DOI: 10.

4149/BLL_2017_072 Bratisl Med J 2017; 118 (5)

CLINICAL STUDY

Red or white wine consumption effect on atherosclerosis in

Olomouc University Hospital, First Clinic of Internal Medicine, Olomouc, Czech Republic.
[email protected]

ABSTRACT
AIMS: Consumption of wine has a protective effect on cardiovascular diseases. Data from prospective, long-term,
head-to-head comparisons of effects of different drinks on markers of atherosclerosis have been insufficient.
METHODS AND RESULTS: In Vino Veritas (IVV) study is long-term, prospective, multi-centre, randomized trial
comparing effects of red and white wine on atherosclerosis. 157 healthy subjects were randomized to white or
red wine consumption for one year. We did not find increase in HDL-cholesterol in the whole group (1.66±0.58
vs 1.62±0.49, p=0.180) or difference between both groups (1.60±0.53 vs 1.64±0.46, p=0.634). At 12 months
there was reduction of LDL-cholesterol in both groups, but with no difference between the groups (3.37±0.75
vs 3.60±1.10, p=0.134); there was no difference between the groups in total cholesterol, CRP, fasting blood
glucose and liver function tests. Both groups had comparable differences from baseline in levels of parameters
of oxidative stress.
CONCLUSION: We did not find any clinically relevant differences in the lipid profile, CRP, fasting blood glucose
and other markers of atherosclerosis, between long-term consumption of red and white wine. Moreover, we
were unable to confirm the hypothesis that wine drinking is associated with an elevation of HDL (Tab. 7, Fig. 1,
Ref. 30). Text in PDF www.elis.sk.
KEY WORDS: red wine, white wine, atherosclerosis, HDL-cholesterol, French paradox.

Introduction (2). However, several experimental studies have also shown that
alcohol itself may have a protective impact (2) and these observa-
The observation of the so-called “French paradox” by Renaud tions were confirmed by data from large population-based studies
and Lorgeril in 1992 (1) started an enormous effort to discover and registries, showing cardiovascular benefits of drinking alco-
the mechanisms behind the beneficial effect of wine drinking hol, regardless of type of beverage, with similar benefits shown
on cardiovascular prognosis. Since the early ‘90s, a number of for red and white wines, beer and even liquors (3, 4). It has been
experimental and clinical studies have been published, describ- shown in animal experiments and in vitro studies that there are
ing the protective effect of red wine on different pathways of the major differences in basic characteristics between red and white
pathogenesis of atherosclerosis. Antioxidants, flavonoids and poly- wines. However, prospective data from long-term, head-to-head
phenols became the first substances contained in red wine with comparisons of the effects of red and white wines on markers of
proven beneficial effects in various diseases, such as inhibition atherosclerosis are missing (5).
of LDL oxidation or attenuation of ischemia-reperfusion injury
Methods
1
Olomouc University Hospital, First Clinic of Internal Medicine, Olo- Objective
mouc, Czech Republic, 2Na Homolce Hospital Prague, Department of
Cardiology, Praha, Czech Republic, 3Olomouc University Hospital, De-
The objective of the IVV trial is to compare the long-term ef-
partment of Clinical Biochemistry, Olomouc, Czech Republic, 4Tomas fects of regular red and white wine drinking on the biomarkers
Bata Regional Hospital in Zlin, Cardiovascular Center, Zlín, and 5Depart- of atherosclerosis.
ment of Cardiology, Karlovarska krajska nemocnice, a.s., Karlovy Vary,
Czech Republic
Study overview
Address for correspondence: T. Skala, MD, PhD, FESC, Olomouc Uni- This is a prospective, multicentre, randomized, comparative
versity Hospital, First Clinic of Internal Medicine Olomouc, IP Pavlova
6, CZ-775 20 Olomouc, Czech Republic.
study in healthy individuals with mild to moderate risk of cardio-
Phone:+420.585.853201, Fax: +420.588.442500 vascular disease. The study protocol, information for patient, and
Registration of clinical trials: The clinical trial was registered in IS- informed consent were reviewed and approved by a multicentre
RCTN registry ethics committee as well as by local ethics committees in each
Registration Number: ISRCTN54359610; DOI 10.1186/ISRCTN54359610 institution before study initiation.
Funding: This work was supported by an unrestricted grant support from Eligible individuals were randomized to one of two arms:
Vino e Cuore, Ltd. The company provided all bottles of wine for the study. regular drinking of red wine (RW; Pinot Noir, 2008, Moravia,

