Although stress- management programs are not of proven value in reducing the risk of cardiovascular events, they are effective in relieving anxiety and reducing depressive symptoms.461 4.4.1.8. Alcohol Consumption Class IIb 1. In patients with SIHD who use alcohol, it might be reasonable for nonpregnant women to have 1 drink (4 ounces of wine, 12 ounces of beer, or 1 ounce of spirits) a day and for men to have 1 or 2 drinks a day, unless alcohol is contraindicated (such as in patients with a history of alcohol abuse or dependence or with liver disease).703 705 (Level of Evidence: C) Observational studies suggest that light to moderate alcohol consumption is associated with a lower risk of IHD and all-cause mortality. Most studies report a J-shaped relation- ship between alcohol consumed and cardiovascular event rate or mortality; light to moderate drinkers have less risk than abstainers, but heavy drinkers are at greatest risk. A meta- analysis of 34 prospective studies found mortality rate reduc- tions of 17% in men and 18% in women with low levels of alcohol intake, with the lowest mortality rate at 6 g of alcohol (approximately one half drink) per day.703 Most of these studies were performed in healthy cohorts, and data in patients with IHD are limited. One study704 examined sur- vival rate among early survivors of MI and found that moderate alcohol consumption in the year before presentation was predictive of lower all-cause mortality. Similarly, among participants in the Physician s Health Study who experienced a self-reported MI, moderate drinkers had a 30% lower risk of death than abstainers.705 Light to moderate alcohol consumption might confer pro- tection against cardiovascular disease through beneficial ef- fects on the lipid profile and on insulin sensitivity. 