BMJ 1998;316:1675 ( 30 May )

Letters

Effect of moderate alcohol consumption on Lp(a) lipoprotein concentrations

    Reduction is supported by other studies
    No effect seen in Australian drinkers
    Reduction is not found in women

Reduction is supported by other studies

EDITOR---We agree with Paassilta et al that there may be a relation between moderate alcohol consumption and lower Lp(a) lipoprotein concentrations.1 The relation between alcohol consumption and cardiovascular mortality is U shaped, with the lowest mortality at an alcohol consumption of 2-4 units (16-32 g) a day.2 Several mechanisms contribute to this cardioprotective effect including beneficial increases in high density lipoprotein cholesterol3 and inhibition of platelet aggregation.4 However, other factors may be involved. Lp(a) lipoprotein is a recognised independent risk factor for the development of atherosclerosis and, as stated by Paassilta et al, little attention has been directed to the effects of alcohol on Lp(a) lipoprotein.

In 1995 we reported a significant reduction in Lp(a) lipoprotein concentration in a prospective study of 20 healthy volunteers (men and women) given 21 g of alcohol daily for 10 days in the form of red wine (median (range) 186 (15-1420) mg/l v 132 (10-1210) mg/l, P<0.001).5 This reduction was not repeated when the same subjects were given white wine, raising the issue of potential differences between various alcoholic drinks. Interestingly, we found no changes in high density lipoprotein cholesterol concentrations.

We have conducted a larger unpublished crossover trial in 50 men comparing the effects of 3 units (24 g) of alcohol a day as red wine or vodka for 14 days on Lp(a) lipoprotein concentrations. Each period of alcohol consumption was preceded by two weeks' abstinence. Both drinks produced a 10-12% decrease in Lp(a) concentration (geometric mean 153 mg/100 ml v 135 mg/l after vodka, P<0.001; 151 mg/l v 136 mg/l after red wine, P<0.01). These results suggest that moderate alcohol consumption results in changes in Lp(a) lipoprotein which are independent of the type of alcoholic drink consumed. In conclusion, we agree with Paassilta et al that lower Lp(a) concentrations may be one factor conferring lower mortality and cardiovascular benefit in social drinkers.

Peter C Sharpe, Senior registrar in clinical biochemistry. 
Ian S Young, Consultant in clinical biochemistry. 
Department of Clinical Biochemistry, Queens University of Belfast and Royal Hospitals Trust, Belfast BT12 6BA

Alun E Evans, Professor of epidemiology. 
Division of Epidemiology, Queen's University of Belfast

  1. Paassilta M, Kervinen K, Rantala AO, Savolainen MJ, Lilja M, Reunanen A, et al. Social alcohol consumption and low Lp(a) lipoprotein concentrations in middle aged Finnish men: population based study. BMJ 1998; 316: 594-595[Free Full Text].(21 February.)
  2. Kannel WB, Ellison RC. Alcohol and coronary heart disease---the evidence for a protective effect. Clin Chim Acta 1996; 246: 59-76[Medline].
  3. Paunio M, Heinonen OP, Virtamo J, Klag MJ, Manninen V, Albanes D, et al. HDL cholesterol and mortality in Finnish men with special reference to alcohol intake. Circulation 1994; 90: 2909-2918[Abstract/Free Full Text].
  4. Renaud S, De Lorgeril M. Wine, alcohol, platelets and the French paradox for coronary heart disease. Lancet 1992; 339: 1523-1526[Medline].
  5. Sharpe PC, McGrath LT, McClean E, Young IS, Archbold GPR. Effect of red wine consumption on lipoprotein (a) and other risk factors for atherosclerosis. Q J Med 1995; 88: 101-108.

No effect seen in Australian drinkers

EDITOR---Paassilta et al suggest that a moderate intake of alcohol in Finnish men is associated with a roughly 50% reduction in median Lp(a) lipoprotein concentration.1 We have published relevant data from a large Australian cohort participating in an ongoing prospective study of cardiovascular disease (2805 subjects >= 60 years, average age 70 years). 2 3

Current alcohol intake was assessed by personal interview and classified as nil, 10-70 g/week, 80-140 g/week, 150-280 g/week, and >280 g/week (the last group in men only). The third and fourth groups correspond most closely with the middle and highest third of alcohol intake described by Paassilta et al.1 Lp(a) lipoprotein concentration was assessed by a sandwich enzyme linked immunosorbentassay (ELISA) with polyclonal sheep antibody raised against purified human apo(a) (TintElize Lp(a) Biopool, Sweden). The table shows median (interquartile range) Lp(a) lipoprotein and mean high density lipoprotein cholesterol concentrations by sex and alcohol intake.

                              
View this table:
[in this window]
[in a new window]
 

Median (interquartile range) Lp(a) lipoprotein and mean high density lipoprotein (HDL) cholesterol concentrations by sex and alcohol intake

There was no significant relation between Lp(a) lipoprotein concentration and alcohol intake in either sex. We drew similar conclusions when the data were examined in those below or above 70 years of age. The usual positive relation between alcohol intake and high density lipoprotein cholesterol was confirmed. Paassilta et al examined only 259 men aged 40-60 years. The median Lp(a) lipoprotein concentration in 37 teetotallers seemed high at 206 mg/l, and this may have been a spurious result. Surprisingly, they found no relation between alcohol intake and high density lipoprotein cholesterol concentration. Though we have reported that any alcohol intake in our cohort is associated with reduced coronary risk3 and raised Lp(a) lipoprotein concentration is associated with increased coronary risk,2 any link between alcohol intake and Lp(a) lipoprotein concentration seems unlikely.