Indexed and abstracted in Science Citation Index Expanded and in Journal Citation Reports/Science Edition
 Taborsky M et al. Red or white wine consumption effect on atherosclerosis…
xx

Tab. 1. Chemical analysis of the selected white wine and red wine. Randomization and follow-up
Chardonnay-Pinot 2008 Pinot Noir 2008 Eligible individuals willing to participate in the IVV study
Polyphenols 269 1974 were (after the signing of informed consent) randomized into one
Flavanols 11.9 11.9 of the two arms. Red or white wine was supplied in bottles di-
Antioxidant activity 42.9 579.6 rectly to the participants’ homes in the respective amount. Each
Catechin 4.07 143.81 participant also obtained a workbook with instructions to make
Epicatechin 1.25 78.11
Trans-resveratrol 0.44 2.97 notes about daily consumption of the study wine as well as other
Trans-piceid 0.17 1.97 alcoholic beverages. Blood samples for the measurement of the
Cis-resveratrol 0.69 5.63 laboratory endpoint and safety parameters were obtained at a ran-
Cis-piceid 0.66 8.79 domization visit and then after one, six, and twelve months. All
Trans-piceatannol 0.05 0.85
Trans-astringin 0.04 0.36
visits included a physical examination and assessment of cardio-
Rutin 0 3.37 vascular events and other medical history since the last visit. At
Myricetin 0 0.55 twelve months, after the final visit, the wine supply was stopped.
Quercetin 0 0.10 Participants were required to return the corks from the wine bottles
Tyrosol 24.01 13.38
to confirm that they had drunk the wine rather than sold it. Dur-
Anthocyans 0 71.20
Data are expressed in mg/L. Both wines were grown and produced by the Gala winery
ing the study period no specific restrictions and recommendations
(Moravia, Czech Republic). were made with respect to diet, lifestyle or possible diagnostic or
therapeutic procedures.
Tab. 2. Baseline characteristics of patients according to type of wine.
Safety assessment
N (%)/Mean (SD) Total White wine Red wine p1
Liver enzymes (alanine aminotransferase, aspartate amino-
N 146 74 72
transferase, gamma glutamyltransferase, alkaline phosphatase)
Female 85 (58.2%) 42 (56.8%) 43 (59.7%) 0.716
Male 61 (41.8%) 32 (43.2%) 29 (40.3%) were investigated during every visit. If any of the parameters ex-
Age 49.3 (11.2) 48.7 (11.5) 49.9 (10.9) 0.499 ceeded threefold (>3x) the upper limit of normal range (ULN),
Height 173 (9) 173 (10) 172 (8) 0.769 an unscheduled safety visit was performed. If any of the liver
Weight 78 (15) 78 (16) 78 (14) 0.897
enzymes remained >3x ULN for 14 days, wine consumption was
BMI 26.2 (3.6) 26.1 (3.8) 26.2 (3.5) 0.900
Waist 88 (12) 88 (12) 89 (11) 0.439 to be stopped.
Hips 103 (9) 102 (9) 104 (9) 0.184
1
statistical significance of difference between wine tested by ML Chi square test for Statistical methods
category parameters and by independent t-test for continuous parameters
Standard descriptive statistics were applied in the analysis: ab-
solute and relative frequencies for categorical variables and mean
supplemented by standard deviation for continuous variables. The
Czech Republic) or white wine (WW; Chardonnay-Pinot, 2008, statistical significance of differences between groups of patients
Moravia, Czech Republic). Women with a body weight of less was computed using maximum likelihood chi-square test for cat-
than 70 kg received 0.2 litres per day, women over 70 kg and egorical variables, independent t-test for continuous variables with
men 0.3 litres per day. The chemical specifications of the respec- two categories and analysis of variance (ANOVA) for three groups
tive wines are shown in Table 1. Participants were followed on an of patients; logarithmic transformation was applied when neces-
intention-to-treat basis. sary. The change of parameters in time was tested by paired t-test.
The level of statistical significance was set at a = 0.05. IBM
Study endpoints SPSS 21 for Windows (Release 21.0.0, IBM Corporation 2012)
The primary endpoint is the level of HDL-cholesterol. was adopted in all analyses.
The secondary endpoints are levels of other markers associated
with the progression of atherosclerosis (total- and LDL-cholesterol, Results
triglycerides, oxidized LDL, C-reactive protein, advanced oxida-
tion protein product, myeloperoxidase, interleukin 6, interleukin Both groups were comparable in baseline physical character-
18, matrix metalloproteinases, glutathione s-transferase, mono- istics (Tab. 2). The groups also did not differ in the baseline blood
cyte chemoattractant protein 1, soluble CD40L, fatty acid binding pressure values, liver function tests, fasting blood glucose level,
protein, Lp-PLA2). and lipid parameters with the exception of total cholesterol, which
was significantly higher in the RW group (Tab. 3).
Study population 11 of 157 study participants (7 %) did not finish the 1-year
157 asymptomatic individuals with mild to moderate risk of follow up. 146 patients completed the study with complete re-
cardiovascular disease according to the HeartScore (6) and without cords. Nobody had to stop wine consumption due to significant
a known acute or chronic inflammatory disease nor liver or renal liver enzyme elevation.
disease were enlisted to the study. The baseline physical charac- The level of HDL significantly decreased at 6 months in the
teristics are shown in Table 2. WW group in comparison with the baseline value (Tab. 4). How-

