We reviewed the roles of both alcohol and red wine in cardiovascular disease by discussing key animal and human studies. Included are studies regarding alcohol's association with coronary heart disease and the proposed mechanisms of action of alcohol. Likewise, studies concerning red wine's cardiovascular benefit and the mechanisms of action of red wine are discussed. Lastly, we reviewed studies on the adverse effects of alcohol and the current consumption recommendations as stated by the American Heart Association. Moderate alcohol consumption (<or=2 drinks per day) is associated with a reduced risk of coronary heart disease. This is believed to occur through alcohol's antithrombotic properties and its ability to increase high-density lipoprotein levels. It remains unclear whether polyphenol compounds in red wine make it an especially cardioprotective alcoholic beverage. These compounds are proposed to act by inhibiting low-density lipoprotein oxidation and thrombosis independently of alcohol. Moderate alcohol consumption is not associated with any significant morbidity; however, three or more drinks per day is associated with hypertriglyceridemia, cardiomyopathy, hypertension, and stroke. The American Heart Association does not recommend alcohol as a treatment approach and suggests that men drink no more than two drinks per day and women no more than one drink per day.