Alcohol consumption and acute coronary syndrome: Epidemiology, pathophysiology, and clinical perspectives

Alcohol consumption is a globally prevalent lifestyle factor with complex and sometimes paradoxical effects on cardiovascular health, particularly regarding acute coronary syndrome. Earlier epidemiological studies described a J-shaped relationship between alcohol consumption and acute coronary syndrome risk; however, emerging evidence increasingly challenges the validity of this concept.
Mendelian randomisation studies, genetic data, and recent pooled analyses suggest that the apparent cardioprotective effects of light-to-moderate drinking are largely attributable to residual confounding, including abstainer bias and socioeconomic factors, rather than to true causal mechanisms. In contrast, excessive alcohol intake is linked to increased oxidative stress, inflammation, hypertension, and prothrombotic states, all of which contribute to plaque instability and the precipitation of acute coronary syndrome. Additionally, acute heavy drinking episodes may induce coronary vasospasm and arrhythmias, further elevating acute coronary syndrome risk. Genetic factors, drinking patterns, and beverage types may also modulate the relationship between alcohol and ACS, indicating the need for personalised risk assessment. Understanding these complex interactions is essential for clinicians when counselling patients on alcohol consumption within the context of cardiovascular prevention.
A review published in the Journal of Clinical Medicine examines current evidence on the epidemiology and pathophysiology linking alcohol consumption with acute coronary syndrome, providing a nuanced perspective that balances potential protective effects with the significant risks associated with excessive alcohol use, and summarises all medical societies’ recommendations regarding alcohol consumption and cardiovascular health.
Source: Iliakis, P., Stamou, E., Vakka, A., Ntalekou, K., Kouremeti, M., Ktenopoulos, N., Karakasis, P., Theofilis, P., Pitsillidi, A., & Sakalidis, A. (2026) Alcohol consumption and acute coronary syndrome: Epidemiology, pathophysiology, and clinical perspectives. Journal of Clinical Medicine, 15(1):299.