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Tab. 3.Value of measured parameters at randomization (enrolment) Tab. 4. Change in endpoints at 6 and 12 months from enrolment ac-
according to type of wine. cording to wine.
Mean (SD) Total White wine Red wine p1 Mean (SD) Total White wine Red wine p1
N 146 74 72 N 146 74 72
SBP 130 (15) 129 (15) 130 (16) 0.619 HDL
DBP 82 (11) 81 (10) 83 (12) 0.444 At enrolment 1.66 (0.58) 1.66 (0.66) 1.65 (0.50) 0.912
HF 72 (11) 72 (11) 73 (11) 0.786 At 6 months 1.58 (0.48) 1.54 (0.52) 1.62 (0.43) 0.317
Primary endpoint Difference 1 -0.09 (0.34) -0.14 (0.41) -0.04 (0.26) 0.074
HDL 1.66 (0.58) 1.66 (0.66) 1.65 (0.50) 0.912 p2 0.002 0.005 0.231
Secondary endpoint At 12 months 1.62 (0.49) 1.60 (0.53) 1.64 (0.46) 0.634
LDL 3.73 (0.90) 3.61 (0.80) 3.85 (0.98) 0.098 Difference 2 -0.04 (0.36) -0.07 (0.42) -0.01 (0.29) 0.362
CRP+ 2.68 (3.54) 2.27 (2.28) 3.09 (4.46) 0.435 p2 0.180 0.171 0.718
TG+ 1.63 (0.95) 1.65 (1.11) 1.61 (0.77) 0.624 TG+
TC 6.06 (1.08) 5.88 (1.01) 6.24 (1.11) 0.040 At enrolment 1.63 (0.95) 1.65 (1.11) 1.61 (0.77) 0.767
q CH/HDLc 3.43 (1.69) 3.35 (1.86) 3.51 (1.52) 0.564 At 6 months 1.61 (1.02) 1.62 (1.10) 1.59 (0.93) 0.852
Glucose+ 5.48 (1.10) 5.49 (0.86) 5.47 (1.31) 0.686 Difference 1 -0.01 (0.82) 0.00 (0.93) -0.02 (0.70) 0.923
Liver function+ p2 0.422 0.903 0.289
ALT 0.48 (0.24) 0.49 (0.26) 0.46 (0.21) 0.537 At 12 months 1.61 (1.01) 1.59 (0.99) 1.64 (1.04) 0.759
AST 0.43 (0.17) 0.42 (0.14) 0.45 (0.20) 0.511 Difference 2 -0.02 (0.91) -0.06 (0.85) 0.03 (0.97) 0.559
ALP 1.28 (0.42) 1.30 (0.45) 1.26 (0.39) 0.868 p2 0.530 0.750 0.572
GGT 0.47 (0.32) 0.45 (0.28) 0.48 (0.35) 0.499 LDL
Bilirubin 11.2 (5.4) 11.8 (5.5) 10.6 (5.2) 0.182 At enrolment 3.73 (0.90) 3.61 (0.80) 3.85 (0.98) 0.098
Additional markers+ At 6 months 3.40 (0.87) 3.23 (0.78) 3.58 (0.93) 0.016
Lp-PLA2 (ng/ml) 281 (116) 285 (102) 276 (129) 0.322 Difference 1 -0.33 (0.71) -0.39 (0.74) -0.27 (0.68) 0.345
Copeptin (pmol/l) 8.19 (4.83) 7.64 (4.45) 8.76 (5.16) 0.236 p2 <0.001 <0.001 0.001
1
statistical significance of difference between wines tested by independent t-test
At 12 months 3.48 (0.94) 3.37 (0.75) 3.60 (1.10) 0.134
+
parameters were logarithmically transformed (ln (x)) before testing Difference 2 -0.24 (0.73) -0.24 (0.68) -0.24 (0.78) 0.982
p2 <0.001 0.003 0.013
TC
ever, there was only a trend to lower HDL level in the WW group At enrolment 6.06 (1.08) 5.88 (1.01) 6.24 (1.11) 0.040
At 6 months 5.74 (0.98) 5.57 (0.88) 5.91 (1.05) 0.035
in the intergroup analysis at 6 months and no difference was ob-
Difference 1 -0.33 (0.99) -0.32 (1.13) -0.33 (0.82) 0.957
served in HDL levels at 12 months in both intra- and intergroup p2 <0.001 0.017 0.001
analyses (Tab. 4). At 12 months 5.84 (1.02) 5.69 (0.82) 5.99 (1.18) 0.085
The levels of TG were comparable between groups during Difference 2 -0.21 (0.87) -0.18 (0.93) -0.24 (0.82) 0.684
