Is a cardioprotective action of alcohol a myth?

Numerous epidemiological studies have demonstrated that light to moderate alcohol consumption is associated with reduced risk of cardiovascular disease (CVD). The purpose of this review is to discuss the potential CV benefit of alcohol consumption with a particular focus on the findings of publications appearing within the past 2 years.

Results of observational studies and meta-analyses are largely concordant in suggesting the possibility of a beneficial effect of alcohol on CVD via several mechanisms, including actions on lipid metabolism and hemostatic factors. There are, however, studies that do not find the classic U-shaped association between alcohol consumption and CVD. Recent data suggest that the findings of coronary protection by alcohol consumption may be partly due to misclassification and confounding factors. Drinking patterns appear to be important factors to take into account when interpreting the results of epidemiological studies.

No data are currently available to directly support a causal relationship between alcohol intake and CVD. As well-conducted randomized studies assessing the causal role of alcohol in cardioprotection are not feasible, future epidemiological studies evaluating the relationship between alcohol and CVD should carefully choose the covariates in any multivariate analysis. It remains premature to promote alcohol consumption as a basis for CV protection.