Our results contribute toward understanding of the basis for these directionally divergent cardiovascular disease associations. For example, our data have suggested that elevated systolic blood pressure could mediate alcohol consumption's positive association with stroke and coronary disease excluding myocardial infarction.44, 47, 48 By contrast, pathways related to HDL-C (but not necessarily HDL-C itself49, 50, 51, 52) could mediate alcohol consumption's inverse association with myocardial infarction. Both blood pressure and HDL-C are known to increase in response to alcohol consumption.50 They have contrasting associations with cardiovascular disease outcomes: the inverse association of HDL-C with cardiovascular disease is substantially stronger for coronary disease than stroke,53, 54 whereas the positive association of systolic blood with cardiovascular disease is considerably stronger for stroke than coronary disease.55 However, we did not find convincing evidence that other known risk factors were important mediators or confounders.
