Substantial evidence has shown that moderate drinkers have lower rates of coronary heart disease (CHD) than abstainers, but the effects of alcohol consumption among patients with established CHD are less clear. Alcohol intake has important effects on risk factors for reinfarction, including higher levels of high-density lipoprotein cholesterol and triglycerides, lower levels of fibrinogen and other prothrombotic factors, lower fibrinolytic potential, and antiplatelet activity. Studies of patients at risk for CHD, such as those with diabetes, hypertension, and hyperlipidemia, have shown that the association of moderate drinking and CHD is at least as strong as it is in the general population. Most recently, studies have found that survivors of acute myocardial infarction who drink moderately have a risk of death approximately 20%–30% lower than do abstainers or rare drinkers. Nonetheless, the risks and benefits of alcohol use remain complex, even among patients with CHD, and no simple recommendation regarding alcohol consumption can be made for all patients.