European Journal of Cardiovascular Medicine

Alcohol use disorder (sometimes called alcoholism) is a common medical condition. People with this condition can’t stop drinking, even if their alcohol use upends their lives and the lives of those around them. Alcohol use disorder can be mild, moderate or severe. Treatments may include medication and behavioral therapy. While people with this condition may start drinking again, studies show that with treatment, most people are able to reduce how much they drink or stop drinking entirely.¹ The American Medical Association recommends a two-drink daily limit for men. Heavy drinking in this population is five or more drinks in one day or 15 or more drinks in a week. Women should limit drinking to one drink a day. Heavy drinking in this population is four or more drinks a day or eight drinks a week.

In 2025, the WHO reports that alcohol consumption remains a significant risk factor for cardiovascular diseases (CVDs), including heart disease, stroke, and heart failure. While some observational studies have suggested a potential protective effect of moderate alcohol consumption on certain CVDs, the World Heart Federation strongly advises that no amount of alcohol is beneficial for heart health. An estimated 474 000 deaths from cardiovascular diseases were caused by alcohol consumption in 2019.² The agent which people start using alcohol has also declined,³ Population studies elevated a positive correlation between alcohol intake and plasma high density lipoprotein and triglycerides,^4,5 The coronary artery disease has been reported to decrease with moderate drinking in both the sex but such benefit disappears with high consumption.^6,7 Heavy alcohol consumption for prolonged periods result in marked perturbation of the lipid transport system, reflecting both effects of alcohol on lipid metabolism in hepatic and extra hepatic issue, as well as it’s marked toxic effects on liver function.⁸  And also some studies were reported that low-to-moderate alcohol consumption has been associated with cardiovascular health benefits in observational ^9,10,11 and experimental studies ^12,13, but the mechanism is still unclear. Alcohol consumption may introduce a cardiovascular benefit by improving an individual’s lipid profile, including an effect on HDL-c levels, HDL particle concentration, and HDL-c sub fractions ^14,15. The relationship between low-to-moderate alcohol use and LDL-c or TG is less clear, with studies reporting reduced LDL-c or TG levels ¹⁶, no effect ¹⁴, or a worsened blood lipid profile ^17,18.

So dyslipidemia is a significant concern associated with alcohol consumption, despite its known effect of increasing high-density lipoprotein (HDL) cholesterol. Observational studies have consistently shown that alcohol consumption is linked to elevated levels of low-density lipoprotein (LDL) cholesterol and triglycerides, which can have detrimental effects on morbidity and mortality. This study aims to investigate the distribution of lipid profiles in chronic alcoholics, with a focus on identifying potential lipid abnormalities that may contribute to increased health risks. So that early interventions can be implemented to mitigate the adverse effects of alcohol consumption on cardiovascular health and reduce the overall health burden in our set up.

This observational study was conducted at the Department of General Medicine, Guntur Medical College, Guntur, over a period of six months, from January 2025 to June 2025. The study included patients chronic alcoholics and non alcoholics, attending the General Medicine OPD, who met the inclusion criteria:- 1. Test subjects include 50 males of age 30 - 50 yrs who are chronic alcoholics and Control subjects include 50 males of age 30 - 50 yrs who are non alcoholics. Exclusion criteria: Patients with clinical evidence of  Diabetes mellitus, Hypertension, Renal disease, Liver disease other than alcoholic liver disease, Pancreatitis,  Malnutrition,  Family history of hyperlipidemia, subjects on drugs affecting lipid metabolism and  females. The study aimed to: 1.Determine the socio-demographic profiles of the study subjects 2. To study the distribution of lipid profiles in association with type & duration of alcoholism.

After obtaining ethical committee clearance, data was collected using a pretested proforma, including: Socio-demographic profiles like age & weight, h/o Hypertension and Diabetes, distribution of lipid profiles in association with hypertension, diabetes and type & duration of alcoholism etc;  The collected data was analyzed using statistical tools, including: Percentages and proportions, Measures of central tendency and dispersion, Standard error of the mean, Correlation coefficient,Tests of significance etc; The study results were compared in the light of published literature of various authors  and discussed to draw conclusions and recommendations.

Table 1: Age & Weight wise distribution of study subjects

    Alcoholics Mean ± SD = 40.13±5.20 Vs Non-Alcoholics Mean ± SD = 40.17±6.19,(P>0.05)

 Similar distribution was observed among both the groups related to age & weight and majority about 56 % of alcoholics were observed between 36 – 45 years of age with the mean age 49 years and more number of alcoholics were present between 61 – 70 kg of weight with the mean 66.5 kg  in this study.

Table 2: Distribution of Mean Blood Pressure among Alcoholics Vs Non-Alcoholics

There was no significant (P>0.01) difference observed between the two groups of alcoholics Vs non alcoholics related to mean blood pressure distribution in this study.

Table 3: Distribution of Lipid Profiles among Alcoholics Vs Non alcoholics

It was observed that there was a highly significant (P<0.01) difference observed among alcoholics Vs non alcoholics related to distribution of Lipid profile with reference to moderate rise of total cholesterol (190 Vs 150), triglycerides (206 Vs 111), HDL (43 Vs 37) and VLDL (41 Vs 22) and mild rise of LDL (106 Vs 98) observed among alcoholics.

