Alcohol and coronary heart disease

Abstract

The belief that alcohol taken regularly in light or moderate amounts is protective against coronary heart disease (CHD) is supported by a considerable amount of evidence which indicates an inverse relationship between recorded alcohol intake and CHD outcomes. It has been suggested that insufficient care has been taken to characterize the non-drinkers who are usually taken as the base-line when relative risk is being determined. There appears to be a migration from drinking towards non-drinking status as individuals get older, associated with the accumulation of ill-health, particularly cardiovascular disease. Several recent studies have attempted to take this hypothesis into account and most still conclude that alcohol protects against CHD even when allowances have been made for those who have underlying illness which might affect their alcohol intake. However, the dose-response relationships observed in these studies frequently challenge biological plausibility. The findings are almost invariably expressed in terms of relative risk of CHD and there is rarely any indication of the effect of alcohol intake on all cardiovascular disease or all-cause mortality. It is suggested that any specific protective effect of alcohol on CHD is likely to be outweighed by the adverse effects of alcohol at the levels required to produce maximum CHD benefit.