The relationship between alcohol consumption and cardiovascular fatal or non-fatal
events or all-cause mortality in healthy people has been depicted as a J-shaped curve
attributed to a dose-related combination of beneficial and harmful effects (Di Castelnuovo
et al., 2002, 2006). Moderate alcohol consumption by apparently healthy
people is associated with lower vascular morbidity, mortality and incidence of type 2
diabetes. Mechanisms supporting this association include increased high-density
cholesterol and fibrinolysis, decreased platelet aggregation and coagulation factors,
and beneficial effects on endothelial function, inflammation and insulin resistance.
These mechanisms could be similarly effective in patients with a history of cardiovascular
disease (CVD) or at high risk for vascular events, such as hypertensive (HTN)
and diabetic (T2DM) patients, but observational studies in these patients have been
inconclusive (Costanzo et al., 2010a). In a recent meta-analysis that examined the relationship between alcohol consumption and cardiovascular and total mortality in
patients with CVD, a reduction in both mortality risks in moderate drinkers was
reported (Costanzo et al., 2010b). These findings were extended by two new metaanalyses
aimed at assessing the relationship of alcohol drinking with vascular and
total mortality in a larger series of patients, including not only patients with a
history of CVD but also diabetic and hypertensive patients.