Version July 2025
INTRODUCTION —
Excessive alcohol use can lead to a variety of adverse effects including liver disease, heart failure, increased cancer risk, neurologic complications, and unintentional injuries. Balanced against these deleterious effects is the observation that, compared with abstinence or heavy drinking, moderate alcohol intake may have sex-specific health benefits, particularly in regard to cardiovascular disease and diabetes.
The cardiovascular benefits and risks of alcohol consumption will be reviewed here. A general review of the risk and benefits of alcohol consumption is presented separately. (See "Overview of the risks and benefits of alcohol consumption".)
DEFINITIONS
Moderate drinking — The 2020 to 2025 Dietary Guidelines for Americans define moderate drinking as having up to one drink per day for females and up to two drinks per day for males (table 1) [1]. This definition refers to the amount of alcohol consumed on any single day and is not intended as an average over several days. The definition of the dose (grams of alcohol) which provides protection from all-cause mortality or specific cardiovascular outcomes has been challenged [2].
Standard drink — Definitions of a "standard drink" differ, both within and between countries (figure 1) [3,4]. The Global Burden of Disease Study defined a standard drink as 10 grams of pure ethyl alcohol consumed daily [2]. However, in the United States, a standard drink contains 14 grams (0.6 fluid ounces) of pure alcohol, and around the world the standard drink ranges from as few as 8 grams of alcohol to as many as 20 grams of alcohol [3,5,6]. (See "Overview of the risks and benefits of alcohol consumption", section on 'Standard drink size'.)
Beverage type — Available data do not clearly support a definitive conclusion regarding the differential benefits of various beverage types. However, it is generally accepted that the type of alcohol is not as important a factor as the amount of alcohol consumed and the pattern of intake [7-9].
However, the French paradox that coronary heart disease (CHD) mortality is lower in France than would be expected from the high national prevalence of smoking and saturated fat intake has been attributed to frequent red wine consumption [10]. Red wine contains phenolic and flavonoid substances that have antithrombotic and antioxidant properties [11,12]. Additionally, wine intake has been associated with improvements in heart rate variability [13], which could contribute to improved prognosis for CHD [11,14].
Data from clinical studies vary on whether the type of alcoholic beverage is a factor in the cardioprotective effect of alcohol, with some suggesting that all alcoholic beverages afford cardioprotective benefits [15,16], while others report that the cardioprotection is strongest for wine [17,18]. As an example, a meta-analysis of 13 cohort studies including 209,418 people reported a strong and statistically significant benefit for moderate consumption of both beer and wine, although the effect was stronger for wine (32 versus 22 percent relative risk reduction) [18]. Results demonstrated a dose-response relationship between wine consumption and vascular risk but not between beer intake and vascular risk.
ADVICE TO PATIENTS REGARDING ALCOHOL USE —
Our approach to advising patients about the benefits of alcohol as part of a strategy to reduce cardiovascular disease (CVD) risk is as follows:
●Individuals who are not currently drinking should not be advised to consume alcohol solely for the purpose of CVD risk reduction.
●Patients who have an underlying medical condition that precludes alcohol use (eg, alcohol use disorder, liver disease, etc) should be advised not to consume alcohol.
●Although patients who choose to drink moderate amounts of alcohol (defined as less than one unit per day [or less than 15 g per day] [19] or less than 100 g per week [20]) may experience cardiovascular health benefits, the absolute benefits of alcohol consumption are unclear in the absence of randomized controlled trials. (See 'Effect of alcohol on cardiovascular risk' below.)
Caution is necessary when promoting the beneficial effects of alcohol for cardiovascular risk reduction. There is little agreement regarding the upper limit of alcohol consumption that correlates with cardiovascular benefit, nor are there good data about which individuals might benefit from small to moderate levels of alcohol intake. (See 'Effect of alcohol on cardiovascular risk' below.)