the study. p2 0.004 0.096 0.016
1
statistical significance of difference between wines tested by independent t-test, 2
On the other hand, we found significant reduction in LDL in statistical significance of difference between two points in time tested by dependent
both groups at 6 and 12 months compared with the baseline. The t-test, + parameters were logarithmically transformed (ln (x)) before testing, Differ-
LDL level was significantly lower at 6 months in the WW group, ence 1 = Value at 6 months – Value at enrolment, Difference 2 = Value at 12 months
– Value at enrolment
however, it was not different at 12 months and the differences from
baseline were comparable between the groups (Tab. 4).
Similarly, we observed a significant reduction of TC in both months in comparison with the baseline value but no differences
groups at 6 months; at 12 months this effect reached statistical were detected in the intergroup analysis (Tab. 6, Fig. 1).
significance only in the RW group, however, the differences from We did not detect any differences in the levels of ALT, GGT
baseline were again comparable (Tab. 4). or bilirubin (Tab. 7). Only a trend towards lower AST level was
The level of CRP was significantly higher at 12 months in the found in the WW group at 12 months in comparison with base-
WW group in comparison to the baseline value, however, no dif- line values, with no difference in the intergroup analysis (Tab. 7).
ferences were found in the intergroup analysis (Tab. 5). Fasting The levels of ALP were significantly reduced in both groups at
blood glucose levels were significantly reduced in both groups at 6 and at 12 months, this effect was comparable in the intergroup
6 months; at 12 months we observed only a trend towards lower analyses (Tab. 7).
glucose levels in comparison with baseline values in the RW group; No clinically relevant differences were found in any other
no differences were found in glucose levels in the intergroup com- parameters. No clinically relevant differences were found in any
parison at 6 or 12 months (Tab. 5). of the measured parameters after adjusting for gender and age.
The Lp-PLA2 levels at 12 months were significantly lower
in the RW group both in comparison with the WW group and in Discussion
comparison with baseline values (Tab. 6, Fig. 1). However, in the
WW group we also found a trend to reduced Lp-PLA2 values in There is a large body of evidence that the Mediterranean diet
comparison to baseline levels and both groups had comparable and light to moderate alcohol consumption, in particular red wine,
differences from baseline (Tab. 6, Fig. 1). We also demonstrated are associated with less cardiovascular diseases and an improved
a trend towards copeptin level reduction in the RW group at 12 lipid profile (7). However, it is still not clear whether alcohol per

