Atherosclerosis 152 2000 503 – 510
Alcohol consumption and its relation to lipid-based cardiovascular risk factors among middle-aged women: the role of HDL
3
cholesterol
Pekka Sillanaukee
a,b,c,
, Timo Koivula
a
, Hannu Jokela
a
, Timo Pitka¨ja¨rvi
d
, Kaija Seppa¨
a
a
Departments of Clinical Chemistry and Psychiatry, Uni6ersity of Tampere, Medical School and Tampere Uni6ersity Hospital, Tampere, Finland
b
Pharmacia Upjohn Diagnostics AB, Alcohol Related Diseases, Uppsala, Sweden
c
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
d
Tampere City Health Center, Tampere, Finland Received 12 May 1999; received in revised form 8 November 1999; accepted 16 December 1999
Abstract
To study the association of alcohol consumption and lipid-based cardiovascular risk factors among middle-age women, cross-sectional analysis among 274 middle-aged healthy women with different drinking habits and a follow-up analysis of
alcoholic women during abstinence was performed. Serum total cholesterol, low and high-density lipoprotein cholesterol LDL and HDL cholesterol, triglycerides TG, apolipoproteins A1 Apo A1 and B Apo B, and HDL-cholesterol subfractions 2
HDL
2
and 3 HDL
3
were measured. All lipid values except LDL cholesterol positively correlated with self-reported alcohol consumption. When alcoholics were excluded the correlation was significant only for HDL cholesterol, HDL
3
, and Apo A1. The increasing trend of HDL cholesterol, HDL
3
and Apo A1 were clearly seen first in women consuming \ 20 – 40 gday of absolute alcohol. Alcohol consumption \ 40 gday increased all lipid values except LDL cholesterol. Abstinence for 2 weeks caused a
significant decrease in HDL
3
cholesterol, and an increase in LDL cholesterol and Apo B. The results indicate that among middle-aged women the Apo A1 and HDL cholesterol via its HDL
3
but not HDL
2
subfraction might play a role in the beneficial coronary consequences associated with moderate alcohol consumption. However, the increasing beneficial trend first appears when
daily drinking exceeds 20 gday. © 2000 Elsevier Science Ireland Ltd. All rights reserved.
Keywords
:
Alcohol consumption; Apo A1; Apo B; Cardiovascular risk; Cholesterol; HDL
3
cholesterol; HDL
2
cholesterol www.elsevier.comlocateatherosclerosis
1. Introduction
Epidemiological studies have shown a negative asso- ciation between alcohol consumption and the risk of
developing coronary artery disease CAD [1 – 4]. Over a broad range of alcohol consumption the relationship
to all-cause mortality seems to be J-shaped [5 – 7]. This issue is not only due to individuals at high risk becom-
ing nondrinkers [8,9] but because studies have sug- gested a beneficial association between moderate
alcohol consumption and atherosclerosis progression and incidence events [10 – 13]. Furthermore, it has been
shown that alcohol consumption may protect against severe coronary atherosclerosis [14]. Excessive alcohol
use, however, has obvious detrimental effects on the cardiovascular system [12,13,15,16].
The mechanism through which alcohol might exert its protective effect remains unclear. Population studies
have shown that moderate alcohol consumption usually does not change proatherogenic low-density lipoprotein
LDL levels but high consumption may even decrease the level [17]. High-density lipoproteins HDL choles-
terol, however, unlike other lipids show a dose-depen- dent relationship to alcohol intake [18 – 20]. Because
HDL cholesterol is thought to play an important role in preventing atherosclerosis [21 – 23], the main hypoth-
Corresponding author. Present address: Oy Finnish Immunotech- nology Ltd., Lenkkeilija¨nkatu 8, 33 520 Tampere, Finland. Tel.
+ 358-3-31387000; fax + 358-3-31387050.
E-mail address
:
finnish-immunotech.com P. Sillanaukee. 0021-915000 - see front matter © 2000 Elsevier Science Ireland Ltd. All rights reserved.
PII: S0021-91500000369-5
esis has been that alcohol protects via increasing HDL cholesterol [23].
Total HDL cholesterol offers useful but incomplete information about HDL’s clinical significance [24].
Subfraction quantitation may not only provide data of the degree of risk of coronary artery disease, but
may also yield new information about the mecha- nisms for the apparent antiatherogenic effects of
HDL. Initially only HDL
2
was considered protective against CAD [25,26], but several studies show that
both, HDL
2
and HDL
3
, may be inversely related to coronary artery disease [25 – 28].
The effect of alcohol consumption on HDL sub- fractions among males is not clear. Some studies
show the effect of alcohol on HDL
3
[29,30] and some also on HDL
2
[31,32]. It has also been hypothesized that heavy drinking preferentially increases HDL
2
and moderate drinking augments HDL
3
[33]. Results also show that Apo A1 levels rise with alcohol consump-
tion [34]
and that
they may
protect against
atherosclerosis even better than HDL cholesterol does [35].
Little is known about alcohol consumption and its relation to lipid-based cardiovascular risk factors
among women. In large cohorts of women, HDL cholesterol is the lipoprotein most strongly associated
with CAD [36,37]. However, women answering sur- veys are particularly likely to underestimate their al-
cohol intake [38], and few studies have included either alcoholics or methods for measuring alcohol use that
are adequate for obtaining reliable data. The present population based cross sectional study focuses on
lipid values among women, employs a detailed history of alcohol use and includes also women with high
alcohol consumption. The effect of 2 weeks cessation of alcohol consumption on lipids was studied, too.
2. Subjects and methods
