There is a functional polymorphism of the mitochondrial aldehyde dehydrogenase (ALDH2) gene with the variant allele (ALDH2*2) encoding a protein subunit that confers low activity to the tetrameric enzyme. Genetic epidemiologic studies have strongly suggested that homozygosity for the allele ALDH2*2 is sufficient in completely inhibiting the development of alcoholism in Asians. To study the pathophysiology of this unique pharmacogenetic effect, we recruited a total of eighteen adult Han Chinese men, matched by age, body-mass index, nutritional state and homozygosity at the alcohol dehydrogenase gene loci from a population base of 273 men. Six individuals were chosen for each of the three ALDH2 allelotypes: homozygous ALDH2*2/*2, heterozygous ALDH2*1/*2, and homozygous ALDH2*1/*1. Following a low dose of ethanol (0.2 g/kg body weight), blood ethanol/acetaldehyde concentrations, cardiac and extracranial/intracranial arterial hemodynamic parameters, as well as self-rated subjective sensations, were measured for 130 min. Homozygous ALDH2*2 individuals were found to be strikingly responsive to the small amount of alcohol, as evidenced by the pronounced cardiovascular hemodynamic effects as well as subjective perception of general discomfort for as long as 2 h following ingestion. This low-dose alcohol hypersensitivity, accompanied by a prolonged and large accumulation of acetaldehyde in blood, provides an explanation for the strong protection against heavy drinking and alcoholism in individuals homozygous for the ALDH2*2 gene allele.