Numerous epidemiological studies have shown that light to moderate drinkers
of alcohol are at lower risk than abstainers for fatal or nonfatal coronary
heart disease (CHD). A recent meta-analysis1
that included 51 (43 cohort) studies estimated a 20% risk reduction for consumption
of 0 to 20 g of alcohol (0-2 drinks) per day and some risk reduction for intake
up to 72 g (6 drinks) per day. The lower CHD risk in drinkers also has been
observed in a wide variety of patient populations, including those with diabetes,2,3 hypertension,4,5
and prior myocardial infarction (MI).6 The
consistency of these findings and the growing evidence that alcohol might
protect against CHD via higher high-density lipoprotein (HDL) cholesterol
levels, antithrombotic actions, or reduced insulin resistance argue for a
causal protective effect of moderate drinking.7- 11
Genetic factors probably play an important role, for example, moderate drinkers
who are homozygous for the ADH3 allele (associated
with slower rate of ethanol metabolism) have higher HDL levels and decreased
risk of MI.12
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