Background: Epidemiological evidence suggests a J-shaped association between alcohol consumption and cardiovascular mortality, with higher cardiovascular event rates occurring among abstainers and heavy drinkers compared to moderate consumers. However, this hypothesis has been challenged by more recent studies. Furthermore, ethnicity, gender, type of alcoholic beverage, and pattern of alcohol intake, influence the relationship between alcohol and heart health. Methods: We undertook a review of the relavent literature utilizing PubMed. Results: Heavy alcohol consumption causes resistant hypertension, cardiomyopathy, arrhythmias, hemorrhagic strokes, as well as hepatic cirrhosis and pancreatitis. Excessive drinking is the third most preventable cause of death worldwide behind hypertension and smoking. Conclusions: In this review, we discuss the effects of alcohol abuse on hypertension (a major cause of myocardial infarction and stroke) and alcoholic cardiomyopathy. Another article in this Special Issue “Alcohol and Heart Health” discusses the problem with alcohol and arrhythmias sudden cardiac death.