ALPSA Paradox - How does alcohol volume and type influence its effect on atherosclerosis?

By Scott Needham
Posted in

Alcohol consumption has been shown to reduce the risk of all-cause mortality and cardiovascular disease (CVD) in the the global burden of disease studies lead by the World Health Organisation (WHO). The surprising nature of this result is indicated by the fact that alcohol consumption is included in the risk factors section of the report where alcohol is the only risk factor that reduces morality.

More detailed analysis indicates that light-to-moderate alcohol consumption has the largest beneficial effect on all-cause mortality and CVD [Claim 3974, 3975]. Alcohol has a U or J-shaped relationship with CVD where light-to-moderate consumption (roughly one standard drink per day) is more beneficial than none [Claim 2307, 2308, 1709], but high alcohol consumption (two or more per day) is detrimental [Claim 1710, 2304, 3038]. Drinking lightly once a week has no benefit [Claim 1708], roughly one drink per day appears to be the sweet spot (tough of the J or U curve). As can be seen in Figure 1, the benefit from light consumption is substantial and the consequences from heavily driving are severe.

Figure 1. A “J”- or “U”-shaped association between atherosclerosis progression and categories of regular alcohol consumption. Taken from Figure 3a in reference 1.

So it appears that while alcohol consumption on average is beneficial, it is the benefit received by light-to-moderate consumers that outweighs the negative effect of heavy consumers in sum. With regard to our paradox, it would be more accurate to say that light alcohol consumption (roughly one per day) decreases atherosclerosis.

Figure 2. Updated ALPSA paradox model based on alcohol dose findings

The updated model makes the top red decreases relation more accurate, but it remains to be discussed in other articles whether the adjustment makes sense with regard to increasing LPS.

How important is the type of alcoholic drink that is consumed?

There are studies that suggest red wine consumption may be more beneficial with regard to CVD and atherosclerosis than other alcoholic drinks [Claim required]. Possibly due to the antioxidants that it contains.

However results from observational studies, where alcohol consumption is linked to the individual's risk of coronary heart disease, provide strong evidence that it is the alcohol that leads to lower lower risk and not the type of alcoholic drink [Claim 3976].


Where there is a reference to a claim number, the details for the supporting evidence and reference can be found on the claim page on

  1. Kiechl S, Willeit J, Rungger G, Egger G, Oberhollenzer F, Bonora E. Alcohol consumption and atherosclerosis: what is the relation? Prospective results from the Bruneck Study. Stroke. 1998 May;29(5):900-7.