Leon A Simons, Associate professor of medicine. 
Judith Simons, Analyst-programmer. 
University of New South Wales, Lipid Research Department, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia

  1. Paassilta M, Kervinen K, Rantala AO, Savolainen MJ, Lilja M, Reunanen A, et al. Social alcohol consumption and low Lp(a) lipoprotein concentrations in middle aged Finnish men: population based study. BMJ 1998; 316: 594-595. (21 February.)
  2. Simons LA, Friedlander Y, McCallum J, Simons J. Risk factors for coronary heart disease in the prospective Dubbo study of Australian elderly. Atherosclerosis 1995; 117: 107-118[Medline].
  3. Simons LA, McCallum J, Friedlander Y, Simons J. Alcohol intake and survival in the elderly: a 77 month follow-up on the Dubbo study. Aus NZ J Med 1996; 26: 662-670[Medline].

Reduction is not found in women

EDITOR---Paassilta et al showed a quantitative association between social alcohol consumption and low Lp(a) lipoprotein concentrations in middle aged men.1 As they indicated, we reported a negative qualitative association between drinking habits and Lp(a) lipoprotein concentrations in men.2 We report here the results of a quantitative analysis of the association between alcohol intake and Lp(a) lipoprotein concentration in the Jichi Medical School cohort study. During 1992-5 we collected population based data in rural districts in Japan. The 9532 subjects (3658 men and 5874 women), which included all subjects in our previous report, were divided into five categories by drinking status; non-drinkers, (963 men), former drinkers (140 men), drinkers in the lowest third of alcohol intake (<107 g/week; 711 men), drinkers in the middle third (107-224 g/week; 942 men), and drinkers in the highest third (>224 g/week; 902 men). Serum Lp(a) lipoprotein concentrations were measured with an enzyme linked immunosorbent assay (ELISA) and Lp(a) lipoprotein and triglyceride concentrations were calculated as geometric means. We used SAS software for statistical analysis.

The groups were similar regarding body mass index and total cholesterol concentrations. The mean age of former drinkers was higher than that of men in the other groups (analysis of variance P<0.0001). We therefore adjusted for age in all other analyses. Lp(a) lipoprotein concentration decreased with increased alcohol consumption in men except in former drinkers (table). Fibrinogen concentrations fell with increasing alcohol consumption (P<0.05).

                              
View this table:
[in this window]
[in a new window]
 

Mean atherosclerotic risk factors by alcohol consumption for men in the Jichi Medical School study, 1992-5 

For women the geometric mean Lp(a) concentrations were 148 mg/l in non-drinkers, 144 mg/l in former drinkers, 144 mg/l in lowest third, 136 mg/l in middle third, and 138 mg/l in highest third. There was no significant association between Lp(a) lipoprotein concentration and alcohol consumption (P=0.27). Fibrinogen concentrations decreased with increasing consumption (P<0.0001).

Our analysis shows a negative relation between alcohol consumption and and Lp(a) lipoprotein concentrations in men but not in women. These results support Paassilta et al's study and confirm our previous qualitative analysis.

Shizukiyo Ishikawa, Researcher. 
Tadao Goto, Researcher. 
Naoki Nago, Visiting lecturer. 
Department of Community and Family Medicine, Jichi Medical School, Minamikawachi, Kawachi, Tochigi, Japan

  1. Paassilta M, Kervinen K, Rantala AO, Savilainen MJ, Lilja M, Reunanen A, et al. Social alcohol consumption and low Lp(a) lipoprotein concentrations in middle aged Finnish men: population based study. BMJ 1998; 316: 594-595. (21 February.)
  2. Nago N, Kyaba K, Hiraoka J, Matsuo H, Goto T, Kario K, et al. Lipoprotein(a) levels in the Japanese population: influence of age and sex, and relation to atherosclerotic risk factors. Am J Epidemiol 1995; 141: 815-821[Abstract/Free Full Text].
© BMJ 1998
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

Related Article

Social alcohol consumption and low Lp(a) lipoprotein concentrations in middle aged Finnish men: population based study
Marita Paassilta, Kari Kervinen, Asko O Rantala, Markku J Savolainen, Mauno Lilja, Antti Reunanen, and Y Antero Kesäniemi
BMJ 1998 316: 594-595. [Full Text] [PDF]

This article has been cited by other articles:

  • Nanchahal, K., Ashton, W D., Wood, D. A (2000). Alcohol consumption, metabolic cardiovascular risk factors and hypertension in women. Int J Epidemiol 29: 57-64 [Abstract] [Full text]  

Student BMJ

Risk of surgery for inflammatory bowel disease: record linkage studies

What can you learn from this BMJ paper? Read Leanne Tite's Paper+

www.student.bmj.com

Listen to the latest BMJ Interview