Alcohol and the cardiovascular system: a double-edged sword.

Low to moderate alcohol intake has been associated with beneficial effects on the heart and the vasculature, including improvements in several established and emerging cardiovascular disease (CVD) risk factors as well as reduced risk for several metabolic diseases, CVD morbidity and mortality. Binge and heavy drinking exert the opposite effects, leading to increased risks for all the above conditions. With regard to beverage type, there is some evidence supporting red wine superiority in cardioprotection, although other beverages have also been reported to exert beneficial metabolic and vascular effects when consumed in moderate amounts. In this narrative review we discuss the associations between alcohol consumption and CVD morbidity and mortality. Alcohol-induced effects on established and emerging CVD risk factors are also discussed taking into consideration different drinking patterns. Physicians should screen for excessive alcohol use and advise individuals to limit their alcohol intake to moderate amounts (up to 20-30 g/day for men and 10-20 g/day for women), preferably consumed with meals. The question of whether alcohol intake should be encouraged as a measure to prevent CVD remains unanswered.