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xx

Tab. 5. Change in measured parameters at 6 and 12 months from en- Tab. 7. Change in parameters of liver function at 6 and 12 months
rolment according to wine. from enrolment according to wine.
Mean (SD) Total White wine Red wine p1 Mean (SD) Total White wine Red wine p1
N 146 74 72 N 146 74 72
CRP+ AST
At enrolment 2.68 (3.54) 2.27 (2.28) 3.09 (4.46) 0.435 At enrolment 0.43 (0.17) 0.42 (0.14) 0.45 (0.20) 0.511
At 6 months 2.98 (5.41) 2.55 (4.68) 3.41 (6.05) 0.181 At 6 months 0.42 (0.15) 0.41 (0.13) 0.43 (0.17) 0.479
Difference 1 0.28 (5.62) 0.24 (4.29) 0.32 (6.70) 0.932 Difference 1 -0.01 (0.12) -0.01 (0.10) -0.02 (0.14) 0.545
p2 0.885 0.571 0.559 p2 0.510 0.642 0.642
At 12 months 3.04 (4.03) 2.61 (2.54) 3.49 (5.12) 0.711 At 12 months 0.41 (0.26) 0.39 (0.15) 0.43 (0.33) 0.501
Difference 2 0.39 (4.53) 0.37 (3.08) 0.40 (5.68) 0.966 Difference 2 -0.02 (0.24) -0.03 (0.12) -0.02 (0.32) 0.819
p2 0.012 0.045 0.138 p2 0.024 0.056 0.178
Glucose+ ALP
At enrolment 5.48 (1.10) 5.49 (0.86) 5.47 (1.31) 0.686 At enrolment 1.28 (0.42) 1.30 (0.45) 1.26 (0.39) 0.868
At 6 months 5.16 (0.75) 5.23 (0.71) 5.08 (0.78) 0.199 At 6 months 1.05 (0.30) 1.07 (0.32) 1.04 (0.28) 0.723
Difference 1 -0.30 (0.94) -0.26 (0.88) -0.35 (1.01) 0.585 Difference 1 -0.22 (0.26) -0.24 (0.29) -0.21 (0.23) 0.404
p2 <0.001 0.027 0.007 p2 <0.001 <0.001 <0.001
At 12 months 5.29 (0.85) 5.39 (0.84) 5.19 (0.86) 0.113 At 12 months 1.05 (0.28) 1.04 (0.30) 1.05 (0.26) 0.689
Difference 2 -0.17 (0.96) -0.09 (0.98) -0.25 (0.94) 0.322 Difference 2 -0.23 (0.27) -0.26 (0.28) -0.20 (0.26) 0.196
p2 0.061 0.443 0.058 p2 <0.001 <0.001 <0.001
1
statistical significance of difference between wines tested by independent t-test, 2 ALT
statistical significance of difference between two points in time tested by dependent At enrolment 0.48 (0.24) 0.49 (0.26) 0.46 (0.21) 0.537
t-test, + parameters were logarithmically transformed (ln (x)) before testing, Differ- At 6 months 0.49 (0.23) 0.52 (0.24) 0.46 (0.22) 0.074
ence 1 = Value at 6 months – Value at enrolment, Difference 2 = Value at 12 months
Difference 1 0.01 (0.21) 0.03 (0.21) 0.00 (0.20) 0.410
– Value at enrolment
p2 0.152 0.063 0.902
At 12 months 0.48 (0.26) 0.51 (0.29) 0.45 (0.21) 0.185
Tab. 6. Change in parameters of oxidative stress at 6 and 12 months Difference 2 0.01 (0.21) 0.02 (0.21) -0.01 (0.21) 0.426
from enrolment according to type of wine. p2 0.533 0.362 0.927
Mean (SD) Total White wine Red wine p1 GGT
At enrolment 0.47 (0.32) 0.45 (0.28) 0.48 (0.35) 0.499
N 146 74 72
At 6 months 0.48 (0.38) 0.51 (0.47) 0.46 (0.26) 0.977
Lp-PLA2 - 1 (ng/ml) Difference 1 0.03 (0.24) 0.06 (0.30) 0.00 (0.17) 0.153
At enrolment 281 (116) 285 (102) 276 (129) 0.322 p2 0.341 0.283 0.856
At 12 months 248 (60) 259 (62) 236 (57) 0.021 At 12 months 0.46 (0.28) 0.47 (0.28) 0.46 (0.29) 0.917
Difference 2 -29.83 (112.60) -26.12 (103.60) -33.71 (121.89) 0.686 Difference 2 0.01 (0.15) 0.02 (0.15) 0.01 (0.14) 0.638
