Key:
NZ    Nahida Zaman
GG    Dr Giovanni de Gaetano

NZ    You are listening to Nahida Zaman with Diabetes Radio.  My guest today is Dr Giovanni de Gaetano.  Doctor, hello and a very warm welcome to Diabetes Radio.

GG    Hello.

NZ    Doctor, you are the Director of the Research Laboratories at the John Paul II Centre for High Technology Research and Education in Biomedical Sciences Catholic University in Italy.  Could you please give our listeners some background into your research interests?

GG    Yes, I started as a young investigator interested in aspirin and the blood platelets which are self-circulating in the blood.  The effect of aspirin is that of reducing the capacity of the cells to aggregate each other and to occlude the circulation so aspirin is used today in myocardial infarction, in cerebral stroke and so on.  The formula of aspirin is very similar to a polyphenol and I was attracted by the fact that several beverages like red wine but also beer and other components of the Mediterranean diet contained a lot of polyphenols so I moved from aspirin to polyphenols and especially I started to be interested in the effect of red wine on blood platelets and cardiovascular diseases mediated by the capacity of blood platelets to aggregate each other at the vascular level and during the last ten years I developed interest also in epidemiological aspects of alcoholic beverages in preventing cardiovascular diseases and our interest from wine moved to beer and also more recently to spirits and liquor.

NZ    Doctor, your recent research culminated in the publication of an original paper in the November 2011 issue of the journal, European Journal of Epidemiology.  The paper was titled Wine, Beer or Spirit drinking in Relation to Fatal and Non-fatal Cardiovascular Events, a Meta Analysis.  What were the objectives of your study?

GG    Yes this is the last of a series of papers we published during the last decade with the aim of evaluating by special statistical technique which is called meta analysis.  The potential effect, the preventative effect of wine and beer or spirits in relation to cardiovascular disease and we collected all available data in the literature which had some quality level to be included in our meta analysis because one problem in this field is that many papers are published each year but one paper says that wine protects, another says that alcohol is very harmful, another one says that beer is without effect so the meta analysis technique allows to put together all available data and the weight analysed calculated the relative weight, the importance, the number included in the study, the quality of the data, the statistical power and the number of information that we can get.  In order to obtain a global answer to this question, not let us say 20, 30 separate answers which can be contradictory to each other.

NZ    Doctor, what was your original hypotheses?

GG    Our hypothesis was that beer could have a similar effect as wine because about ten years ago we had performed a similar meta analysis but the data available at the time allowed us to clearly identify a dose response effect for wine but not for beer so the questions remained whether there was a difference between these two beverages or the difference was apparent and so in the last years the number of data available were such that we could repeat and also with more sophisticated statistical technique.  A comparative analysis of data on wine and beer and we found that virtually the same data which are essentially that at low and moderate doses, both wine and beer are protective against cardiovascular events.  If you continue to drink, this beneficial effect disappears and the certain moment, both wine and beer become dangerous for your health.

NZ    And how was your study designed?

GG    It was designed as a meta analysis, as a statistical comparison of people who do not drink alcohol at all and the people who drink alcohol, either wine or beer or spirits but I would leave spirits outside for the moment, at different doses.  The important point was that we did not compare drinkers versus non-drinkers but drinkers at different level and different amount of alcohol and clinical events and so we could obtain a clear dose response curve which is important for our listeners that are different from smoking.  Sometimes one compares smoking and alcohol as two bad things.  Smoking is definitely a bad thing because if you smoke one cigarette you have harm, if you smoke two cigarettes you have more harm and so on but if you drink a glass of wine or a pint of beer, you do not get harm, you get the benefit.  You get harm only if you drink either wine or beer in amounts which are above the moderate quantities which we have evaluated in our study so comparing alcohol and smoking as two harmful life habits is not correct.

NZ    And what were the results?

GG    In this specific meta analysis we could not compare women and men but we did so in previous studies and we did not find any important difference in the sense that both women and men get benefit from moderate alcohol, however women are more prone to miss the beneficial effect of alcohol.  If you drink one glass of wine and you are a man or a woman, you get similar benefits but if you drink three glasses of wine, if you are a man you still get the benefit, if you are a woman you start to lose this benefit so women are more sensitive to the harmful effects of alcohol.

