What to Advise Patients About Drinking Alcohol

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Abstract
The current issue ofThe Journalcontains a report of yet another mechanism by which alcohol consumption may prevent the onset of coronary heart disease. Ridker et al1demonstrate an association between alcohol consumption and plasma levels of tissue plasminogen activator—a major component of the fibrinolytic system. This article is consistent with the sizable literature on the protective effects of alcohol with regard to coronary heart disease2and may account for the other half of coronary disease reduction not explained by the beneficial effects of alcohol on high-density lipoprotein cholesterol (HDL-C) levels. The article also suggests that in addition to the antiatherosclerotic effect of alcohol via HDL-C metabolism, alcohol may affect the second step in the pathogenesis of myocardial infarction, namely, coronary thrombosis. See also p 929. Conundrum is defined byAmerican Heritage Dictionaryas "a problem admitting of no satisfactory solution." The stance that the medical community

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