Benefits and hazards of alcohol − the J-shaped curve and public health

A J-shaped association between alcohol consumption and the risk of CHD and all-cause mortality has been observed in many studies during the last 50 years. The authors reviewed the evidence from the first observation of a J-shaped association between a moderate alcohol intake and CHD in 1926 to recent studies of the effect of healthy lifestyles (including moderate alcohol intake) on life expectancy free of cardiovascular disease, cancer and type 2 diabetes in order to create a basis for sensible individual health deliberations. Plausible and robust J-shaped relations between light to moderate alcohol consumption and the risk of CHD, cardiovascular disease (CVD) mortality and all-cause mortality have been found in a large number of epidemiological studies. Among the potential mechanisms underlying the proposed protective effects are higher levels of HDL lacking apoC3, reduced platelet aggregability, increased level of endothelial cell fibrinolysis, increased insulin sensitivity and decreased inflammation.
Concern about the dangers of heavy drinking and addiction often leads to emotional denials that alcohol might have any benefits, particularly by those who have experienced or seen its bad effects. However, while the existence of a J-shaped association between alcohol consumption and the risk of CHD and all-cause mortality is based on observational evidence and a formal proof of causality cannot be established in observational studies, a weighting of the overall evidence and the substantiation of plausible mechanisms in experimental studies lead to the conclusion that a causal nature of the J-shaped association is established beyond reasonable doubt.
The authors propose that communication on the pros and cons of alcohol intake should emphasize the nadir of a J-shaped curve as a healthy range for the general population while advice regarding the consumption of alcohol should be adjusted to factor in the risks and potential benefits for each individual patient considering age, sex, family history, personal drinking history and specific medical history.
Source: Skovenborg, E., Grønbæk, M. and Ellison, R.C. (2020), “Benefits and hazards of alcohol-the J-shaped curve and public health”, Drugs and Alcohol Today, Vol. 21 No. 1, pp. 54-69.