Background: Moderate alcohol consumption is associated with a lower risk of myocardial infarction (MI). Whether alcohol is truly protective or whether the amount, type, or pattern of intake is the most important is still under debate.

Objective: The purpose of this study was to determine whether alcohol intake and drinking patterns are associated with plasma lipids and the risk of MI in Costa Ricans, a population with a low intake of wine.

Design: We conducted a study of 2090 cases of a first nonfatal acute MI and 2090 population-based controls matched by age, sex, and residence in Costa Rica, a country with diet and lifestyles different from those of Western countries. Alcohol and dietary intakes were assessed by using validated questionnaires.

Results: In a multivariate conditional regression model that controlled for other cardiovascular disease risk factors, the lowest risk of MI [odds ratio (OR) = 0.44; 95% CI: 0.31, 0.61] was observed for those who drank on average 3 drinks/wk (compared with lifelong abstainers). When we looked at the frequency of consumption, we found that the risk of MI among daily drinkers (OR = 0.64; 95% CI: 0.41, 1.01) was not significantly different (P= 0.23) from that of weekend drinkers (OR = 0.76; 95% CI: 0.59, 0.98) regardless of the amount consumed. HDL cholesterol increased with the amount and frequency of alcohol intake. Similar to a few other populations, apparent protection was observed at very low alcohol intakes.

Conclusion: Low to moderate consumption of alcohol 1–2 d/wk is independently associated with a reduced risk of MI.