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Am Fam Physician. 1999;59(7):1926

The beneficial effect of alcohol consumption on reducing the risk of coronary heart disease seems to be largely related to alcohol's direct effect of increasing the high-density lipoprotein (HDL) cholesterol level, decreasing platelet aggregation or clotting, and enhancing fibrinolysis. Studies have yielded conflicting results as to whether greater benefits are derived from drinking wine, beer or liquor. Gaziano and associates studied the relationship between the type of alcoholic beverage and the incidence of myocardial infarction in a case-control study of 340 patients admitted to the hospital because of myocardial infarction.

A control subject of the same age was matched with each case, providing a total of 340 case-controlled pairs. All case and control subjects were interviewed in their homes; in the case subjects, the interviews occurred approximately 10 weeks after myocardial infarction. Information was collected on various pre-existing risk factors, including diet and alcohol consumption. Of the 680 case and control subjects, 199 were classified as nondrinkers (less than one drink per month), and 331 were classified as regular drinkers (average consumption of more than one-half drink per day). Of the 331 drinkers, 62 preferred wine, 89 preferred beer and 160 preferred liquor. In addition to information about risk factors, lipid profiles were obtained for 160 nondrinkers and 217 regular drinkers.

As would be expected, the proportions of known risk factors for coronary heart disease were higher among study subjects with a myocardial infarction compared with control subjects. Previous alcohol consumption was significantly lower among case subjects. Compared with nondrinkers, regular drinkers of wine, beer or liquor had higher age- and sex-adjusted total HDL cholesterol levels. The risk of myocardial infarction adjusted for age and sex was significantly reduced in regular drinkers of any alcoholic beverage. The age- and sex-adjusted relative risk of myocardial infarction was 0.54 for any drink, 0.48 for wine, 0.55 for beer and 0.59 for liquor. The risk factor–adjusted model demonstrated relative risks of 0.58, 0.58, 0.75 and 0.50 for any alcoholic drink, wine, beer and liquor, respectively.

The authors conclude that there is an inverse association between wine, beer and liquor consumption and the risk of myocardial infarction, which may be mediated by HDL cholesterol level. The data from their study suggest that ethanol in alcoholic beverages, rather than other constituents, is responsible for the reduced risk of myocardial infarction.

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