The potential cardiovascular benefit of moderate alcohol intake must be balanced against the effect of alcohol on other disorders, such as cirrhosis and cancer, and the total alcohol-attributable deaths [21,22]. The net risk-benefit balance associated with moderate alcohol consumption varies in different age groups and populations. As an example, alcohol consumption in younger adults (ages 15 to 39) is associated with increased risks of overall mortality and disability at all levels of drinking [23,24]. (See "Overview of the risks and benefits of alcohol consumption", section on 'Alcohol effect on overall health'.)
EFFECT OF ALCOHOL ON CARDIOVASCULAR RISK
Limitations of the evidence — No long-term randomized trials of alcohol consumption have been performed. The available evidence is from observational studies (including meta-analyses of numerous studies) that typically compare the characteristics of alcohol users with nonusers. As such, the apparent effect of alcohol is subject to confounding. As one example, moderate alcohol use is more common among those of higher socioeconomic status, thereby introducing the likelihood of confounding by factors associated with higher socioeconomic status [25,26].
Alcohol use that exceeds the definition of moderate drinking is associated with enhanced all-cause and cause-specific mortality risk, ranging from 39 to 126 percent [27].
Cardiovascular mortality — Many studies have found that moderate alcohol consumption is associated with a specific reduction in cardiovascular and all-cause mortality (figure 2) [28-30]. However, other results show no benefit on all-cause mortality [2,20,31-33]. Additionally, heavy alcohol consumption (six or more drinks per day) or binge drinking increases the risk for many medical conditions, including sudden cardiac death [2,34]. (See "Overview of sudden cardiac arrest and sudden cardiac death".)
Patients without known CVD — In individuals without cardiovascular disease (CVD), light to moderate alcohol consumption appears associated with a reduced risk of cardiovascular events and possibly mortality. However, it seems to exert dissimilar effects on individual cardiovascular outcomes, with studies suggesting that light to moderate alcohol intake may reduce the risk of myocardial infarction (MI) and increase the risk of other cardiovascular outcomes. Findings from representative studies of patients without known CVD include the following:
●Some studies demonstrate an association between light and moderate alcohol intake and lower rates of cardiovascular events and mortality. As an example, a population-based cohort study from the United Kingdom followed close to two million adults who were free from CVD [35]. At a median follow-up of six years, non-drinking compared with moderate drinking was associated with an increased risk of multiple CVD outcomes, including unstable angina, MI, coronary heart disease (CHD) death, heart failure (HF), ischemic stroke, and peripheral arterial disease, whereas heavy drinking was generally associated with worse cardiovascular outcomes. Similarly, in a large, representative United States sample, participants with light and moderate levels of alcohol consumption had lower risks of cardiovascular mortality (light: hazard ratio [HR] 0.74, 95% CI 0.69-0.80; moderate: 0.71, 95% CI 0.64-0.78) compared with lifetime abstainers [29,36].
●Initiation of moderate drinking may also be associated with a lower risk of CVD events. As an example, starting moderate drinking (≤2 drinks/day for males, ≤1 drink/day for females) in a cohort of adults aged 45 to 64 years who did not drink alcohol at baseline was associated with a reduced risk of cardiovascular events (adjusted odds ratio 0.62, 95% CI 0.41-0.94) [37].
●Light to moderate alcohol intake may reduce the risk of MI but increase the risk of other CVD outcomes. As an example, a combined analysis of three large data sources (Emerging Risk Factor Collaboration, European Prospective Investigation into Cancer and Nutrition [EPIC] – Cardiovascular Disease, and United Kingdom Biobank) from 19 high-income countries evaluated cardiovascular outcomes among 599,912 individuals who currently consumed alcohol [20]. After adjustment for age, sex, smoking, and history of diabetes, a J-shaped association was observed for total cardiovascular events, with the lowest rates of CVD outcomes with approximately 100 g/week of alcohol intake. For individual CVD outcomes, higher levels of alcohol consumption were associated with lower rates of MI but increased rates of stroke, HF, and non-MI-related cardiovascular mortality (figure 3). For outcomes other than MI, all levels of alcohol intake were associated increased CVD risk, compared with the reference intake of 0 to 25 g/week.