NZ    Doctor, your study’s results confirmed a J shaped relationship between wine intake and reduced vascular risk.  How much alcohol did participants consume to achieve maximal protection?

GG    I would say something that we do not want to transform beer or wine into drugs and drugs are taken at 200 mg or 150 mg.  Both wine and beer must remain something which constitutes a pleasure of life which are consumed together in the context of a Mediterranean diet or good food with good friends and so on, so please take the number I will tell you with this perspective in mind that we are not speaking about the milligrams or the amounts of chemical compounds known as drugs, so I would say that for wine we can advise men to drink up to three glasses of wine per day, preferably during meals and preferably every day not during the weekend only as it is done in some northern European countries and better during meals because the animal fats we can consume, if we do that together with a glass of wine, the amount of oxidised lipids which are absorbed is diminished if we drink a glass of wine together so we can eat red meat but with some wine together the harmful effects of the animal fats which contribute to atherosclerosis is somewhat diminished so it is better to drink together in the context of meals.  For women it is advised to drink up to two glasses of wine per day so a little bit less than men.

NZ    Were the results similar for beer consumption?

GG    Yes, for beer which contains less alcohol in comparison with the alcohol content, we calculated that the amount at which you can get the best of the benefit is about the 500 millilitre so two or three small bottles of 200 millilitre always per day.

NZ    Doctor, did your study show any statistically significant association between spirits intake and vascular disease?

GG    As far as spirits are concerned, the amount of data available for these studies we performed is still relatively small so I think that this is the main reason at the moment that we could not reproduce with spirits the shape curve we observe with wine or beer.  Looking at the data we have at the moment, we must say that there is no measurable relationship between the amount of alcohol and cardiovascular event so we cannot say that there is a certain amount of spirit there is a benefit on cardiovascular disease so at the moment it is better to be prudent concerning spirits.

NZ    Are there any limitations to your study?

GG    There are several limitations in the sense that collecting data obtained in different countries in different context there might be variables which we try to take into account but which can escape our analysis and so it has been suggested that in some countries people who drink wine are also those who have a better healthier lifestyle habit because they are more cultivated, they practice physical exercise, sports and so the risk is to attribute to wine benefit which could be linked to other variables.  We tried to take all these things into account so the limitations we must tell them but we tried to reduce them to a minimum.

NZ    Doctor, did your results help shed light on the impact that the pattern of drinking can have on cardiovascular outcomes?

GG    Yes, in the sense that we confirm that moderation is the key word when we speak about alcohol consumption.  In the present moment especially in the UK and in Scandinavian countries, there are campaigns against alcohol which do not take into account the potential beneficial effect of a moderate drinking so the concept of moderation apparently either is not known or it is not practised and then since it is not practised alcohol is banned as a drug, as a dangerous or the most dangerous drug available today.  Now this pessimistic, negative approach has no basis under our data and our recent meta analysis confirms not only for wine but also for beer that drinking in moderation is a healthy habit for our life.

NZ    And finally doctor, what conclusions should be drawn from your results?

GG    The conclusion is that the young people must be helped to learn to drink.  In Italy children sit at the table with their parents and a bottle of wine is on the table and the mama and pappy and the grandma, grandpa drink a little bit of wine during meals and the children understand that there is no scene, no danger, nothing particularly interesting in drinking wine or alcohol and this is why young people in Italy behave at least until they will become near similar to other European adolescents or young people.  They still keep the way of considering alcohol as something familiar.  Since in other countries this is not so traditionalism, it is not to be the right attitude because if you forbid something to young people, the young people would only do that forbidden thing.  We should promote the campaigns especially in the secondary school, even at the university level to defuse the concept that drinking is a pleasure and can be a pleasure accompanied by something else for our life but always one must underline that drinking as binge drinking or in excess as unfortunately sometimes happens is a very, very dangerous attitude for our life, not only for cardiovascular disease but also for cancer.  Definitely some cancers increase in association with heavy drinking.

NZ    Dr Giovanni de Gaetano, thank you so much for taking the time to speak with us today, it has been a real pleasure.