Alcohol in moderation is associated with lower risk of coronary heart disease in healthy men and women. New evidence suggests that this association, described in over 70 epidemiologic studies, is causal and can be explained, in part, by alcohol's beneficial effects on serum lipids and clotting factors. Recently, the inverse association between alcohol and cardiovascular disease also has been reported in populations with adult-onset diabetes and among individuals with previous cardiovascular disease. Although mounting evidence strongly supports the cardiovascular benefits of moderate alcohol consumption in most populations, clinical advice to abstainers to initiate daily alcohol consumption has not yet been substantiated in the literature and must be taken with caution and given on an individual basis.