J-curve revisited: Cardiovascular benefits of moderate alcohol use cannot be dismissed

While the Australian National Health and Medical Research Council guideline document of 2009 on reducing health risks from drinking alcohol provided sensible advice for public policy on alcohol, it appeared to dismiss the cardiovascular benefits of low to moderate consumption. Undue prominence was given to a hypothesis from a single research group that the well documented J-curve relationship of lower risk of ischaemic heart disease events with low to moderate intake alcohol consumption may have been due to a misclassification of drinking patterns. The misclassification hypothesis suggested that the higher risks among abstainers may have been due to the inclusion of high-risk subjects who had become abstainers later in life. Recent studies have separated recent abstainers from lifetime abstainers and the misclassification hypothesis has not been confirmed as an explanation for the J-shaped curve. The J-shaped relationship between alcohol consumption and cardiovascular risk has been studied and confirmed in multiple studies; while it complicates the formulation of public policy on alcohol consumption, it cannot be dismissed.