●Similarly, in a meta-analysis of 592 cohort studies, which included 28 million individuals aged 15 to 49 years, light to moderate alcohol consumption had a protective effect on ischemic heart disease in males and females residing in countries with high sociodemographic index (SDI) and males in low-SDI countries but not on other cardiovascular outcomes [2]. The minimum risk of ischemic heart disease occurred at low levels of alcohol intake (0.83 and 0.92 standard drinks daily for males and females, respectively).
Patients with known CVD — Moderate alcohol intake also appears to be beneficial in patients with known cardiovascular disease (CVD). A 2010 meta-analysis of eight prospective studies, including 16,351 patients with a history of CVD, found a J-shaped curve between alcohol consumption and cardiovascular mortality, with a maximal protection (22 percent decreased risk) for consumption of 26 g per day of alcohol, equivalent to slightly less than two glasses of alcohol daily [38]. In a subsequent study of 1818 men from the Health Professionals Follow-up Study with prior MI, a U-shaped relationship between alcohol consumption and mortality (both all-cause and cardiovascular) was seen, with the greatest benefit for alcohol consumption between 10 and 30 grams per day, compared with abstinence (for all-cause mortality: HR 0.66, 95% CI 0.51-0.86; for cardiovascular mortality: HR 0.58, 95% CI 0.39-0.84). [39].
However, binge drinking in patients with a history of MI is associated with increased mortality [40].
Coronary heart disease — Moderate alcohol consumption is associated with a reduced risk of CHD [15,41-43]. Several prospective cohort studies suggest that light to moderate alcohol consumption decreases the risk of CHD by 40 to 70 percent, compared with drinking no alcohol or with heavy alcohol intake [7]. As an example, a pooled analysis of data from three large cohorts compared levels of cardiovascular risk among nearly 600,000 participants who currently used alcohol; the risk of MI was lowest in those who consumed greater than 0 but less than 100 grams of alcohol per week (figure 3) [20].
In contrast, binge drinking increases the risk for CHD [44,45]. As one example, in a pooled meta-analysis of case-control studies, the RR for fatal and nonfatal MI was 1.45 (95% CI 1.24-1.70) comparing those who reported irregular heavy drinking (≥5 drinks per occasion or intoxication at least monthly) with those who did not [44].
Hypertension — Multiple studies have shown an association between excess alcohol intake and the development of hypertension [46-48]. Moderate alcohol consumption may also be associated with an increased risk of hypertension [49,50]. As an example, a meta-analysis of seven studies including 19,548 participants followed for a median of 5.3 years revealed an association between higher levels of alcohol consumption and increases in systolic and diastolic blood pressure over time [50]. Compared with no alcohol intake, a linear dose-response association was observed between lower (12 g/day) and higher levels of alcohol consumption (48 g/day) and increases in systolic blood pressure (1.25 mmHg and 4.90 mmHg, respectively).
Decreasing alcohol intake can reduce blood pressure in those with moderate levels of drinking. In a meta-analysis of 36 trials, decreasing alcohol intake reduced blood pressure in people who drank more than two drinks per day [51]. In participants who consumed six or more drinks per day, a 50 percent decrease in alcohol intake resulted in a 5.5 mmHg (95% CI 4.3-6.7) reduction in systolic blood pressure and a 4 mmHg (95% CI 3.2-4.7) reduction in diastolic blood pressure. In contrast, in those who consumed two or fewer drinks per day, blood pressure reductions did not occur with reductions in alcohol intake. (See "Definition, risk factors, and evaluation of resistant hypertension".)
The immediate effects of alcohol on blood pressure appear biphasic. In a review of 32 trials of alcohol consumption in healthy persons, alcohol had a biphasic effect on blood pressure in the hours after consumption [52]. Although both medium- (14 to 28 grams) and high-dose alcohol (greater than 30 grams) decreased blood pressure within six hours of consumption, high-dose alcohol produced an increase in blood pressure after 12 hours.
