The causal effects of alcohol-in-moderation on cardiometabolic health are continuously debated. Mendelian randomization (MR) is an established method to address causal questions in observational studies. We performed a systematic review of the current evidence from MR studies on the association between alcohol consumption and cardiometabolic diseases, all-cause mortality and cardiovascular risk factors. We performed a systematic search of the literature, including search terms on type of design and exposure. We assessed methodological quality based on key elements of the MR design: use of a full instrumental variable analysis and validation of the three key MR assumptions. We additionally looked at exploration of non-linearity. We reported the direction of the studied associations. Our search yielded 24 studies that were eligible for inclusion. A full instrumental variable analysis was performed in 17 studies (71%) and 13 out of 24 studies (54%) validated all three key assumptions. Five studies (21%) assessed potential non-linearity. In general, null associations were reported for genetically predicted alcohol consumption with the primary outcomes cardiovascular disease (67%) and diabetes (75%), while the only study on all-cause mortality reported a detrimental association. Considering the heterogeneity in methodological quality of the included MR studies, it is not yet possible to draw conclusions on the causal role of moderate alcohol consumption on cardiometabolic health. As MR is a rapidly evolving field, we expect that future MR studies, especially with recent developments regarding instrument selection and non-linearity methodology, will further substantiate this discussion.

适量饮酒对心脏代谢健康的因果影响一直存在争议。孟德尔随机化 (MR) 是一种解决观察性研究中因果问题的既定方法。我们对 MR 研究中关于饮酒与心脏代谢疾病、全因死亡率和心血管危险因素之间关系的现有证据进行了系统回顾。我们对文献进行了系统搜索，包括有关设计类型和曝光的搜索术语。我们根据 MR 设计的关键要素评估方法质量：使用完整的工具变量分析和三个关键 MR 假设的验证。我们还研究了非线性的探索。我们报告了所研究协会的方向。我们的检索产生了 24 项符合纳入条件的研究。 17 项研究 (71%) 进行了完整的工具变量分析，24 项研究中有 13 项 (54%) 验证了所有三个关键假设。五项研究 (21%) 评估了潜在的非线性。总体而言，基因预测的饮酒量与主要结局心血管疾病（67%）和糖尿病（75%）之间存在无效关联，而唯一一项关于全因死亡率的研究则报告了有害关联。考虑到纳入的 MR 研究方法学质量的异质性，目前还无法就适量饮酒对心脏代谢健康的因果作用得出结论。由于 MR 是一个快速发展的领域，我们预计未来的 MR 研究，尤其是仪器选择和非线性方法方面的最新进展，将进一步证实这一讨论。