A high level of adherence to the Mediterranean diet (MedDiet) was associated with a lower risk of cardiovascular disease and all-cause mortality, and this rate was even lower among those individuals who drank wine as part of the MedDiet, according to an extended follow-up using results from the PREDIMED trial, published Feb. 11 in EHJ. Some interactions and nonsignificant associations suggest caution in the interpretation of these results.

PREDIMED included 7,447 high-risk participants (57% women, aged 55-80 years) at 11 centers in Spain. Participants were randomized 1:1:1 to three dietary interventions: MedDiet supplemented with extra-virgin olive oil, MedDiet supplemented with mixed nuts, or a low-fat control diet. The MedDiet includes moderate consumption of wine, typically one glass a day with meals, and this is included in the validated Mediterranean Diet Adherence Screener. Wine consumption and MedDiet adherence were assessed using a 14-item questionnaire completed by participants.

Miguel A. Martínez-González, MD, et al., recorded cardiovascular events over a 4.8-year follow-up and all-cause mortality was tracked for 17 years.

For this analysis, to complement the findings from PREDIMED, researchers also included 23,133 participants of the prospective Spanish SUN project who were younger at baseline and followed for 22 years.

Results from PREDIMED showed that after multivariable adjustment the risk for cardiovascular disease was lower among high, vs. low, adherents of the MedDiet who did not drink wine (hazard ratio [HR] 0.84) and was still lower among those who drank wine (HR 0.55). Similarly, the risk of all-cause mortality was lower in the two groups respectively (HR 0.77 and HR 0.67.)

Importantly, researchers found that drinking more wine (three or more glasses of wine a day) erased the reduced mortality risk that was seen with those who drank less, in exploratory dose-response analyses.

In the SUN cohort, no significant interactions were observed between MedDiet adherence, wine and cardiovascular disease risk. However, all-cause mortality risk was lower among high adherents to the MedDiet who drank wine compared to those who did not (HR 0.54 vs. 0.94).

When researchers combined the two cohorts, consuming wine within the MedDiet was associated with lower all-cause mortality (p=0.01).

"To confirm these observations, large-scale randomized controlled trials, specifically designed to compare moderate wine consumption vs. abstention wine, are warranted," write the authors.