p2 0.004 0.072 0.027 p2 0.234 0.180 0.839
Copeptin -1 (pmol/l) Bilirubin
At enrolment 8.19 (4.83) 7.64 (4.45) 8.76 (5.16) 0.236 At enrolment 11.2 (5.4) 11.8 (5.5) 10.6 (5.2) 0.182
At 12 months 7.63 (5.52) 7.52 (4.20) 7.75 (6.65) 0.765 At 6 months 11.2 (5.8) 11.5 (6.0) 10.9 (5.6) 0.649
Difference 2 -0.51 (6.05) -0.12 (4.98) -0.93 (7.00) 0.421 Difference 1 0.02 (4.93) -0.20 (5.27) 0.25 (4.57) 0.602
p2 0.241 0.995 0.083 p2 0.707 0.577 0.893
1
statistical significance of difference between wines tested by independent t-test, At 12 months 11.3 (5.1) 12.0 (5.5) 10.6 (4.5) 0.139
2
statistical significance of difference between two points in time tested by depen- Difference 2 0.19 (4.58) 0.31 (5.06) 0.06 (4.03) 0.753
dent t-test, All parameters were logarithmically transformed (ln (x)) before testing,
p2 0.300 0.457 0.474
Difference 1 = Value at 6 months – Value at enrolment, Difference 2 = Value at 12
months – Value at enrolment
1
statistical significance of difference between wines tested by independent t-test,
2
statistical significance of difference between two points in time tested by depen-
dent t-test, All parameters were logarithmically transformed (ln (x)) before testing,
Difference 1 = Value at 6 months – Value at enrolment, Difference 2 = Value at 12
se or other components of alcoholic beverages protect against heart months – Value at enrolment
disease (8). A number of studies demonstrated that alcohol per se
exhibits a protective effect (3, 9). On the other hand, several au-
thors described cardio-protective properties of other components, development of atherosclerosis) in rat and human vascular smooth
particularly flavonoids (10). muscle cells (VSMCs) induced by red wine, whereas white wine
Currently there are conflicting results regarding the compari- had no effect. On the other hand, Munday et al (11) did not find
son of the effects of red and white wines on different clinically any differences between red and white wine in serum lipoprotein
relevant endpoints in experimental as well as in small clinical profile and fatty streak formation in the C57BL/6 mouse athero-
studies (11–13). It is well known that there are major differences sclerosis model. López et al (17) observed a similar reduction in
in basic characteristics between red and white wines. Red wine superoxide production and an increase in expression and activity
exhibits a higher antioxidant capacity and, according to several of NO-synthase (iNOS) by dealcoholized red and white wines in
studies, a protective effect against LDL-oxidation when compared a rat model, while up-regulation of cyclo-oxygenase-2 (COX-2)
with white wine (14). Rosenkranz et al (15) and Sparwel et al (16) was detected only in the red wine group. Moreover, Auger et al
have shown attenuation of platelet-derived growth factor receptor (18) described that both red wine and polyphenols-enriched white
(PDGFR) signalling (an important pathogenic mechanism in the wine prevent early atherosclerosis in hamsters.

