Alcohol and coronary heart disease

The data on two questions are reviewed: does heavy alcohol intake increase the risk of coronary heart disease (CHD)? And, is moderate intake protectiv e? Identified alcoholics and problem drinkers have an increased risk of CHD , and in Britain there is a correlation among 22 towns, between the proport ion of heavy drinkers in a town and CHD mortality. Of seven longitudinal st udies reviewed, one shows heavy drinkers to have an increased CHD incidence . An inverse association between alcohol consumption and CHD mortality is s een in international comparisons and in time trends in the USA. Of six case -control studies reviewed from England and the USA, all show an inverse ass ociation between CHD and alcohol consumption which persists after control f or other risk factors. Longitudinal studies, in Japanese-Americans, white A merican men and women, British civil servants, Puerto Ricans, Yugoslavs and Australians, all show moderate drinkers to have a lower CHD risk than abst ainers. Abstainers are likely to differ from moderate drinkers in a number of ways. To date it has not proved possible to show that any of these diffe rences account for the higher CHD risk of abstainers. The apparent protecti ve effect is not large (RR=0.5) but the consistency of the association and the existence of plausible mechanisms increase the likelihood that the nega tive association is causal. However, if alcohol intake were to increase in the population the social and medical consequences would be large. An incre ased intake is therefore not recommended as a community measure for CHD pre vention.