High-density lipoprotein functionality, cardiovascular health, and patterns of alcohol consumption: new insights and future perspectives

Abstract

Purpose of review Cardiovascular diseases (CVD) pose a significant public health challenge, contributing to 422 million disability-adjusted life years in 2021. The role of high-density lipoproteins (HDL) and alcohol consumption, one of their major modifiable determinants, remains controversial. The objective of this review is to provide a comprehensive narrative overview of HDL functionality and its predictive value for CVD in relation to patterns of alcohol consumption. Recent findings HDL phenotypes beyond HDL-cholesterol (HDL-c) such as distribution of HDL subspecies, HDL particle abundance, and reverse cholesterol transport capacity are promising indicators of atherosclerotic CVD risk. Low-to-moderate alcohol consumption seems to improve HDL functionality and reduce the incidence of CVD among primarily middle-aged men and postmenopausal women. Advancements in our understanding of HDL biogenesis, structure, and function hold promise for improving HDL-related measures and their predictive value for cardiovascular health. Summary Low-to-moderate alcohol consumption appears to not only increase HDL-c concentration found in the HDL fraction of plasma but also enhance HDL functionality, providing insights into the underlying mechanisms linking alcohol exposure and cardiovascular health benefits. However, rigorous, well designed intervention trials of alcohol consumption on hard cardiovascular outcomes are needed to identify robust causal associations of HDL phenotypes and alcohol consumption with cardiovascular risk.

Alcohol Consumption, High-Density Lipoprotein Particles and Subspecies, and Risk of Cardiovascular Disease: Findings from the PREVEND Prospective Study

“…Several of our findings deserve explanation. The increase in HDL-C, HDL-P, large and medium HDL, HDL size, and some HDL subspecies with increasing alcohol consumption likely reflects the combined effects of stimulation of Apo-AI synthesis [30], stimulation of the reverse cholesterol transport pathway reflected by an increase in cholesterol efflux capacity [28,31], inhibition of concentration and activity of CETP at high alcohol consumption [32], and enhanced lipoprotein lipase activity [33,34]. These pathways reflect HDL functionality and may potentially account for the protective effect of occasional to light alcohol consumption on cardiovascular risk.…”