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Fig. 1. Change in Lp-PLA2 and copeptin at 12 months from enrolment according to type of wine

Regarding the effects on atherosclerosis, there is only limited (Tab. 1), we are unable to demonstrate any clinically important
evidence from prospective head-to-head comparisons of differ- differences in the effects of both wines on monitored parameters.
ent alcoholic beverages in human subjects; the published studies We cannot, therefore, confirm our primary hypothesis that red wine
were focused mostly on the acute effects of drinking. Tousoulis consumption is associated with higher levels of HDL in compari-
et al (19) observed reactive hyperaemia after beer and red wine son with white wine. In the IVV trial we compared the effects of
consumption that was not detected after white wine, whiskey or consumption of red wine with a high concentration of flavonoids
water in healthy young individuals. A reduction in urinary prosta- and other antioxidants and white wine with a low concentration
glandin PGF2α-III as a marker of oxidative stress was expressed of these components and we were unable to find any clinically
more after red wine than after white wine in a study on healthy important differences in biomarkers of atherosclerosis.
subjects by Pignatelli et al (20). Pace-Asciak et al (21) did not find It has been repeatedly shown that wine drinking is associated
any advantage in red wine over white wine in preventing platelet with several changes in lipid profile. The data in the literature are
aggregation in healthy males. A similar increase in total antioxi- almost consistent in showing that wine consumption decreases
dant capacity as a result of red or white wine consumption was the levels of LDL while it increases the levels of HDL (8, 25, 26).
described by Pinzani et al (22). In concordance with these literature data, we observed a highly
Williams et al. (12) did not observe any significant difference in significant and lasting effect of wine consumption on LDL re-
the acute effects of red and white wine drinking on blood pressure, duction that was observed in both 6-month and 12-month blood
heart rate, plasma lipids, levels of interleukin-6 (IL-6), intercellular samples. Contrary to the previously published studies, however,
adhesion molecule-1 (ICAM-1), and vascular cell adhesion mole- we found a transient and weak reduction of HDL after 6 months of
cule-1 (VCAM-1) in males with angiographic evidence of coronary white wine consumption. This effect was no more detectable after
artery disease (CAD). Moreover, a comparable acute improvement 12 months. Neither white wine nor red wine drinking was associat-
of endothelial function after red and white wine drinking was re- ed with an increase of HDL levels. We can speculate that the inabil-
ported by Whelan et al (13) in subjects with proven CAD. Blann ity to demonstrate any elevation of HDL levels in our study could
et al (23) described an increase in beta-thromboglobulin levels be at least partially caused by the different design of the IVV trial in
after red wine, whereas white wine had no effect. comparison with the previously published studies: whereas the IVV
Until now, the longest exposure to red and white wines in a trial was a prospective and long-term intervention, the literature
prospective trial was examined by Sacanella et al (24) in their evidence for an increase of HDL after wine consumption comes
four-week study; in a group of thirty-six healthy females they mostly from retrospective or small and short-term prospective stud-
found a stronger anti-inflammatory effect of red wine compared ies. Moreover, abstinence from alcohol was not required for sub-
with white wine consumption. ject enrolment in our study and therefore the baseline HDL levels
To the best of our knowledge, the IVV trial is the first long- could be already elevated as a result of previous drinking; how-
term, randomized, prospective study focused on the comparison ever, in that case we would not expect further reduction of LDL.
of the effects of regular white and red wine drinking on several We also found a significant elevation in CRP levels at the
markers of atherosclerosis. Despite there being significant dif- 12-month follow-up in the WW group and in the total study popu-
ferences in the composition of the red and white wine used in lation. There are conflicting literature data on the effects of wine
this study (e.g. resveratrol concentration or antioxidant capacity) consumption on inflammatory markers. Our results are in contra-

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xx

diction with the results from retrospective studies (27). On the 6. Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer
other hand, an increase in plasma pro-inflammatory cytokines con- G et al. Estimation of ten-year risk of fatal cardiovascular disease in Eu-
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