Alcohol, the Mediterranean Diet and Cardiovascular Risks: Where is the New Evidence?

The Mediterranean diet has consistently shown associations with lower risks of cardiovascular disease (CVD) in randomised controlled trials and large prospective cohorts. Traditionally, moderate wine consumption was considered part of the Mediterranean diet. However, whether low-to-moderate alcohol intake contributes independently to lower risk remains controversial. Early epidemiological reports supported a J-shaped association between alcohol intake and CVD, but residual confounding, selection biases or misclassification of former drinkers challenge causal interpretations. Methodological limitations, particularly the inability to capture drinking patterns, have also been raised in recent assessments of the Global Burden of Disease and Mendelian randomisation studies. A more nuanced view may be that low-to-moderate wine consumption in older adults is not likely to be harmful but alcohol should not be recommended for CVD prevention. Large-scale randomised trials, such as the ongoing UNATI study, are expected to clarify the impact of moderate drinking versus abstention. Meanwhile, clinical guidance should emphasise the proven cardiometabolic benefits of the Mediterranean diet overall independent of alcohol consumption.