Alcohol Use and Mortality from Coronary Heart Disease: The Role of High-Density Lipoprotein Cholesterol

Abstract

In middle-aged men who are light to moderate drinkers, the inverse association between alcohol consumption and death from coronary heart disease can be explained, in large part, by the HDL cholesterol level, which increases with alcohol consumption. However, alcohol consumption cannot be recommended because of the known adverse effects of excess alcohol use.

Alcohol and coronary heart disease: the roles of HDL‐cholesterol and smoking

“…Differences in study populations and end-points may explain part of the discrepancy between the present and previous estimations of the role of HDLc as an intermediate in the causal pathway [6][7][8][9]. Other explanations are related to statistical modelling and the risk factor nature of HDLc.…”

“…Previous studies have estimated the contribution of HDLc in mediating the protective effect of alcohol from the changes in either beta coefficients [7] or relative risks [6,8,9] when HDLc has been introduced into the models. However, this kind of an approach is very complex, especially when alcohol is used as a continuous variable, since the effect of alcohol on HDLc seems to be linear and the protective effect against CHD is curvilinear.…”

“…smoking, we used a categorical variable describing the combined levels of alcohol consumption (A) and smoking (S) : (Ak, Sk), (Ak, Sj), (Aj, Sk), (Aj, Sj). To investigate to what extent the protective effect of alcohol was mediated through HDLc, we also used the methods applied in previous papers [6][7][8][9]. In these the extent of the mediating effect is estimated from the change in the beta coefficient or relative risk of alcohol, when a new variable thought to be an intermediate in the causal pathway (e.g.…”

“…Nevertheless, the consistency, specificity, dose-response and independence of the association are proposed to imply a causal association, though the exact underlying mechanism has yet to be resolved. However, in the context of atherosclerosis aetiology, elevation of high density lipoprotein cholesterol (HDLc) offers a plausible explanation [6][7][8][9] because alcohol is known to Results. A U-shaped association was detected between alcohol consumption and CHD.…”

Evidence Regarding the Level of Alcohol Consumption Considered to be Low-Risk for Men and Women

“…First, moderate alcohol intake has been clearly linked to favourable lipid profiles (Baraona and Lieber, 1998). It has been estimated that as much as 40%-50% of the protective effect may be attributable to this mechanism (Criqui et al, 1987;Suh et al, 1992;Criqui, 1994). Second, moderate alcohol intake favourably affects coagulation profiles (Baraona and Lieber, 1998), in particular, through its effects on platelet aggregation (McKenzie and Eisenberg, 1996) and fibrinolysis (Reeder et al, 1996).…”