Regular wine consumption in chronic heart failure: impact on outcomes, quality of life, and circulating biomarkers.
BACKGROUND
Moderate, regular alcohol consumption is generally associated with a lower risk of cardiovascular events but data in patients with chronic heart failure are scarce. We evaluated the relations between wine consumption, health status, circulating biomarkers, and clinical outcomes in a large Italian population of patients with chronic heart failure enrolled in a multicenter clinical trial.


RESULTS
A brief questionnaire on dietary habits was administered at baseline to 6973 patients enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) trial. The relations between wine consumption, fatal and nonfatal clinical end points, quality of life, symptoms of depression, and circulating biomarkers of cardiac function and inflammation (in subsets of patients) were evaluated with simple and multivariable-adjusted statistical models. Almost 56% of the patients reported drinking at least 1 glass of wine per day. After adjustment, clinical outcomes were not significantly different in the predefined 4 groups of wine consumption. However, patients with more frequent wine consumption had a significantly better perception of health status (Kansas City Cardiomyopathy Questionnaire score, adjusted P<0.0001), less frequent symptoms of depression (Geriatric Depression Scale, adjusted P=0.01), and lower plasma levels of biomarkers of vascular inflammation (osteoprotegerin and C-terminal proendothelin-1, adjusted P<0.0001, and pentraxin-3, P=0.01) after adjusting for possible confounders.


CONCLUSIONS
We show for the first time in a large cohort of patients with chronic heart failure that moderate wine consumption is associated with a better perceived and objective health status, lower prevalence of depression, and less vascular inflammation, but does not translate into more favorable clinical 4-year outcomes.


BACKGROUND
URL: http://www.clinicaltrials.gov. Unique identifier: NCT0033633.
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Franco
F
Cosmi
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Paola
P
Di Giulio
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Serge
S
Masson
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Andrea
A
Finzi
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Rosa Maria
RM
Marfisi
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Deborah
D
Cosmi
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Marco
M
Scarano
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Gianni
G
Tognoni
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Aldo P
AP
Maggioni
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Maurizio
M
Porcu
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Silvana
S
Boni
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Giovanni
G
Cutrupi
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.).
Luigi
L
Tavazzi
From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu-San Michele, Cagliari, Italy (M.P.); U.O.C. di Cardiologia, Mater Salutis Hospital, Legnago, Italy (S.B.); Policlinico Madonna della Consolazione-U.O. di Cardiologia, Reggio Calabria, Italy (G.C.); and Scientific Direction, Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy (L.T.). roberto.latini@marionegri.it.
Roberto
R
Latini
D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology* / Q000523:psychology; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D065840:Protective Factors; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D014657:Vasculitis / Q000453:epidemiology; D016277:Ventricular Function, Left; D014920:Wine / Q000009:adverse effects
D015415:Biomarkers
biological markers; quality of life; wine