We evaluated in a prospective manner the effects of alcohol consumption on coronary heart disease (CHD) risk, overall mortality, metabolic syndrome (MS) and relevant risk variables based on the baseline data of the original cohort of the Turkish Adult Risk Factor Study. Alcohol status was assessed in two ways: a) abstinents and 5 increasing categories of alcohol intake, b) abstinents, moderate and severe alcohol intake brackets. In addition to smoking as a confounding factor, 4 components of the MS, as well as total cholesterol and C-reactive protein were evaluated. Criteria of ascertainment of cause of death and of CHD had been previously published. The 2714 men and women included in 1990 in the study and followed up for a mean of 10.0 (5 to 12) years had a mean age of 41.7 (±15) years. Consumers of alcoholic beverages were limited to 17.9% of adults (32.5% of men and 3.6% of women). Consistency of alcohol consumption data obtained 12 years apart and HDL-cholesterol values obtained 4 years apart showed a good correlation (r = 0.6) with each other. In logistic regression analysis adjusted for age and smoking status, alcohol status -despite failing to attain level of significance- showed a trend towards predicting fatal and nonfatal CHD: raising in men and lowering in women. Alcohol intake was not significantly associated with overall mortality but was an independent predictor of subsequent MS 10 years later, when adjusted for age and smoking status, raising this risk in men (p=0.002), lowering it among women (p=0.05). By linear regression, alcohol status was found to be a determinant, independent of age and smoking status, of plasma HDL-cholesterol concentrations 10 and 12 years later, significantly in men (by 4 mg/dl [2 to 6]), showing only a trend in women. It was also associated with a significantly elevated (5.3 mmHg) systolic and diastolic (by 3.7 mmHg) blood pressure in men, while being associated with a trend to diminution of levels in women. Again, when age and smoking status was controlled for, alcohol status was correlated significantly with waist circumference, systolic and diastolic blood pressures, total cholesterol (and triglycerides at borderline significance) among men, whereas women showed no correlation or a reverse trend. We concluded that alcohol intake raised the risk for MS, abdominal obesity and elevated blood pressure in Turkish men, diminished the risk for MS in women while raising HDL-cholesterol levels in both genders. In contrast to a trend to an inverse association with CHD risk in women, men disclosed a trend towards rising CHD events even with moderate consumption, presumably consequent to their alcohol drinking pattern.