Heart failure — It is not clear how light to moderate alcohol intake affects the development of HF. In a cohort analysis of 599,912 individuals who currently consumed alcohol, all levels of alcohol consumption above 25 g/week were associated with increased rates of HF, compared with the reference standard of 0 to 25 g/week of alcohol intake [20]. By contrast, several earlier, smaller cohort studies suggested a protective effect of light to moderate alcohol consumption on the development of HF [53,54]. As an example, among 7686 participants in the Framingham Heart Study who were without HF or coronary disease at baseline, the risk of developing HF in males was significantly lower at all levels of alcohol consumption [55]. Among females, the consumption of one to seven drinks per week was also associated with a lower risk of HF.
The use of alcohol in individuals with pre-existing HF is discussed separately. (See "Heart failure self-management", section on 'Smoking cessation and alcohol use'.)
Chronic consumption of large amounts of alcohol may lead to alcohol-induced cardiomyopathy. This condition is discussed separately. (See "Alcohol-induced cardiomyopathy".)
In patients with diabetes mellitus — Light to moderate alcohol consumption appears to protect against development of CHD and the risk of coronary death in adults with diabetes [56-58].
●In the Health Professionals Follow-up Study of 2419 men with type 2 diabetes over the age of 30, moderate alcohol intake was associated with a lower risk for CHD [58]. Alcohol also protects against the risk of CHD death in patients with diabetes. Among 2790 men with diabetes in the Physicians' Health Study who were free of MI, cancer, or liver disease at baseline, those men with diabetes who consumed alcohol on a weekly or daily basis had a significantly lower risk of death from CHD compared with those who rarely or never consumed alcohol (adjusted RR 0.67 and 0.42) [56].
●Among 5103 females in the Nurses' Health Study with a diagnosis of diabetes at ≥30 years of age who were free of CHD, stroke, or cancer at baseline, the adjusted RR for nonfatal or fatal CHD for diabetic females reporting a daily intake of 0.1 to 4.9 grams of alcohol (<0.5 drinks) or ≥5 grams (≥0.5 drinks) was 0.72 and 0.45, respectively, compared with abstainers [57]. (See "Prevalence of and risk factors for coronary heart disease in patients with diabetes mellitus".)
In addition, moderate alcohol consumption may lower the risk of developing type 2 diabetes, as reported in a meta-analyses of 15 prospective cohort studies [59]. (See "Overview of the risks and benefits of alcohol consumption", section on 'Diabetes mellitus'.)
Stroke risk — Different studies have reported disparate outcomes regarding the impact of light to moderate alcohol intake on stroke risk.
●Moderate alcohol intake (up to two glasses per day) has been associated with a decreased risk of ischemic stroke in most studies [28,60-63].
●In a combined analysis of three large-scale data sources (Emerging Risk Factor Collaboration, EPIC – Cardiovascular Disease, and United Kingdom Biobank) of 19 high-income countries and across 83 prospective studies, 599,912 individuals who currently drank alcohol were followed for a minimum of one year and a median of 7.5 years (figure 4) [20]. The amount of alcohol had a positive, nearly linear relationship with stroke (HR 1.14, 95% CI 1.10-1.17), both ischemic and hemorrhagic.
●In a cohort study of 38,156 male health professionals published subsequent to this meta-analysis, light alcohol consumption (<10 g/day) had no effect on the risk of ischemic stroke (RR 0.99, 95% CI 0.72-1.37) [61]. Consumption of more than two drinks daily (>29.9 g per day) appeared to be associated with an increased risk of ischemic stroke (RR 1.42, 95% CI 0.97-2.09). Data collected over 26 years (>1,695,000 person-years) from the Nurses' Health Study found that, compared with abstainers, the risk of stroke was decreased in females who drank less than 15 g/day of alcohol (RR 0.83, 95% CI 0.75-0.92 for <5 g per day and RR 0.79, 95% CI 0.70-0.90 for 5.0 to 14.9 g per day) [63]. There was no difference between the incidence of ischemic or hemorrhagic stroke [64].
