The relationship between alcohol and IHD risk is further complicated by the fact that at least two dimensions of consumption have to be taken into account in determining IHD risk. Heavy drinking occasions, not adequately captured by measurement of average consumption, have been linked to adverse cardiovascular events for some time [108;117;140]. Unfortunately, most epidemiological studies on alcohol and IHD risk have used average consumption as the exposure measure, and it is only recently that studies have been conducted with methodologically rigorous assessment of IHD as an endpoint, and with control for average volume as a confounder and/or with lifetime abstention as reference (e.g. [141-144]). All of these recent studies found a protective effect for daily average light to moderate drinkers but no or detrimental effects for people whose drinking patterns included heavy drinking occasions (even if their usual pattern was moderate). A review by Agarwal [145] and a study conducted by Mukamal and colleagues [137] also found drinking patterns to be important to the risk of IHD for a given volume of alcohol consumption. The detrimental effects of heavy
