Alcohol versus exercise for coronary protection.

Both alcohol and exercise have been said to protect against coronary heart disease. The epidemiologic data suggest exercise, per se, does, but alcohol, per se, does not protect against coronary heart disease. Recent longitudinal data suggest teetotalers, especially those who have never smoked, have the lowest coronary heart disease mortality of all. Other cross-sectional and longitudinal studies that suggest light drinkers have the lowest coronary heart disease mortality may be biased because: (1) the teetotalers include some ex-drinkers who may have quit drinking because of coronary heart disease; and (2) the light drinkers include some who drink very rarely, and/or drink very small amounts, and/or have a lower risk of coronary heart disease independent of alcohol because they are more health-conscious in general. The metabolic data also suggest exercise, but not alcohol, protects against coronary heart disease. Exercise increases the level of high-density lipoprotein 2, which correlates well with coronary heart disease risk; alcohol in moderation seems to increase the level of high-density lipoprotein 3, which correlates poorly with coronary heart disease risk and may merely reflect hepatic enzyme induction. Exercise and alcohol influence blood pressure, body weight, and glucose tolerance in opposite directions; in each instance, the influence of exercise is beneficial, that of alcohol detrimental, to the prevention of coronary heart disease. There seems to be no reason to use alcohol for coronary protection.