The great medical and social harm of alcohol abuse is well established.

In the case of cardiovascular disease, however, alcohol appears to have conflicting effects. At high levels, alcohol use can contribute to a range of cardiovascular disorders. At low to moderate levels it can still produce some harmful effects, but these may be balanced by some benefits. However, further research is needed in this area.

On the harmful side, alcohol consumption at any level tends to raise blood pressure, the effect appearing at the lowest levels of intake and increasing with the amount consumed. Considered alone, this must be presumed to increase the risk of diseases associated with raised blood pressure, such as heart attack and stroke. Alcohol is high in energy and its consumption can contribute to being overweight, which is a cardiovascular risk factor.

Alcohol use can also raise blood triglyceride levels and thus complicate the effects of elevated blood cholesterol levels when they are present. Very heavy alcohol intake can cause cardiomyopathy with heart failure, and binge drinking is associated with stroke. In population studies alcohol consumption beyond moderate levels is associated with greater mortality from heart attack and cardiovascular disease generally.

Moderate alcohol intake can be defined as no more than two standard drinks of alcohol daily for women and no more than four for men. (A standard drink is 10gm of alcohol.) At a given level, alcohol has more harmful effects on women than on men. However, in population studies, low to moderate alcohol intake is not associated with a higher cardiovascular mortality than occurs among teetotallers and may even be associated with slightly lower mortality.

The reasons for this finding are unclear and subject to continuing research. In the case of cardiovascular disease, it is scientifically premature to conclude that moderate alcohol intake produces a cardiovascular benefit on balance, but it seems certain that it poses little or negligible risk to most users.

In view of these considerations, the Heart Foundation makes the following recommendations and conclusions:

1. The relationship of various levels of alcohol intake to cardiovascular disease and its risk factors should be studied further. With knowledge of community patterns of consumption, this permits an estimate of alcohol's contribution to overall cardiovascular health status in Australia, as well as its effects on particular groups.
   
2. On cardiovascular and other health grounds, there is no justification for recommending that non-drinkers of alcohol should take up the habit or that any drinkers should increase their intake.
   
3. On those same grounds, there are strong reasons for all people who drink alcohol to limit intake to moderate levels.
   
4. Those whose blood pressure or blood cholesterol levels are high, or who are overweight, have additional reasons for moderating or avoiding use. Alcohol consumers on medication to lower their blood pressure, should either stop drinking or restrict their intake to one or two drinks per day at most, with the hope of reducing the need for such medication.