The purpose in preventing a man’s second heart attack is to prevent death. And disability.
In other words, it’s quality of life, not just quantity. For decades, American physicians have proscribed alcohol to men, warning of its dangers (which are real, if done in excess) and putting aside the data which show regular, moderate drinking improves mortality and morbidity.
And it does, if you’ve had a heart attack and if you’re trying to prevent one. The latest research study, on >50k U.S. men over 20 years confirms the former yet again. For women, there is an increased breast cancer risk at some alcohol intake, though the cardiovascular benefits remain.
There is a lot else to say: physiologic mechanisms (HDL-cholesterol, (HbA1C), fibrinogen); the antioxidant and anti-inflammatory agents quercetin in grapes and resveratrol in wine; the continuing French Paradox; the U shaped curve of benefit (none for tee-totalers, and hazards for those who average over 3 glasses/day); the definition of regular (daily) and moderate (up to two five ounce glasses of wine, 12 oz beer, 1 oz spirits).
The Rx, however, should be written, for most men.
The real concern, however, is not liver damage or drunkenness. It’s calories: alcohol is metabolized and stored before other calories, especially fat calories, which are those most people try to burn–especially the ones that are stored around the middle.
Alcohol has little or no satiety effect, and tends to increase food intake: it turns on other appetites. The research is equivocal about whether it causes weight gain in men (except for heavy drinkers, where it does). It’s quite solid about whether it can prevent second heart attacks, in a delicious way.