Alcohol, cardiovascular diseases and public health policy

Public health policy should aim to reduce the harm done by alcohol use, whilst recognizing its real and perceived benefits. The reduced risk of coronary heart disease (CHD) with the consequent reduction of mortality for some people in older age is one such benefit. The increased risk of sudden coronary death from acute alcohol intoxication is one such harm. A number of policies have been demonstrated to be effective in the reduction of the harm done by alcohol use, at least in industrialized countries. These are: enforcement of a minimum drinking age; drink-drive deterrence; enforced prevention of intoxication in public drinking places; controls on access to alcohol, including restrictions on numbers of licensed premises and hours and days of sale; and taxation policy to regulate the affordability of alcohol. Many of these strategies seem unlikely to have a direct effect on drinking relevant for reduced risk of CHD, but are likely to have a direct beneficial effect on drinking relevant for sudden coronary death. The level of alcohol consumption associated with the lowest mortality rate for a population will vary depending on patterns of ill health and causes of death. In countries with high rates of CHD the per capita level may be in the order of about three litres of absolute alcohol per year among drinking adults. In countries with low rates of CHD, the level is likely to be substantially lower. Many countries in which alcohol is readily available are consuming at a level substantially above three litres per capita of drinking adults per year and in these countries public health policy should continue to advise action to reduce per capita consumption.