Drinking a small or moderate amount of wine may lower the risk of serious cardiovascular disease in people at a higher risk who are following a Mediterranean diet, according to research published in the European Heart Journal.

Previous studies on the effects of wine on cardiovascular health have produced inconsistent results. This may be in part because research often relies on people reporting how much wine they drink. Instead, in the new study, researchers measured the amount of a chemical, called tartaric acid, in participants’ urine. Researchers say this is an “objective and reliable measure” of wine consumption.

The research was led by Professor Ramon Estruch from the University of Barcelona and the Hospital Clinic Barcelona, Spain.

The new research is part of a larger Spanish study investigating the effect of a Mediterranean diet (high in olive oil, vegetables, fruit, nuts and fish, and low in sweet or processed food and drink) on people with a higher risk of developing cardiovascular disease.

All the people taking part had no cardiovascular disease at the start of the study, but they either had type 2 diabetes, or they had a combination of cardiovascular disease risk factors such as smoking, high blood pressure, high cholesterol, being overweight and/or a family history of cardiovascular disease.

As well as completing questionnaires about what they ate and drank, participants gave urine samples at the beginning of the study and after a year of following a Mediterranean diet. Tartaric acid is a chemical naturally found in grapes and grape-derived products such as wine. Tartaric acid is excreted in urine, meaning it can be measured to show if someone has consumed wine and/or grapes in the last five to six days.

To investigate the effect of drinking wine, researchers included a total of 1,232 participants. Participants were followed up for four to five years and during that time, there were 685 cases of cardiovascular disease (heart attack, coronary revascularization, stroke or death from cardiovascular disease) during the study.

In this group of people at high risk of cardiovascular disease who were following a Mediterranean diet, researchers found that the risk of developing a cardiovascular event was reduced by 50% in light-to-moderate wine drinkers, defined as consuming half to one glass of wine per day, compared to those drinking very little or no wine.

Light drinking (between one glass per week and less than half a glass per day) reduced cardiovascular risk by 38%. However, this protective effect disappears in people who drank more than one glass per day.

The researchers took account of other factors that are known to influence the risk of cardiovascular disease, but they acknowledge that the design of the study means it can only show a link between drinking wine and cardiovascular events, and other factors cannot be ruled out.

Professor Estruch said, “By measuring tartaric acid in the urine, alongside food and drink questionnaires, we have been able to make a more accurate measurement of wine consumption. We have found a much greater protective effect of wine than that observed in other studies. A reduction in risk of 50% is much higher than can be achieved with some drugs, such as statins.

“This study examines the importance of moderate wine consumption within a healthy dietary pattern, such as the Mediterranean diet. Until now, we believed that 20% of the effects of the Mediterranean diet could be attributed to moderate wine consumption; however, in light of these results, the effect may be even greater.

“The participants in our study were older people at high risk of cardiovascular disease living in a Mediterranean country, so the results may not apply to other populations. Another key question is at what age moderate wine consumption could be considered ‘acceptable’.

“Recent studies indicate that the protective effects of wine consumption are observed starting from the age of 35 to 40. It is also important to note that moderate consumption for women should always be half that of men, and it should be consumed with meals.”

In an accompanying editorial, Professor Giovanni de Gaetano from IRCCS NEUROMED, Pozzilli, Italy and colleagues said, “The relationship between alcohol consumption, particularly wine, and cardiovascular disease (CVD) risk remains a topic of ongoing debate despite decades of related research.

“Numerous studies have suggested that moderate wine consumption, often defined as one glass per day, preferably during meals, is associated with a reduced risk of total mortality and CVD. However, this apparent protective effect is clouded by persistent uncertainties.

“The paper by Inés Domínguez-López et al, published in this issue of the European Heart Journal, sheds new light on this complex relationship by introducing an objective biomarker—urinary tartaric acid—as a measure of wine consumption and provides compelling evidence for its association with lower CVD risk.

“However, Domínguez-López et al also highlight the complexity of studying the effects of alcohol on health. While biomarkers such as urinary tartaric acid provide a more objective measure of exposure to wine, they do not capture the broader context of alcohol consumption, such as drinking patterns, lifestyle factors, and possible interactions with other dietary components.

“This limitation underscores the need for more refined research that captures the complexity of dietary patterns and their impact on health.