●Binge drinking (≥6 drinks in one session for males, or ≥4 drinks for females) was associated with increased risk for all strokes (HR 1.85) and for ischemic strokes (HR 1.99) [65].
Peripheral artery disease — Alcohol appears to reduce the risk of peripheral artery disease (PAD) among apparently healthy people. Moderate alcohol intake (one to two drinks per day in males and 0.5 to 1.0 drinks per day in females) also reduces the risk of intermittent claudication [66]. It is difficult to account for the influences of dietary pattern and alcohol consumption on disease outcomes, although the PREDIMED study examined the risk of developing PAD in their trial participants; nearly 50 percent had type 2 diabetes. Moderate alcohol consumption, non-smoking, physical activity, and following a Mediterranean diet pattern were inversely associated with incident PAD [67].
The effects of alcohol on risk for abdominal aortic aneurysm are discussed in detail elsewhere. (See "Epidemiology, risk factors, pathogenesis, and natural history of abdominal aortic aneurysm", section on 'Food and alcohol consumption'.)
Atrial fibrillation — Both heavy binge drinking and heavy chronic alcohol use have been reported to increase the incidence of atrial fibrillation (AF), while chronic moderate alcohol use does not appear to significantly increase the incidence of AF [68]. Evidence suggests there is no benefit from light to moderate alcohol intakes with respect to incident AF [69].
However, among individuals with existing AF, even moderate alcohol consumption appears to increase the risk of recurrent AF. As an example, in a trial of 140 individuals with paroxysmal or persistent AF who were currently in sinus rhythm, participants randomized to abstain from alcohol experienced lower rates of recurrent AF compared with those assigned to continue their usual alcohol consumption (53 versus 73 percent; HR 0.55, 95% CI 0.36-0.84) [70]. Ablation treatment for AF is also less successful among patients who consume moderate and heavy amounts of alcohol [70-72]. (See "Epidemiology, risk factors, and prevention of atrial fibrillation", section on 'Alcohol'.)
Advice from professional societies — Most professional organizations recommend limiting alcohol intake and state that those who do not drink alcohol should not start.
●The 2021 scientific statement by the American Heart Association (AHA) states that individuals who do not drink alcohol should not start and that those who currently drink alcohol should limit intake [73].
●The National Institute on Alcohol Abuse and Alcoholism states that individuals who do not drink alcohol should not start "for any reason" and that "even drinking in moderation increases the risk for stroke, cancer, and premature death" [74].
●A 2016 report from the Department of Health in the United Kingdom states that "people who do not drink any alcohol at all should not be recommended to start drinking in the interests of their health" [75].
●A 2020 scientific statement from the AHA recommends that individuals with AF "who regularly consume moderate or high levels of alcohol should be counseled to reduce their intake" [72].
PROPOSED MECHANISMS OF BENEFIT —
Factors responsible for the apparent cardiovascular benefits of light to moderate alcohol intake are uncertain. Proposed mechanisms include alcohol's antioxidant, antithrombotic, and anti-inflammatory effects and positive impact on serum lipid profiles and insulin sensitivity. As an example, a meta-analysis of 42 clinical studies documented the following beneficial changes in levels of biochemical markers before and after an experimental dose of 30 grams of ethanol per day [76]:
●Serum apolipoprotein A-I increased by 8.8 mg/dL
●Plasma fibrinogen concentration decreased by 7.5 mg/dL
●Tissue-type plasminogen activator (tPA) concentration increased by 1.25 ng/mL
●Serum triglycerides increased by 5.7 mg/dL (potentially detrimental rather than beneficial)
●Serum high-density lipoprotein (HDL) cholesterol increased by 4 mg/dL (or 0.1 mmol/L)
A subsequent meta-analysis found similar results [77,78]. Changes of this magnitude could potentially reduce the risk of coronary heart disease (CHD) by 25 percent.
