The role of alcohol as a risk factor in patients with established heart disease needs further empirical clarification and the literature that addresses the problem is limited. In healthy young males studied prospectively alcohol has a negative role as a risk factor in the development of coronary heart disease. However, conclusions about this group do not necessarily hold for those with already established cardiac damage. Two studies report a significant difference between normal controls and patients with cardiac disease using even small amounts of alcohol. One prospective study of risk factors for coronary heart disease found a record of alcohol intemperance significantly increased the risk of acute myocardial infarction or sudden death. The epidemiological, metabolic, hemodynamic and autopsy studies that bear on the effects of alcohol and its major metabolites on the heart are reviewed.
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