Alcohol and coronary heart disease: can we learn more?

Abstract

Research on the association between alcohol consump? tion and coronary heart disease has spanned more than 3 decades. Over 100 studies, including ecological, casecontrol, and cohort studies, have addressed this complex relationship. There has also been an almost equal num? ber of reviews, editorials, meta-analyses, and letters.1-6 The excessive use of alcohol is linked to cirrhosis, aerodigestive cancers, motor vehicle deaths, and is frequently implicated in homicides and domestic disputes. Nevertheless, the evidence supporting an inverse asso? ciation between moderate alcohol consumption and cor? onary heart disease is overwhelming and consistent. With the exception of the link between smoking and lung cancer, few other associations are so uniformly reported in the literature despite diverse population sam? ples, varying exposure and outcome measurements, and inconsistent control for confounding. In this issue of Epidemiology, Brenner et al report a substantial reduction in risk of coronary heart disease (CHD) associated with alcohol consumption.7 These results from Germany are similar to those reported in China, Japan, France, the United States, and the United Kingdom, to name a few.8-13 A long-term, large-scale clinical trial of alcohol and coronary heart disease would be difficult to conduct. Thus, guidelines and clinical advice must be based on evidence from these types of non-experimental studies and from our understanding of the effect of short-term administration of alcohol from experimental studies. A summary of this body of data suggests strongly that abstaining from alcohol is a risk factor for coronary heart disease; yet, advice to abstainers to drink alcohol in moderation is generally not prudent on a population level but may be on an individual basis. If the evidence is so strong in favor of an inverse association between alcohol and coronary heart disease, what can we learn from new research in this area? If alcohol (ethanol) were always consumed in the same manner and as part of the same beverage, there would be less to learn; however, recent evidence indi? cates that drinking patterns (including beverage choice), other dietary constituents, and even genetic predisposi? tion to ethanol metabolism may modify the underlying association between moderate alcohol consumption and coronary heart disease.14-18 Beverage preference has re-