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Doctors’ perception of red wine consumption and cardiovascular health
Percepción de los médicos frente al consumo de vino tinto y la salud cardiovascular
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de Málaga (IBIMA), Málaga, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Percepción de los médicos frente al consumo de vino tinto y la salud cardiovascular" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1793 "Ancho" => 1607 "Tamanyo" => 100371 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Data breakdown by specialities.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> 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,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> as well as to take into account that physicians' perception of risk factors will influence such interventions.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Notwithstanding, red wine consumption, compared to other alcoholic beverages, has shown some benefit in the prevention of cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> 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.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> Molecules known as polyphenols, with antioxidant and anti-inflammatory properties, play an important role in this process.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Furthermore, epidemiological studies and meta-analyses have shown a protective effect of red wine on ischaemic heart disease<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and stroke prevention, especially at low doses of less than 20<span class="elsevierStyleHsp" style=""></span>g/day.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In addition, it has been pointed out that industry-funded studies tend to distort the research agenda and priorities.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objective</span><p id="par0015" class="elsevierStylePara elsevierViewall">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.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material and methods</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study population</span><p id="par0020" class="elsevierStylePara elsevierViewall">An individual survey was carried out on the different doctors via WhatsApp on 09/01/2022 with the following question: <span class="elsevierStyleItalic">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.</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical aspects</span><p id="par0025" class="elsevierStylePara elsevierViewall">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.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 184 physicians responded (100% of those surveyed), with a mean age of 35<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>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 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The option most chosen was d (109; 59.2%), followed by a (39; 21.1%), c (27; 14.6%) and b (9; 5%) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">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”.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> 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.</p><p id="par0040" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">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.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0050" class="elsevierStylePara elsevierViewall">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.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Authorship</span><p id="par0055" class="elsevierStylePara elsevierViewall">Manuscript conception and design: J. Espíldora Hernández.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Data collection: J. Espíldora Hernández, S. Martín Cortés.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: J. Espíldora Hernández, M. J. Benítez Toledo and I. Coca Prieto.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Redaction, review, approval of submitted manuscript: J. Espíldora Hernández, M. A. Sánchez Chaparro and P. Valdivielso Felices.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2080254" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1774661" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2080253" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1774662" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objective" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Material and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical aspects" ] ] ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0045" "titulo" => "Authorship" ] 11 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-01-12" "fechaAceptado" => "2023-05-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1774661" "palabras" => array:4 [ 0 => "Alcohol" 1 => "Red wine" 2 => "Cardiovascular health" 3 => "Cardiovascular risk" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1774662" "palabras" => array:4 [ 0 => "Alcohol" 1 => "Vino tinto" 2 => "Salud cardiovascular" 3 => "Riesgo cardiovascular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The consumption of red wine has historically been associated with a reduction in cardiovascular risk, with sometimes controversial scientific evidence.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">184 physicians answered, with a mean age of 35 years<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>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%).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">More than half of the doctors surveyed recommended zero consumption, and only 20% indicated that a daily drink could be healthy in non-drinkers.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El consumo de vino tinto se ha relacionado históricamente con una reducción de riesgo cardiovascular, con una evidencia científica en ocasiones controvertida.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Contestaron 184 facultativos, con media de edad de 35 años<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>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%).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">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.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1793 "Ancho" => 1607 "Tamanyo" => 100371 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Data breakdown by specialities.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1042 "Ancho" => 2508 "Tamanyo" => 94693 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Survey to physicians in the province of Malaga (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>184).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "GBD 2016 Disease and Injury Incidence and Prevalence Collaborators" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(18)31310-2" "Revista" => array:7 [ "tituloSerie" => "Lancet." 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