Alcohol

Caution

2 studies · 1 recommendation

Last updated: February 25, 2026

Caution2 studies

Moderate alcohol may not raise coronary heart disease risk but excess increases overall mortality

Two large cohort studies totaling over 403,000 participants examined alcohol's relationship with coronary heart disease outcomes. In the European EPIC study (380,395 participants, 12.6-year follow-up), no significant increase in CVD/CHD mortality appeared across drinking levels compared to moderate drinkers, though never-drinkers showed higher hazard ratios. Extreme consumption (≥60 g/day men, ≥30 g/day women) elevated overall mortality significantly — HR 1.53 (95% CI 1.39–1.68) in men and 1.27 (95% CI 1.13–1.43) in women. In the Greek EPIC cohort (23,349 participants, 8.5-year follow-up), moderate ethanol intake contributed the largest individual share (23.5%) to the Mediterranean diet's protective association with mortality, with an adjusted mortality ratio of 0.864 per 2-unit diet score increase. Light-to-moderate consumption appears neutral or potentially protective for CHD specifically, but heavy drinking carries substantial mortality risk.

Evidence

Lifetime alcohol use and overall and cause-specific mortality in the European Prospective Investigation into Cancer and nutrition (EPIC) study

Authors: Agnoli, Claudia, Arriola, Larraitz, Barricarte, Aurelio, Benetou, Vasiliki, Beulens, Joline Wj, Boeing, Heiner, Bradbury, Kathryn E, Brennan, Paul, Dartois, Laureen, Dossus, Laure, Duell, Eric J, Fagherazzi, Guy, Ferrari, Pietro, Gunter, Marc, Johansson, Mattias, Kaaks, Rudolf, Khaw, Kay-Tee, Kragh Andersen, Per, Li, Kuanrong, Licaj, Idlir, Lund University., Lund University., Molina-Montes, Esther, Muller, David C, Norat, Teresa, Nunes, Luciana, Olsen, Anja, Overvad, Kim, Palli, Domenico, Peeters, Petra, Riboli, Elio, Romieu, Isabelle, Sacerdote, Carlotta, Sanchez, Carmen Navarro, Tjønneland, Anne, Trichopoulos, Dimitrios, Trichopoulou, Antonia, Tumino, Rosario, Wallström, Peter,, Wareham, Nick, Weiderpass, Elisabete

Published: January 1, 2014

Among 380,395 participants with 4,187 CVD/CHD deaths over 12.6 years of follow-up, no significant associations were observed for CVD/CHD mortality among drinkers across consumption levels. However, never-drinkers had higher HRs compared to moderate drinkers (0.1–4.9 g/day). In competing risks analyses, CVD/CHD mortality was more pronounced than ARC in men. Despite this apparent lack of increased CVD risk with drinking, extreme alcohol consumption (≥60 g/day men, ≥30 g/day women) was associated with significantly elevated overall mortality: HR 1.53 (95% CI 1.39–1.68) in men and 1.27 (95% CI 1.13–1.43) in women.

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Anatomy of Health Effects of Mediterranean Diet: Greek EPIC Prospective Cohort Study

Authors: Bamia, Christina, Trichopoulos, Dimitrios, Trichopoulou, Antonia

Published: April 13, 2012

Among 23,349 Greek EPIC cohort participants followed for a mean of 8.5 years, moderate ethanol consumption contributed the largest individual share — 23.5% — to the Mediterranean diet score's inverse association with all-cause mortality. The overall adjusted mortality ratio was 0.864 per 2-unit score increase (95% CI: 0.802-0.932). This contribution exceeded all other components including low meat consumption (16.6%), high vegetable intake (16.2%), and high fruit and nut consumption (11.2%). A total of 652 deaths occurred among 12,694 lower-adherence participants versus 423 among 10,655 higher-adherence participants.

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