Effects on high-density lipoprotein cholesterol — Changes in HDL cholesterol are markers of lower CHD risk but not a target of nonpharmacologic or pharmacologic therapy [79]. For many decades, light to moderate alcohol intake was proposed as a way to increase serum HDL cholesterol and thereby reduce cardiovascular risk. However, although short-term light to moderate alcohol consumption can increase HDL cholesterol [76], it is unclear if this translates into cardiovascular risk reduction. Other pharmacologic strategies (eg, niacin, cholesteryl ester transfer protein inhibitors) directed at raising HDL cholesterol as a means of reducing cardiovascular events have failed in multiple clinical trials [79]. (See "HDL cholesterol: Clinical aspects of abnormal values".)
Alcohol may also affect HDL functional measures. In Mendelian randomization studies, self-reported alcohol intakes of Japanese adults were linearly related to increases in HDL particle numbers, while decreasing in low-density lipoprotein particle numbers. Still, others propose that the cardioprotective effects of alcohol may be related to its metabolite acetate, which interacts with the adipocyte free fatty acid receptor 2 to elicit an antilipolytic effect [80,81].
Antioxidant effects — Red wine and two of its antioxidants, but not other sources of alcohol, also prevent the activation of mononuclear cell nuclear factor kappa B, a redox-sensitive transcription factor that is involved in various processes that may contribute to atherosclerosis [82]. In another study, use of antioxidants N-acetylcysteine and resveratrol from wine inhibited macrophage reactive oxygen species production and facilitated cell migration through restoration of focal adhesion kinase activity [83].
Further study of the dynamic modeling of arterial lesions by dietary or other lifestyle behaviors is warranted. Endothelial progenitor cells are mobilized into circulation when vascular repair and neovascularization are needed. Red wine and a major constituent of red wine, resveratrol, slow endothelial progenitor cell senescence through a protein kinase B-dependent mechanism [84]. When 14 healthy volunteers consumed 250 mL of red wine for 21 consecutive days, apoptosis of endothelial progenitor cells was reduced, and their migration and proliferation were significantly improved [82]. These findings may contribute to the mechanism of cardiovascular protection observed with regular, moderate consumption of red wine.
Enhanced insulin sensitivity — Consuming moderate amounts of alcohol has been shown to enhance insulin sensitivity and glucose utilization for the subsequent 12 to 24 hours [85]. Fasting and postprandial insulin concentrations are reduced with two drinks per day, and insulin sensitivity is also improved in randomized controlled trials [86]. The mechanism by which insulin sensitivity is enhanced by alcohol is not entirely known but may involve suppression of fatty acid release from adipose tissue and improved glucose metabolism [81,87]. A more detailed discussion of this subject is presented separately. (See "Overview of the risks and benefits of alcohol consumption", section on 'Diabetes mellitus'.)
Antithrombotic effects — Alcohol has antithrombotic activities that may contribute to the observed reduction in CHD. These include modification of platelet function and of other components of the clotting system and fibrinolysis [11,12,76].
●Platelet aggregation is inhibited by the same quantities of alcohol that reduce CHD risk [88]; this effect may persist for six hours after a single alcohol drink, even when the blood alcohol level has returned to baseline [89].
●Fibrinolysis also may be induced by moderate alcohol intake (three to seven drinks per week) and may contribute to the cardiovascular benefit. Reduced levels of plasminogen activator inhibitor (PAI) activity, fibrinogen, plasma viscosity, von Willebrand factor, factor VII, and increased concentrations of tPA have been described [76,90,91].
By contrast, a higher intake of alcohol (7 to 21 drinks per week) is associated with impaired fibrinolytic potential, manifested by higher levels of PAI antigen-1 and tPA antigen [90].
Anti-inflammatory effects — There appears to be an inverse relationship between levels of inflammatory markers and mild to moderate alcohol intake.
