This study examined the association between consumption of alcoholic beverages and all-cause and cardiovascular disease (CVD) mortality in a cohort of men ( ,367). In the Cox proportional hazards model adjusted for age, year of examination, body mass index (BMI), smoking, family history of CVD, and aerobic fitness, there were no significant differences in risk of all-cause mortality across alcohol intake groups. Risk of CVD mortality was reduced 29% in quartile 1 (HR = 0.71, 95% confidence interval (CI): 0.53, 0.95) and 25% in quartile 2 (HR = 0.75, 95% CI: 0.58, 0.98). The amount of alcohol consumed to achieve this risk reduction was <6 drinks/week; less than the amount currently recommended. The addition of other potential confounders and effect modifiers including blood pressure, insulin sensitivity, lipid levels, and psychological variables did not affect the magnitude of association. Future research is needed to validate the current public health recommendations for alcohol consumption. 1. Introduction Light-to-moderate alcohol consumption has been shown in several prospective studies to reduce the risk of all-cause mortality and several cardiac outcomes, including cardiovascular disease (CVD) mortality in men [1–10]. Several hypotheses exist for the mechanism of this protective effect including increased exposure to antioxidants, improved lipid profiles, reduced insulin resistance, decreased blood coagulation, and modified inflammation pathways [11, 12]. Despite a large number of studies examining alcohol consumption and mortality, questions remain about the nature of this relationship. Three primary concerns include the influence of confounding factors, appropriate public health recommendations, and differential effects between types of alcohol [13, 14]. Selection bias is a particular concern when comparing nondrinkers to drinkers. Nondrinkers may abstain from alcohol because of an initial health condition and be more likely to have other conditions that might confound the relationship including obesity, physical inactivity, and overall health problems [14]. In addition, moderate alcohol consumption has been associated with positive psychosocial outcomes including sociability and stress reduction, which may further confound the association with mortality [15, 16]. Confounding is a limitation of nonexperimental studies, yet it is unethical and impractical to conduct long-term randomized controlled trials of alcohol consumption. In an attempt to address this challenge, investigators have used statistical methods to control for possible confounders
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