the response of a third of the sample was that moderate alcohol consumption had a positive impact on cardiovascular health.¹⁵

Our study is not without limitations: the sample size is small and the sample selection was limited to the province of Malaga, so conclusions should not be extrapolated to the national level. The convenience of a larger scale survey is proposed.

Conclusions

The evidence linking wine consumption in the population with cardiovascular health is controversial, with evidence both for and against. Perhaps for this reason, more than half of the doctors surveyed recommended zero consumption and only 20% indicated that a daily drink could be healthy in non-abstainers.

Authorship

Manuscript conception and design: J. Espíldora Hernández.

Data collection: J. Espíldora Hernández, S. Martín Cortés.

Data analysis and interpretation: J. Espíldora Hernández, M. J. Benítez Toledo and I. Coca Prieto.

Redaction, review, approval of submitted manuscript: J. Espíldora Hernández, M. A. Sánchez Chaparro and P. Valdivielso Felices.

Conflict of interests

The authors have no conflict of interests to declare.