ISCHEMIC HEART DISEASE (D MUKHERJEE, SECTION EDITOR) Effect of Alcohol Consumption on Cardiovascular Health Sunny Goel 1 & Abhishek Sharma 2,3 & Aakash Garg 4 # Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Purpose of Review This review aims to discuss the effect of alcohol consumption on various cardiovascular (CV) diseases and CV mortality. Recent Findings Alcohol intake has consistently shown a J- or U-shaped relationship with several cardiovascular diseases. Light to moderate alcohol intake has been associated with lower risk of coronary artery disease, heart failure (HF), as well as CV mortality. On the other hand, heavy consumption has been associated with deleterious CV outcomes including increased mortality. However, the evidence is based from observational and population-based studies where risk of confounding cannot be excluded even after meticulous methodological approaches. This is compounded by conflicting data such as higher risk of certain CV diseases like HF in former drinkers compared to abstainers. Further, Mendelian randomization studies using genetic polymorphisms in enzymes have recently questioned the beneficial association of low-moderate drinking with CV system. Summary There has been substantial and consistent evidence that light to moderate alcohol consumption have beneficial effect on overall cardiovascular profile and mortality. However, there are considerable limitations in the reported literature to determine a strong causality of a protective effect of moderate alcohol consumption by itself. Further robust studies or possibly a well- structured randomized controlled could bring an end to this debate. Keywords Alcohol . Coronary artery disease . Heart failure . Cardiovascular mortality . Cardio protection . Cardiomyopathy Introduction Alcohol has been an integral part of human culture since the beginning of recorded history. While moderate alcohol con- sumption might be associated with overall beneficial health effects, excess and binge drinking is one of the leading causes of mortality worldwide [1–4]. The same correlation holds true for alcohol and cardiovascular diseases [5••, 6]. It is suggested that whereas moderate amount of alcohol is protective against coronary artery disease (CAD), higher cardiovascular morbid- ity and mortality is observed among abstainers and heavy drinkers [7]. There have been multiple observational studies and meta-analyses demonstrating a J- or U-shaped association between alcohol consumption and all-cause mortality [5••, 6–11]. However, there is a growing skepticism around this observation, with recent studies pointing out several method- ological shortcomings in the evidence on which the U-shaped association is based [12, 13]. In addition, age, ethnicity, gen- der, type and pattern of alcoholic beverage, and other con- founding biases were not taken into account while arriving at these conclusions. The purpose of this review is to discuss the effect of alcohol consumption on cardiovascular mortality and coronary artery disease (CAD), the shortcomings of the reported studies, the cardioprotective mechanism of alcohol and the disparities due to age, sex, ethnicity, pattern, and type of beverage consumed. Sunny Goel and Abhishek Sharma contributed equally to this work. This article is part of the Topical Collection on Ischemic Heart Disease * Abhishek Sharma abhisheksharma4mamc@gmail.com 1 Division of Cardiovascular Medicine, Maimonides Medical Center, Brooklyn, NY, USA 2 Division of Cardiovascular Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA 3 Institute of Cardiovascular Research and Technology, Brooklyn, NY, USA 4 Rutgers Robert Wood Johnson Medical School, 69 Duke Street, New Brunswick, NJ, USA Current Cardiology Reports (2018) 20:19 https://doi.org/10.1007/s11886-018-0962-2