Basic Res Cardiol 96: 128 – 135 (2001) © Steinkopff Verlag 2001 REVIEW Markus Flesch Stephan Rosenkranz Erland Erdmann Michael Böhm Alcohol and the risk of myocardial infarction  Abstract Epidemiological studies have repeatedly demonstrated a benefi- cial effect of moderate alcohol consumption on the incidence of coronary heart disease, myocardial infarction and overall mortality. The latter increases with excessive alcohol consumption. Although most epidemiolog- ical studies demonstrate a beneficial effect of alcohol consumption inde- pendent from the specific kind of alcoholic beverage, there is increasing evidence that wine and in particular red wine might contain pharmacologi- cal substances, which prevent atherosclerosis and myocardial infarction inde- pendent from the wine ethanol. Pathophysiological mechanisms mediating these beneficial effects include effects of wine phenols and tannins on LDL- cholesterol oxidation status, thrombocyte aggregation, endothelial function and smooth muscle cell proliferation. Identification and characterization of the pharmacologically active substances might provide the stage for the devel- opment of new substances to be used in the prevention of coronary artery disease and myocardial infarction.  Key words Alcohol – wine – coronary artery disease – myocardial infarc- tion – platelet function – cholesterol BRC 269 M. Flesch () · S. Rosenkranz E. Erdmann · M. Böhm Klinik III für Innere Medizin der Universität zu Köln Joseph-Stelzmann-Str. 9 50924 Köln, Germany E-mail: markus.flesch@medizin.uni-koeln.de Received: 14 August 2000 Returned for 1. revision: 6 September 2000 1. Revision received: 23 November 2000 Returned for 2. revision: 5 December 2000 2. Revision received: 21 December 2000 Accepted: 8 January 2001 Introduction Coronary heart disease is the most important cause of death in Western industrialized nations. The most important risk factors are genetic predisposition, nico- tine abuse, hypercholesterolaemia, arterial hypertension and diabetes mellitus. On the other hand, there are some factors, which seem to be protective against myocardial infarction. One of these factors having a beneficial influ- ence on the development of coronary atherosclerosis and the incidence of myocardial infarction appears to be the regular consumption of alcoholic beverages. This article reviews some recent data on the association between alcohol consumption and the risk of myocardial infarc- tion and discusses some of the mechanisms by which cardioprotective effects of alcoholic beverages might be mediated. Alcohol and myocardial infarction – epidemiological data A great number of epidemiological studies have demon- strated an inverse correlation between the regular con- sumption of alcohol and the incidence of coronary artery disease and myocardial infarction. Evidence has been provided by socio-economic studies as well as by retro- spective or prospective studies (8, 15, 25–27, 41, 45). In one prospective study in more than 50 000 men, it has been demonstrated that the relative risk of myocardial infarction is reduced by 25 % in men consuming 5–30 g alcohol per day and by 50 % in those consuming more than 30 g (41). This correlation holds true even if people with an increased cardiovascular risk profile or with established coronary artery disease are excluded assum- ing that those may be people consuming less alcoholic