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Vol. 75. Issue 2.
Pages 191 (February 2022)
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Vol. 75. Issue 2.
Pages 191 (February 2022)
Letter to the Editor
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The alcohol-intake paradox: caution in a field of developing evidence. Response
La paradoja del consumo de alcohol: cautela ante una evidencia en desarrollo. Respuesta
Ramón Estrucha,b,
Corresponding author

Corresponding author:
, Emilio Sacanellaa,b
a Servicio de Medicina Interna, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
b Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Spain
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Rev Esp Cardiol. 2022;75:190-110.1016/j.rec.2021.08.014
Martín Negreira-Caamaño, José Abellán-Huerta
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To the Editor,

We are writing in reference to our editorial,1 in which we mention that the most effective measures shown to extend life expectancy include moderate alcohol intake (5-14.9g of ethanol/d). A healthy lifestyle, including moderate intake of alcoholic beverages, led to a reduction of 74% in all-cause death, 65% in cancer mortality, and 82% in cardiovascular mortality.2

Numerous studies have found that moderate alcohol intake has a protective effect on the cardiovascular system. Meta-analysis results3 indicate that a moderate intake of alcoholic beverages—mainly wine—lowers the risk of breast cancer, provided that it is part of a healthy dietary pattern. These studies take into consideration the presence of confounding factors, such as the lack of “patients” in the control arm (abstainers), avoid inaccurate records on the use of alcoholic beverages, specify the alcohol intake pattern (differentiating between daily alcohol intake and cumulative weekend or binge drinking), and look at the effect of healthy dietary patterns, such as the Mediterranean diet. Additionally, in vitro studies have identified various possible mechanisms for the protective effects of moderate alcohol intake, supporting the plausibility of epidemiologic results.

In conclusion, as clinicians we have sufficient evidence to counsel patients according to alcohol consumption: a) patients who drink in excess should be urged to reduce intake to less than 20g of alcohol a day for men and less than 10g for women; b) patients with moderate alcohol intake should be reminded to avoid any increase in intake, and c) patients who abstain should never be advised to drink alcohol. All of these patients should be encouraged to eat a healthy diet, namely the Mediterranean diet, and those who drink alcohol should be directed to preferably drink wine or beer, always with meals.


The authors state that they received no funding for this manuscript.


Both authors contributed equally to this manuscript.


R. Estruch states that he has received research aid from the Carlos III Health Institute, the Health Research Fund, and CIBER Physiopathology of Obesity and Nutrition and that he is a member of the Advisory Board of the Mediterranean Diet Foundation, the Beer and Health Foundation, and the Foundation for Wine and Nutrition Research (FIVIN). He has received aid from the European Union (EIT-Health) and Laboratoires Grand Fontaine, Spain, to conduct clinical trials and has given educational lectures for the Cervantes Institute (Madrid), Brewers of Europe (Belgium), Wine in Moderation (Belgium), Uriach (Barcelona), and Lilly (Madrid). He has also received travel aid from the Karolinska Institute (Sweden) and from ERAB (Belgium). Last, he is a member of the Data Safety Monitoring Board for the CARDIOPRES study (Spain). E. Scanella declares no conflicts of interest.

R. Estruch, E. Sacanella.
Is a picture worth a thousand words in cardiovascular risk assessment?.
Rev Esp Cardiol., 74 (2021), pp. 1006-1007
Y. Li, A. Pan, D.D. Wang, et al.
Impact of healthy lifestyle factors on life expectancies in the US population.
Circulation., 138 (2018), pp. 345-355
L. Schwingshackl, C. Schwedhelm, C. Galbete, G. Hoffmann.
Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis.
Nutrients., 9 (2017), pp. 1063
Copyright © 2021. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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