Importance of pattern of alcohol consumption.

Over the last several decades, prospective epidemiological studies have consistently shown that moderate alcohol consumers have a lower risk than abstainers of an initial myocardial infarction (MI)1,2 or of recurrent cardiovascular disease.3,4 Moderate alcohol intake has similarly been inversely associated with total mortality.5–7 For developed nations, epidemiological studies estimate that a population with more moderate drinkers and fewer abstainers will have lower rates of cardiovascular disease and total mortality.5,6,8 In fact, guidelines for sensible drinking developed in the United Kingdom suggest that “middle aged or elderly men and post-menopausal women who drink infrequently or not at all may wish to consider the possibility that light drinking might benefit their health.”9 Still, the absence of a clinical trial for the effects of alcohol on cardiovascular disease and mortality forces us to use observational data and studies of the effects of alcohol on risk factors to make recommendations encouraging alcohol use, a condition some physicians remain reluctant to accept. In addition, the adverse health and societal effects of heavy or inappropriate drinking are well known to all.