Does alcohol intake increase low-density lipoprotein (LDL) cholesterol and triglycerides?

Alcohol's Effect on Cholesterol

Alcohol intake does not increase LDL cholesterol—in fact, it decreases LDL cholesterol while increasing HDL cholesterol and triglycerides. 1, 2

Effects on LDL Cholesterol

• Alcohol consumption is associated with lower LDL cholesterol levels in a dose-dependent manner. 2, 3
• In a 5-year cohort study of 933 Japanese men, those consuming 69.0 g/day or more of ethanol had a 46% lower risk of developing elevated LDL cholesterol compared to non-drinkers (relative risk 0.54, p < 0.001). 3
• Multiple studies demonstrate that alcohol intake shows a significant negative relationship with LDL cholesterol levels, independent of age, body mass index, and smoking status. 4
• The reduction in LDL cholesterol appears stronger with higher alcohol intake, showing an inverse dose-response relationship. 2, 3

Effects on HDL Cholesterol

• Alcohol increases HDL cholesterol by approximately 12% with 1-2 drinks per day. 1
• This HDL elevation occurs at all time points measured and results in a more favorable HDL-to-LDL ratio. 5, 4
• The HDL-raising effect is similar to that achieved with exercise programs and fibric acid medications. 1

Effects on Triglycerides

• Alcohol increases plasma triglyceride levels, particularly in individuals with underlying hypertriglyceridemia. 1
• The mechanism involves increased triglyceride production and secretion in very-low-density lipoprotein (VLDL). 1
• Obese individuals are more susceptible to alcohol-induced hypertriglyceridemia, with 4 out of 6 obese patients developing increased triglycerides versus only 1 out of 6 lean individuals. 6
• At moderate intakes (up to 1 oz daily), some studies show no association with triglycerides, while higher intakes consistently elevate levels by 5-10%. 1
• In patients with severe hypertriglyceridemia, complete alcohol abstinence is strongly recommended to reduce pancreatitis risk. 1

Critical Clinical Caveats

Do Not Recommend Alcohol for Lipid Management

• Despite favorable effects on LDL and HDL cholesterol, alcohol should never be recommended as a cardiovascular protection strategy. 2
• No clinical trials have verified that alcohol can be used to improve lipid profiles therapeutically. 1, 2
• The adverse effects of alcohol—including cardiomyopathy, hypertension, hemorrhagic stroke, cardiac arrhythmia, sudden death, liver disease, and cancer—outweigh any lipid benefits. 1, 2

Special Populations at Risk

• Patients with metabolic syndrome or metabolic dysfunction-associated steatotic liver disease (MASLD) may have complex interactions with alcohol that worsen metabolic risk. 2
• Chronic high alcohol intake and binge drinking disrupt metabolic balance and increase cardiovascular disease risk despite favorable lipid changes. 2
• Individuals with genetic susceptibility to liver disease combined with obesity/diabetes face accelerated liver disease progression with alcohol use. 2

Interaction with Smoking

• Cigarette smoking can completely negate the HDL-raising benefits of moderate alcohol consumption. 7
• In smokers consuming more than 10 cigarettes per day, alcohol's effect on LDL cholesterol is reversed—LDL decreases rather than the typical pattern seen in non-smokers. 7

Summary of Lipid Effects

The lipid profile changes with alcohol are:

• LDL cholesterol: Decreases (dose-dependent reduction) 2, 3, 4
• HDL cholesterol: Increases (~12% with 1-2 drinks/day) 1, 2
• Triglycerides: Increase (especially in obese individuals and those with baseline hypertriglyceridemia) 1, 6
• HDL/LDL ratio: Improves (becomes more favorable) 5, 4