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Moderate alcohol consumption and coronary heart disease: a review
  1. L M Hinesa,
  2. E B Rimmb
  1. aDepartment of Epidemiology, Harvard School of Public Health, Boston, bDepartments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
  1. Eric B Rimm, Harvard School of Public Health, Department of Nutrition, 677 Huntington Ave, Boston, MA 02115, USAerimm{at}hsph.harvard.edu

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Consumption of alcoholic beverages has been a prominent feature of many cultures since the ancient civilisations. Throughout history, the pros and cons of alcohol have been debated. Although the original debates stemmed from the public perception of intoxication, current research has convincingly demonstrated the permanent physiological damage due to prolonged overconsumption. However, the effect of “moderate” alcohol consumption on overall health remains controversial. The beneficial effects of alcohol on the cardiovascular system have been touted since the 18th century, but the bulk of scientific research has accumulated over the last few decades. The majority of the literature suggests that alcohol in moderation is beneficial on the cardiovascular system, and excess is detrimental to overall health. The deleterious effects of heavy alcohol consumption on health are numerous: aerodigestive cancers; haemorrhagic stroke and cardiomyopathy; hepatic cirrhosis; fetal alcohol syndrome; fatal car crashes, and suicides. However, these effects have not been documented among light to moderate drinkers.

Key messages

  • Moderate alcohol consumption, regardless of beverage type, reduces risk of coronary heart disease (CHD) among men and older women.

  • There is strong evidence to support that ethanol, the main constituent in alcoholic beverages, is causally related to lower risk of CHD through changes in lipids and haemostatic factors.

  • The effect of alcohol on high density lipoprotein levels accounts for the majority of the reduction in risk of CHD, however, the mechanisms by which alcohol exerts its protective effect on the cardiovascular system are very complex and not completely understood.

  • Genetic factors modify the effect of alcohol consumption on risk of CHD, resulting in population variability in the amount of benefit achieved from alcohol consumption.

Although the risks substantially outweigh the benefits for heavy consumption, the burden of coronary heart disease (CHD) has tipped the scale in favour of moderate alcohol consumption for overall health. …

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