●Patients with moderate alcohol consumption have lower concentrations of C-reactive protein (CRP) than those who consume occasional or no alcohol [92]. In the Point PRevalence In Neurocritical CarE (PRINCE) study, which correlated self-reported alcohol intake with CRP levels in 2833 subjects (41 percent with a history of cardiovascular disease), there was a progressive decline in CRP levels with increasing alcohol intake, from 2.6 mg/L for less than one drink per month to 1.6 mg/L for five to seven drinks per week.
●A study of alcohol intake and inflammatory markers in a biracial cohort of 2574 older people (aged 70 to 79 years) identified a J-shaped relationship between alcohol intake and both interleukin (IL) 6 and CRP levels [93]. Compared with people who drank one to seven drinks per week, people who never drank or who drank eight or more drinks per week were more likely to have high levels of IL-6 and CRP. However, in a subsequent study from the same population, the benefit of light to moderate alcohol intake on cardiac events and mortality persisted even after adjustment for levels of CRP and IL-6, leading to questions of the role of anti-inflammatory properties as a mechanism of cardioprotection [94].
SOCIETY GUIDELINE LINKS —
Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Alcohol consumption".)
INFORMATION FOR PATIENTS —
UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)
●Beyond the Basics topic (see "Patient education: Risks and benefits of alcohol (Beyond the Basics)")
The National Institute on Alcohol Abuse and Alcoholism, under the National Institutes of Health (NIH) maintains an active website for the general public (www.niaaa.nih.gov/alcohol-health). Patient information specific to the interaction of alcohol intake and the effect on the body is available within this site (www.niaaa.nih.gov/alcohol-health/alcohols-effects-body).
SUMMARY AND RECOMMENDATIONS
●Definition of moderate alcohol consumption – The 2020 to 2025 Dietary Guidelines for Americans define moderate drinking as having up to one drink per day for females and up to two drinks per day for males. Definitions of a "standard drink" differ, both within and between countries, with a standard drink containing from as few as 8 grams of alcohol to as many as 20 grams of alcohol (table 1 and figure 1). (See 'Definitions' above.)
●Advice to patients – Our approach to advising patients about the benefits of alcohol as part of a strategy to reduce cardiovascular disease (CVD) risk is as follows (see 'Advice to patients regarding alcohol use' above):
•Individuals who are not currently drinking, or those who have a personal preference to avoid alcohol, should not be advised to consume alcohol solely for the purpose of CVD risk reduction.
•Patients who have an underlying medical condition that precludes alcohol use (eg, alcohol use disorder, liver disease, etc) should be advised not to consume alcohol and seek counseling, if needed, to abstain from alcohol.
•Patients who choose to drink moderate amounts of alcohol, such as those who drink alcohol less than one unit per day (or less than 15 g per day) or less than 100 g per week, may experience benefits for their health.
●Possible cardiovascular benefits – No long-term randomized trials of alcohol consumption have been performed. Most studies have found that light to moderate alcohol consumption is associated with a specific reduction in cardiovascular mortality, with several prospective cohort studies suggesting that light to moderate alcohol consumption decreases the risk of coronary heart disease (CHD) compared with drinking no alcohol or with heavy alcohol intake (figure 3 and figure 2). However, other data have challenged this potential benefit on CHD risk and CHD mortality, and no level of drinking has shown to be beneficial for other CVD outcomes (eg, stroke, hypertension, heart failure, etc) (figure 4). (See 'Effect of alcohol on cardiovascular risk' above.)
●Possible mechanisms of benefit – Moderate alcohol consumption most likely reduces the risk of myocardial infarction through its effects on insulin sensitivity, thrombotic activity, and inflammation. It is uncertain whether wine is more cardioprotective than other types of alcohol; however, it is likely that the type of alcohol is not as important as the amount of alcohol consumed and the pattern of intake. (See 'Proposed mechanisms of benefit' above and 'Beverage type' above.)