Table 4: Distribution of Lipid Profiles according to duration of alcoholism

With regard to Duration of alcoholism there was a significant (P<0.05) difference observed between alcoholics of <10 years & >10 years of duration  related to distribution of  Lipid profile viz. total cholesterol, triglycerides & LDL which were increased among alcoholics of prolonged duration.

Table 5: Distribution of Lipid profiles according to type of alcoholic

With reference to type of alcoholic there was highly significant (P<0.01) difference observed between alcoholics of moderate drinkers and heavy drinkers related to distribution Lipid profile viz. among heavy drinkers there was significant increased levels of total cholesterol (214 Vs 154), triglycerides (254 Vs 132), LDL (123 Vs 80) and VLDL (51 Vs 26) except HDL (40 Vs 47) in which mild decreased was observed.

This study observed a similar distribution among both groups regarding age and weight, with the majority of alcoholics (56%) between 36-45 years old and a mean age of 49 years. Notably, a larger number of alcoholics weighed between 61-70 kg. These findings align with George S et al.,¹⁹ who reported that most study subjects were between 41-50 years old.

No significant difference was observed in mean blood pressure distribution between alcoholics and non-alcoholics in this study. A significant difference (P<0.01) was observed between alcoholics and non-alcoholics regarding lipid profile distribution. Alcoholics exhibited a moderate increase in: Total cholesterol (190 vs. 150), Triglycerides (206 vs. 111), HDL (43 vs. 37), VLDL (41 vs. 22),LDL (106 vs. 98) showing a mild increase. These findings correlate with studies by Drago et al.,²⁰ Vaswani et al.,²¹ and Vu KN et al.²²Additionally, X.X. Li et al. (2018)²³ observed a significant rise in triglycerides among alcoholics. But in contrary to this the study done by Scott Q Siler et al.,²⁴ which showed an increase in VLDL cholesterol production after alcohol consumption whereas the study by William P et al.,²⁵ showed an increase of HDL levels among alcoholics which were similar to our study results. And Hao G et al.,²⁶ also reported that there was an increase of HDL cholesterol levels among those who have been taking alcohol <30g/day.

A significant difference (P<0.05) was observed between alcoholics with <10 years and >10 years of duration regarding lipid profile distribution. Alcoholics with prolonged duration (>10 years) showed increased levels of: Total cholesterol, Triglycerides and LDL.

A highly significant difference (P<0.01) was observed between moderate drinkers and heavy drinkers regarding lipid profile distribution related to type of alcoholic. Heavy drinkers exhibited significantly increased levels of: Total cholesterol (214 vs. 154),Triglycerides (254 vs. 132) ,LDL (123 vs. 80) and  VLDL (51 vs. 26) except for HDL which showed a mild decrease (40 vs. 47). These results are consistent with studies by Arun Lakshmipathy et al.,²⁷ L Feinman and Charles S Lieber et al.,²⁸ Goldberg et al.,²⁹ Sheethal et al.,³⁰ Vaswani et al.²¹, Vasisht et al.,³¹ Suzuki et al.,³² Hao G et al.,²⁶ and Hyejin Park et al.,³³  And in 2019 during health checkups in Japan also observed the same. Interestingly, it is the light HDL particles that are most consistently associated with cardiac protection. Therefore, it is unlikely that the effect of alcohol consumption on HDL species provides a simple and complete explanation for the relation between alcohol consumption and coronary artery disease. However, nutritional habits, lower cardiovascular risk and higher social status linked to a wine consumption pattern could induce a more favorable blood lipid profile. In contrast, high alcohol intake is associated with high blood pressure, high waist hip ratio, the rise of triglyceride levels and unfavorable lifestyle, bad behaviors such as smoking habits and low physical activity  which will adversely effects the cardiovascular health etc.

LIMITATIONS

The hospital-based design and small sample size of this study may limit the generalizability of the findings to the broader population.

The relationship between alcohol consumption and cardiovascular health is complex. While moderate alcohol consumption may offer some benefits, such as increased HDL levels, excessive drinking can lead to significant cardiovascular risks, including hypertension, atrial fibrillation, and unfavorable lipid profiles. Nutritional habits, lifestyle, and social status may also influence the relationship between alcohol consumption and cardiovascular health.^34,35

Chronic and heavy alcohol consumption has been strongly linked to the development of dyslipidemia, a condition characterized by abnormal lipid profiles. Given the significant health implications of dyslipidemia, including increased risk of cardiovascular disease, it is crucial to address alcohol consumption patterns in high-risk populations. Given the risks associated with alcohol consumption, complete abstinence is advisable for individuals with a history of heavy or chronic drinking. Moderate drinking: For those who find abstinence challenging, adherence to moderate drinking guidelines, as outlined by the American Heart Association (AHA), is recommended.

Public Health Implications:

To mitigate the risk of dyslipidemia and its consequences, regular mass awareness programs and de-addiction campaigns should be conducted targeting: High-risk populations: Individuals with a history of chronic or heavy alcohol consumption, as well as those with existing dyslipidemia or cardiovascular disease. Community-based interventions: Public health initiatives should focus on promoting healthy lifestyle choices, including responsible alcohol consumption and lipid profile monitoring.

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