The present paper provides a comprehensive review of the literature pertaining to the impact of alcohol intake on cardiovascular disease. Both cross-sectional and prospective studies have disclosed a negative association between moderate intake of alcoholic beverages and cardiovascular disease. The relationship appears to be present for both wine, beer and spirits. Effects of alcohol itself and also the role of different cardio-protective substances in alcoholic beverages are discussed. Alcohol has been suggested to beneficially affect the blood lipid profile, as it increases plasma HDL-cholesterol level. Furthermore, it may inhibit thrombogenesis by reducing thromboxan formation and decreasing the plasma level of fibrinogen. However, high blood concentrations of alcohol may impair fibrinolysis by increasing plasma plasminogen activator inhibitor-1 level. This action could contribute to explaining the 'U'-shaped association between alcohol intake and cardiac events. Alcohol seems to promote abdominal fat distribution, but the importance of this effect in non-obese individuals is uncertain. Wine in particular, but also beer, contains polyphenols which act as antioxidants. Their action could maintain the integrity of the endothelial function by reducing the formation of superoxide. Moreover, these antioxidants may protect against LDL oxidation and modulate the macrophage attack on the endothelium. Although the cardio-protective effect of alcohol can hardly be addressed in healthy individuals by intervention studies with hard end points, there are many observational and experimental findings indicating that moderate alcohol drinking possesses properties preventive of cardiovascular disease.