The progression of carotid-plaque volume in patients with type 2 diabetes is common. Previous observational studies showed an association between moderate alcohol and reduced risk of coronary disease. We examined whether consuming moderate wine affects the progression of carotid atherosclerosis.


In the CASCADE (CArdiovaSCulAr Diabetes and Ethanol), a 2-year randomized controlled trial, we randomized abstainers with type 2 diabetes were to drink 150 ml of either red wine, white wine, or water, provided for 2 years. In addition, groups were guided to maintain a Mediterranean diet. We followed 2-year changes in carotid total plaque volume (carotid-TPV) and carotid vessel wall volume (carotid-VWV), using three-dimensional ultrasound.


Carotid images were available from 174 of the 224 CASCADE participants (67% men; age = 59 yr; HbA1C = 6.8%). Forty-five percent had detectable plaque at baseline. After 2 years, no significant progression in carotid-TPV was observed (water, −1.4 (17.0) mm3, CI (−2.7, 5.5), white-wine, −1.2 (16.9) mm3, CI (−3.8, 6.2), red wine, −1.3 (17.6) mm3, CI (−3.4, 6.0; p = 0.9 between groups)). In post hoc analysis, we divided the 78 participants with detectable baseline carotid plaque into tertiles. Those with the higher baseline plaque burden, whom were assigned to drink wine, reduced their plaque volume significantly after 2 years, as compared to baseline.

Two-year reductions in Apo(B)/Apo(A) ratio(s) were independently associated with regression in carotid-TPV (β = 0.4; p < 0.001). Two-year decreases in systolic blood pressure were independently associated with regression in carotid-VWV (β = 0.2; p = 0.005).


No progression in carotid-TPV was observed. In subgroup analyses, those with the greatest plaque burden assigned to drink wine may have had a small regression of plaque burden

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We acknowledge the participants of CASCADE for their valuable collaboration. We honor Harel Segal and Osnat Tangi-Rosental; we thank Dr. Tatiana Shuster, Sagit Saadon, Malka Kaminsky, Yasmin Asuly, Roman Tsirkin, David Shushan, Tamara Lipovetzky-Yasky, Maya Rovner, Ortal Chadad from Soroka-Medical-Center; Eyal Goshen, Meir Aviv, Hassia Krakauer, Haim Strasler, Dr. Ziva Schwartz, Dr. Einat Sheiner, Dr. Dov Brickner, Dr. Rachel Marko, Esther Katorza, Ilanit Asulin, Tzvika Tzur from Nuclear Research Center Negev; Canadian 3DUS team Aaron Fenster, Christiane Mallett, David Tessier, Andrew Wheatley, Christine Piechowicz, Sandra Halko, Shayna McKay, Shi Sherebrin, and Maria DiCiccco for their important contributions.


This study was funded by the European Foundation for the Study of Diabetes, which had no role in the design, analysis, or writing of this article.

Author information


  1. Ben-Gurion University of the Negev, Beer Sheva, Israel

    • Rachel Golan
    • , Iris Shai
    • , Yftach Gepner
    • , Michael Friger
    • , Sivan Ben-Avraham
    • , Dana Sefarty
    • , Nitzan Bril
    • , Michal Rein
    • , Noa Cohen
    •  & Assaf Rudich
  2. Soroka University Medical Center, Beer-Sheva, Israel

    • Ilana Harman-Boehm
    • , Shula Witkow
    • , Idit F Liberty
    •  & Yaakov Henkin
  3. Israel Nuclear Research Center Negev, Dimona, Israel

    • Dan Schwarzfuchs
    •  & Benjamin Sarusi
  4. Robarts Research Institute, University of Western Ontario, London, ON, Canada

    • J. David Spence
    • , Grace Parraga
    •  & Dan Buchanan
  5. Department of Medicine, University of Leipzig, Leipzig, Germany

    • Uta Ceglarek
    • , Joachim Thiery
    • , Michael Stumvoll
    •  & Matthias Blüher
  6. Department of Medicine, Channing Laboratory, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    • Meir J Stampfer
  7. Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, MA, USA

    • Meir J Stampfer


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The authors declare that they have no conflict of interest.

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Correspondence to Rachel Golan.

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