Key result
Cardiovascular benefits of moderate alcohol in the Mediterranean diet remain unproven, warranting definitive randomized trials.
Why the study?
Whether low-to-moderate alcohol intake independently contributes to lower cardiovascular risk remains controversial due to methodological limitations and biases in prior studies.
Does low-to-moderate alcohol intake within a Mediterranean dietary pattern reduce cardiovascular disease incidence and all-cause mortality in adults compared to total abstention?
Does low-to-moderate alcohol intake within a Mediterranean dietary pattern reduce cardiovascular disease incidence and all-cause mortality in adults compared to total abstention?
While moderate wine consumption in older adults within a Mediterranean diet is unlikely to be harmful, alcohol should not be recommended for cardiovascular prevention, as proven benefits derive from the diet as a whole.
Clinicians should not recommend alcohol for CVD prevention; challenges observational J-curve and leaves causal effects open pending RCTs.
The Mediterranean diet has consistently shown associations with lower risks of cardiovascular disease (CVD) in randomised controlled trials and large prospective cohorts. Traditionally, moderate wine consumption was considered part of the Mediterranean diet. However, whether low-to-moderate alcohol intake contributes independently to lower risk remains controversial. Early epidemiological reports supported a J-shaped association between alcohol intake and CVD, but residual confounding, selection biases or misclassification of former drinkers challenge causal interpretations. Methodological limitations, particularly the inability to capture drinking patterns, have also been raised in recent assessments of the Global Burden of Disease and Mendelian randomisation studies. A more nuanced view may be that low-to-moderate wine consumption in older adults is not likely to be harmful but alcohol should not be recommended for CVD prevention. Large-scale randomised trials, such as the ongoing UNATI study, are expected to clarify the impact of moderate drinking versus abstention. Meanwhile, clinical guidance should emphasise the proven cardiometabolic benefits of the Mediterranean diet overall independent of alcohol consumption.
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Martínez‐González et al. (2026) conducted a review in Cardiovascular disease. Low-to-moderate alcohol consumption vs. Abstention was evaluated. The cardiovascular benefits of low-to-moderate alcohol consumption within the Mediterranean diet remain controversial, highlighting the need for definitive large-scale randomized controlled trials to address observational biases.
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