Alcohol and cardiovascular disease--more than one paradox to consider. Type of alcoholic beverage and cardiovascular disease--does it matter?

While a large number of studies have shown a U- or J-shaped relation between alcohol intake and cardiovascular disease, the question remains whether this risk function persists in all subsets of the population or derives from all types of alcoholic beverages. Recent large population studies have suggested that the effect of alcohol and cardiovascular disease and all cause mortality is modified by factors such as age, gender, cardiovascular risk factor status, drinking pattern and type of alcohol. The author reviews the studies indicating this effect modification, while focusing on the potential beverage specific differences. The review goes through several of the methodological issues in studying the effects of the different types of beverages on health, and gives some of the plausible biological mechanisms that might explain the differences, but stresses the different biases, which are the reasons why the issue is not settled yet.