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April 18, 2001

Should Patients With Heart Disease Drink Alcohol?

Author Affiliations

Author Affiliation: Division of Cardiology, Kaiser Permanente Medical Center, Oakland, Calif.

JAMA. 2001;285(15):2004-2006. doi:10.1001/jama.285.15.2004

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.711 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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