Most world populations consume alcoholic beverages. Ethanol may have both protective and harmful effects on health depending on the amount and way of consumption. An extensive body of data shows concordant J or U-shaped associations between alcohol intake and a variety of adverse health outcomes, including coronary heart disease, diabetes, hypertension, congestive heart failure, stroke, and all-cause mortality. In particular, moderate ethanol consumption is associated with cardioprotective benefits such as lower cardiovascular risk and mortality, probably mediated by beneficial effects on inflammation, lipids, and coagulation. In contrast, binge and/or heavy drinking results in proportional worsening of outcomes, increasing cardiovascular events and mortality. This harmful effect has been recently associated with the blockade of ischemic preconditioning mediated by high doses of ethanol. In this review, we highlight the recent epidemiological and experimental evidences regarding the specific benefits and risks of ethanol in the setting of ischemic heart disease.