Another consideration is the individual risk of alcohol dependence. It is extremely difficult in observational studies to control for all possible indirect explanations, such as psycho-social factors, among persons with different alcohol intake patterns. Alcohol intake is related to and conditioned by lifestyle, ill health and medication. Light to moderate drinkers in most Western cultures have other lifestyle characteristics which are advantageous compared to all other drinking categories. The latter s health and lifestyle characteristics are often less advantageous than those of light to moderate drinkers or lifelong abstainers.
All observational studies have limited ability to establish causality.
With respect to alcohol, the consistency of the findings, the existence of reasonable biological explanations, and the relative specificity for CHD are all factors arguing for a causal protective effect. The major preventive measures against CHD remain avoidance of tobacco, proper diet, physical exercise, and control of high blood pressure and high blood cholesterol. The possible benefits of light to moderate drinking can be taken into consideration for those at high coronary risk and with low risk of alcohol problems. This applies particularly to middle-aged and older men and women. The balance of risks and benefits for individuals must be considered on a personal basis.