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(Circulation. 2002;105:2806.)
© 2002 American Heart Association, Inc.

Editorial

Wine, Beer, and Spirits

Are They Really Horses of a Different Color?

Eric B. Rimm, ScD; Meir J. Stampfer, MD, DrPH

From the Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, Mass.

Correspondence to Eric B. Rimm, ScD, Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115. E-mail erimm@hsph.harvard.edu

Key Words: Editorials • alcohol • cardiovascular diseases • mortality

The study of alcohol and its effects on health has a long history, ranging from anecdotal accounts in biblical times to more recent rigorous studies of populations with hundreds of thousands of participants. The largest studies suggest that men and women who drink 1 to 2 drinks per day on average have lower total mortality rates,^1–3 reflected in lower incidence of coronary heart disease, diabetes, and in some populations, ischemic stroke. The clear benefit of moderate alcohol consumption on risk of coronary disease has been documented in almost 100 studies. The early hypothesis that the apparent benefit might be explained by inclusion of sicker individuals among the nondrinkers ("sick quitter effect") has been decisively refuted in studies that excluded those with poor health at baseline or included only lifelong nondrinkers in the comparison group. Although no randomized trials with clinical end points have been conducted, further evidence for a causal link between moderate alcohol consumption and lower risk of coronary disease derives from genetic and metabolic studies. The finding of a strong interaction between alcohol intake and a common polymorphism in the gene for alcohol dehydrogenase⁴ strongly supports causality because such a result cannot plausibly be attributed to confounding factors (that is, the polymorphism can be considered as distributed at random with regard to other lifestyle practices like diet and exercise). Our understanding of the beneficial metabolic changes caused by alcohol consumption and the importance of genetic predisposition to these changes has advanced tremendously in recent years.^4,5 With the general . . . [Full Text of this Article]

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