Original Research| Volume 17, ISSUE 1, P124-130, January 2023

Download started.


The Relationship of Alcohol Consumption and HDL Metabolism in the Multiethnic Dallas Heart Study

Published:October 28, 2022DOI:


      • Increasing alcohol consumption leads to increased HDL markers.
      • Moderate drinkers have higher HDL values compared to light drinkers.
      • Race and sex can modify the relationship between HDL and cholesterol efflux.
      • Unable to evaluate impact of HDL markers due to low number of cardiovascular events.


      Small studies have suggested that moderate alcohol consumption increases HDL cholesterol (HDL-C) levels and cholesterol efflux capacity (CEC), a main anti-atherosclerotic HDL function.


      This study aimed to understand the degree to which alcohol intake is associated with various HDL markers in a large, multiethnic population cohort, the Dallas Heart Study (DHS), and whether alcohol modifies the link between HDL markers and atherosclerotic cardiovascular disease (ASCVD).


      Participants of the DHS were included if they had self-reported alcohol intake and CEC measurements (N=2,919). Alcohol intake was analyzed continuously (grams/week) and as an ordered categorical variable (never, past, light, moderate, heavy, and binge drinkers). HDL-C, CEC, HDL particle number (HDL-P), HDL particle size (HDL-size), and ApoA-I were the primary HDL measures.


      After adjustment for confounding variables, increasing continuous measure of alcohol intake was associated with increased levels of all HDL markers. Moreover, as compared to moderate drinkers, light drinkers had decreased levels of the HDL markers.


      In a large, multiethnic cohort, increased alcohol intake was associated with increased levels of multiple markers of HDL metabolism. However, the association of HDL markers with ASCVD risk as modified by alcohol consumption is unable to be determined in this low-risk cohort.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Lipidology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Emerging Risk Factors C
        • Di Angelantonio E
        • Sarwar N
        • et al.
        Major lipids, apolipoproteins, and risk of vascular disease.
        JAMA. 2009; 302: 1993-2000
        • Rohatgi A.
        Reverse Cholesterol Transport and Atherosclerosis.
        Arterioscler Thromb Vasc Biol. 2019; 39: 2-4
        • Qiu C
        • Zhao X
        • Zhou Q
        • Zhang Z.
        High-density lipoprotein cholesterol efflux capacity is inversely associated with cardiovascular risk: a systematic review and meta-analysis.
        Lipids Health Dis. 2017; 16: 212
        • Singh K
        • Chandra A
        • Sperry T
        • et al.
        Associations Between High-Density Lipoprotein Particles and Ischemic Events by Vascular Domain, Sex, and Ethnicity: A Pooled Cohort Analysis.
        Circulation. 2020; 142: 657-669
        • Brownell N
        • Rohatgi A.
        Modulating cholesterol efflux capacity to improve cardiovascular disease.
        Curr Opin Lipidol. 2016; 27: 398-407
        • Beulens JW
        • Sierksma A
        • van Tol A
        • et al.
        Moderate alcohol consumption increases cholesterol efflux mediated by ABCA1.
        J Lipid Res. 2004; 45: 1716-1723
        • Naissides M
        • Mamo JC
        • James AP
        • Pal S.
        The effect of chronic consumption of red wine on cardiovascular disease risk factors in postmenopausal women.
        Atherosclerosis. 2006; 185: 438-445
        • Padro T
        • Munoz-Garcia N
        • Vilahur G
        • et al.
        Moderate Beer Intake and Cardiovascular Health in Overweight Individuals.
        Nutrients. 2018; 10
        • Sierksma A
        • Vermunt SH
        • Lankhuizen IM
        • et al.
        Effect of moderate alcohol consumption on parameters of reverse cholesterol transport in postmenopausal women.
        Alcohol Clin Exp Res. 2004; 28: 662-666
        • McEvoy LK
        • Bergstrom J
        • Tu X
        • et al.
        Moderate Alcohol Use Is Associated with Reduced Cardiovascular Risk in Middle-Aged Men Independent of Health, Behavior, Psychosocial, and Earlier Life Factors.
        Nutrients. 2022; 14: 2183
        • Song RJ
        • Nguyen XT
        • Quaden R
        • et al.
        Alcohol Consumption and Risk of Coronary Artery Disease (from the Million Veteran Program).
        Am J Cardiol. 2018; 121: 1162-1168
        • Victor RG
        • Haley RW
        • Willett DL
        • et al.
        The Dallas Heart Study: a population-based probability sample for the multidisciplinary study of ethnic differences in cardiovascular health.
        Am J Cardiol. 2004; 93: 1473-1480
        • Rohatgi A
        • Khera A
        • Berry JD
        • et al.
        HDL cholesterol efflux capacity and incident cardiovascular events.
        N Engl J Med. 2014; 371: 2383-2393
        • Sesso HD.
        Alcohol and cardiovascular health: recent findings.
        Am J Cardiovasc Drugs. 2001; 1: 167-172
      1. Drinking levels defined. National Institute on Alcohol Abuse and Alcoholism. Accessed July 19, 2022.

        • Makela SM
        • Jauhiainen M
        • Ala-Korpela M
        • et al.
        HDL2 of heavy alcohol drinkers enhances cholesterol efflux from raw macrophages via phospholipid-rich HDL 2b particles.
        Alcohol Clin Exp Res. 2008; 32: 991-1000
        • Muth ND
        • Laughlin GA
        • von Muhlen D
        • Smith SC
        • Barrett-Connor E.
        High-density lipoprotein subclasses are a potential intermediary between alcohol intake and reduced risk of cardiovascular disease: the Rancho Bernardo Study.
        Br J Nutr. 2010; 104: 1034-1042
        • Huang S
        • Li J
        • Shearer GC
        • et al.
        Longitudinal study of alcohol consumption and HDL concentrations: a community-based study.
        Am J Clin Nutr. 2017; 105: 905-912
        • Fan AZ
        • Russell M
        • Naimi T
        • et al.
        Patterns of alcohol consumption and the metabolic syndrome.
        J Clin Endocrinol Metab. 2008; 93: 3833-3838
        • Naimi TS
        • Brown DW
        • Brewer RD
        • et al.
        Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults.
        Am J Prev Med. 2005; 28: 369-373
        • Ebtehaj S
        • Gruppen EG
        • Bakker SJL
        • Dullaart RPF
        • Tietge UJF.
        HDL (High-Density Lipoprotein) cholesterol efflux capacity is associated with incident cardiovascular disease in the general population.
        Arterioscler Thromb Vasc Biol. 2019; 39: 1874-1883
        • Wakabayashi I
        • Araki Y.
        Influences of gender and age on relationships between alcohol drinking and atherosclerotic risk factors.
        Alcohol Clin Exp Res. 2010; 34 (Suppl): S54-S60
        • Oliveira e Silva E
        • Foster D
        • Harper M
        • et al.
        Alcohol consumption raises HDL cholesteorl levels by increasing the transport rate of apolipoproteins A-I and A-II.
        Circulation. 2000; 102: 2347-2352
        • van der Gaag M.S.
        • van Tol A.
        • Vermunt S.H.F.
        • Scheek L.M.
        • Schaafsma G.
        • Hendriks H.F.J.
        Alcohol consumption stimulates early steps in reverse cholesterol transport.
        J. Lipid Res. 2001; 42: 2077-2083
        • Rosales C
        • Gillard BK
        • Gotto Jr., AM
        • Pownall HJ.
        The alcohol–high-density lipoprotein athero-protective axis.
        Biomolecules. 2020; 10: 987