“The study by Domínguez-López et al represents an important step forward in our understanding of the complex relationship between wine consumption and cardiovascular health. By leveraging urinary tartaric acid as an objective biomarker, the authors provide robust evidence that moderate wine consumption is associated with lower CVD risk in a Mediterranean population at high cardiovascular risk.

“This work not only highlights the value of objective biomarkers in nutritional epidemiology but also supports the notion that light-to-moderate wine consumption may be part of a heart-healthy diet. However, the findings also remind us of the risks associated with higher levels of consumption, underscoring the importance of moderation.

“Future research should continue to explore the potential of biomarkers in unraveling the intricate links between dietary habits, lifestyle, and health outcomes.”

Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases at UT Health San Antonio, Boston University School of Medicine and the Framingham Heart Study have found that higher scores on the Dietary Inflammatory Index (DII) are associated with an increased incidence of all-cause dementia and Alzheimer’s disease (AD) dementia.

Dementia is projected to reach 152 million cases by 2050, according to the World Health Organization, placing an increasing strain on caregivers and health care systems. While advancements in drug therapies have improved care and targeted disease mechanisms, preventive measures remain elusive.

Diet has been identified as a potential avenue for reducing dementia risk. Previous observational studies have linked anti-inflammatory diets, such as the Mediterranean and MIND diets, with slower cognitive decline and lower dementia risk.

The DII is a standardized tool that quantifies the inflammatory potential of diets by analyzing nutrients, bioactive compounds, and food components. Prior studies have suggested that higher DII scores are associated with systemic inflammation, which is separately understood to contribute to neurodegenerative processes.

In the study, “Association Between Dietary Inflammatory Index Score and Incident Dementia,” published in Alzheimer’s & Dementia, researchers utilized data from the Framingham Heart Study (FHS) Offspring cohort to analyze dietary data, dementia incidence, and Alzheimer’s disease diagnoses over a median follow-up period of around 13 years.

The study cohort included 1,487 participants aged 60 or older and free of dementia at baseline. Dietary information was obtained from food frequency questionnaires (FFQs) administered during three examination cycles (1991–1995, 1995–1998, and 1998–2001).

DII scores were calculated for 36 dietary components, which were categorized as either anti-inflammatory (e.g., fiber, vitamins A, C, D, E, omega-3 fats) or pro-inflammatory (e.g., saturated fats, total energy intake, and carbohydrates). Higher positive scores indicated more pro-inflammatory diets.

Dementia diagnoses, including Alzheimer’s disease, were ascertained using a combination of neurological evaluations, neuropsychological tests, and medical record reviews. Continuous surveillance ensured the comprehensive capture of dementia cases.

Of the 1,487 participants, 246 developed all-cause dementia, including 187 cases of Alzheimer’s disease. Participants with higher DII scores, indicating pro-inflammatory diets, had significantly increased risks of both all-cause and AD dementia.

For every unit increase in the DII score, the risk of all-cause dementia rose by 21%. A similar increase in DII scores was associated with a 20% higher risk of AD dementia.

When participants were grouped based on their DII scores, those with the most pro-inflammatory diets were 84% more likely to develop all-cause dementia compared to those with the most anti-inflammatory diets.

The association persisted after adjusting for demographic, lifestyle, and clinical factors, including age, sex, education, body mass index, physical activity, smoking, and total energy intake.

Findings support the hypothesis that dietary inflammation contributes to neurodegenerative processes, likely through systemic inflammation pathways. Chronic inflammation, driven by diets high in pro-inflammatory components such as saturated fats and processed carbohydrates, may exacerbate brain inflammation and promote amyloid-beta plaque formation, a hallmark of Alzheimer’s disease.

Anti-inflammatory nutrients, like omega-3 fatty acids and flavonoids, may counteract these effects by reducing cytokine production and supporting brain health. Studies such as the PREDIMED trial have demonstrated that anti-inflammatory diets, like the Mediterranean diet, can improve cognition, likely by reducing systemic inflammation.

As an observational study, there is no way to establish specific causality. The current study’s finding of an 84% risk swing correlation between highest and lowest DII scores is still highly significant.

The results suggest dietary interventions emphasizing anti-inflammatory foods may reduce dementia risk as a long-term strategy. Incorporating DII-type assessments into dietary guidelines could help identify at-risk individuals and develop targeted nutrition strategies at a population level.