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© 1998 Medical Council on Alcohol
review-article
ALCOHOL, HEALTH, AND THE HEART: IMPLICATIONS FOR CLINICIANS
Alcohol Problems Clinic, Royal Edinburgh Hospital Edinburgh EH10 5DX, UK
*The author has no conflict of interest, receives no financial support from, nor has any other connections with, the alcohol beverage industry, and is a clinician employed by the Edinburgh Healthcare NHS Trust
Received 2 February 1998; first review notified 14 April 1998; accepted 8 April 1998
The association between light drinking and reduced mortality compared to lifetime abstinence is robust. Confounders, such as unhealthy diet, social class, and social isolation, which are associated both with abstaining and with poorer health, have made it difficult for doctors to assess the meaning of the association, and to know how to respond to individual patients seeking advice on ‘drinking for health’. This paper attempts to bring up to date the evidence concerning the confounders. The evidence for a preventive effect is reviewed according to pattern of alcohol use and type of patient. The balance of risk to benefit appears to favour giving medical advice to some patients in middle life with uncontrollable risk factors for coronary heart disease (and probably of ischaemic stroke), who are very infrequent drinkers, to increase slightly the frequency of drinking (not the per session amount) and for some abstainers to consider starting to take alcohol. However, caveats render quite small the number of patients to whom physicians will give this advice. There is also the theoretical risk of a ripple in the population such that more people may move into harmful drinking.
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