The effects of alcohol Intake on serum Hpids and lipoproteins depend on the dose and mode of alcohol intake, indlvfduat susceptibitlty, genetic variables, and dktsry factors. Therefore the changes of lrpoprotein pattern are merent among moderate and heavy drinkers. Moderate Wake of alcohol increases the concentrations of apottpoproteins (ape) Al, apo All, and high-density lipoprotein subfraction (HD4) in piasma without any effects on other Hpoproteins. If alcohol intake exceeds 60 to 80 gm per day, the synthesis of very lo&density lipoprotein (VLDL) partkies is stimulated. Even short-term use of akohol stimulates Upoprptein Ilpase (LPL) actlvity ‘in adipose tissue, and consequently the concentration of VLDL In plesma stays normal or is even subnormal. If alcohol intake cantinues in excessive amounts, the increased transport rate of VLDL particles as a result of high LPL acthrity results in the up regulation oEHDL,. This 1s clearly evident in chronic alcoholics. Low or subnormal low-density lipoprotein (LDL) levels are another characteristic of the lipoprotein pattern in chronk afcoholks. The increase of HDL (HDL?) and reduction of LDL levels could well explain the reduced risk of coronary heart disease In chronic akoholcs, whereas the causal factors remain open among moderate drinkers. (AM HEART J lgS7; 113458.) Marja-Riitta Taskinen, M.D., * Esko A. Nikkilii, M.D., Matti Viilimiiki, M.D., Timo Sane, M.D., Timo Kuusi, M.D., Y. Antero Kesliniemi, M.D.,* and Rein0 Ylikahri, M.D.** Helsinki, Finland The recognition of an association between alcohol intake and coronary heart disease’ has prompted an increasing interest in alcohol-induced changes in serum lipids and lipoproteins. Cross-sectional popu- lation studies2-6 have shown that the amount of alcohol consumption correlates positively with the concentration of high-density lipoprotein (HDL) cholesterol. On an individual level, regular intake of alcohol increases the HDL cholesterol level, as is clearly evident in chronic alcoholics, whereas absti- nence is followed by a decliae of HDL cholesterol.7-11 These changes have mainly occured in HDL, choles- terol.“, l2 In contrast, the response of the major HDL subfractions to moderate doses of alcohol is less clear,13 and recent cross-sectional studies14 suggest that the HDL, level is elevated, whereas no change occurs in the HDL,. Similarly, Haskell et a1.15 observed a fall of HDL, mass after abstention in From the *Second and Third Departments of Medicine and **Research Unit of Alcohol Diseases, University of Helsinki. Supported by grants from the Sigrid Juselius Foundation, the Finnish State Alcohol Monopoly (Alko), the Medical Research Council of the Academy of Finland, and the Paavo Nurmi Foundation, Helsinki, Fin- land. Reprint requests: Marja-Riitta Taskinen, M.D., Second Department of Medicine, University of Helsinki, Haartmaninkatu 4, 00290 Helsinki, Finland. moderate drinkers. The resumption of drinking induced an increase in HDL, mass.15 It is rational to propose that an increase in HDL mediates the alcohol-induced protection from coronary heart dis- ease. However, this hypothesis does not explain the reduced risk of coronary heart disease in moderate drinkers without presuming that HDL, has similar antiatherogenic action to HDL,. PLASMA LIPOPROTEIN METABOLISM IN CHRONlC ALCOHOLICS Lipoprotein pattern end effect of alcohol withdrawal. We have recently conducted several studies”, 16, l7 to determine the characteristics of the lipoprotein pat- tern in chronic alcoholics and to define the mecha- nisms behind the observed changes. In alcoholic men with normal liver morphology and function the lipoprotein pattern was characterized by normal or subnormal very low-density lipoprotein (VLDL) tri- glyceride (TG), low low-density lipoprotein (LDL) cholesterol, and increased levels of HDL choles- terol.” Similar data have been reported in other studies.7-10 During alcohol withdrawal the HDL cho- lesterol level returned to normal in 2 weeks. The LDL cholesterol started to increase slightly but did not reach the normal range. Immediately following the drinking period the 458