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Background: Abdominal aortic aneurysm (AAA) is an increasingly recognized cause of morbidity and mortality in the aging US population. While moderate alcohol consumption has been shown to be associated with a lower risk of atherosclerotic macrovascular disease, its relationship with AAA remains inconsistent in previous studies. We therefore sought to elucidate the relationship between alcohol consumption and risk of AAA in a prospective cohort of middle-aged and older men.Methods: Our study included 21,842 male physicians (mean age: 53.7 years) in the Physicians’ Health Study I who reported no history of AAA at baseline. Self-reported information on alcohol consumption and known AAA risk factors including body mass index (BMI), smoking and exercise was obtained on baseline questionnaires. Incidence of clinically diagnosed AAA was assessed via self-reported information on annual questionnaires and validated successfully in a subsample. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of AAA in each category of alcohol intake. Cubic spline regression was used to assess non-linear trend.Results: During an average follow-up of 23.0 years, 655 cases of newly diagnosed AAA were reported. Compared with men reporting less than one alcoholic drink (combined beer, wine, and liquor) per month, the HR [95% CI] of incident AAA after adjustment for age, BMI, smoking, and exercise was 0.69 [0.50 - 0.95] with one to three drinks per month, 0.80 [0.60 - 1.08] with one drink per week, 0.75 [0.58 - 0.97] with two to four drinks per week, 0.67 [0.49 - 0.90] with five to six drinks per week, 0.77 [0.61 - 0.99] with one drink per day, and 0.73 [0.47 - 1.13] with two or more drinks per day (P, non-linear trend=0.17).Conclusions: In this large cohort of middle-aged and older male physicians, light-to-moderate alcohol consumption was associated with a lower risk of clinically diagnosed AAA.