Serum lipids in alcoholics

Haemolytic anaemia in alcohol abuse. A review of 14 cases

Clinical and haematological data on 14 patients (8 women and 6 men) with alcohol-induced haemolytic anaemia and mild to moderate liver injury are presented. Nine of the patients were obvious drinkers, while 5 were socially well adjusted individuals in whom alcohol dependence was not suspected on admission to hospital. Four patients presented with a typical Zieve's syndrome. Two further patients had a moderate transient stomatocytosis, as assessed by microscopy of dried blood smears and by scanning electron microscopy. The majority of the patients, however, did not fit into any of the syndromes proposed in the literature. Indeed, the validity of both Zieve's syndrome and the "transient stomatocytosis with hemolysis" syndrome is questioned.

Alcohol and lipids

Alcoholic fatty liver and hyperlipemia result from the interaction of ethanol and its oxidation products with hepatic lipid metabolism. An early target of ethanol toxicity is mitochondrial fatty acid oxidation. Acetaldehyde and reactive oxygen species have been incriminated in the pathogenesis of the mitochondrial injury. Microsomal changes offset deleterious accumulation of fatty acids, leading to enhanced formation of triacylglycerols, which are partly secreted into the plasma and partly accumulate in the liver. However, this compensatory mechanism fades with progression of the liver injury, whereas the production of toxic metabolites increases, exacerbating the lesions and promoting fibrogenesis. The early presence of these changes confers to the fatty liver a worse prognosis than previously thought. Alcoholic hyperlipemia results primarily from increased hepatic secretion of very-low-density lipoprotein and secondarily from impairment in the removal of triacylglycerol-rich lipoproteins from the plasma. Hyperlipemia tends to disappear because of enhanced lipolytic activity and aggravation of the liver injury. With moderate alcohol consumption, the increase in high-density lipoprotein becomes the predominant feature. Its mechanism is multifactorial (increased hepatic secretion and increased extrahepatic formation as well as decreased removal) and explains part of the enhanced cholesterol transport from tissues to bile. These changes contribute to, but do not fully account for, the effects on atherosclerosis and/or coronary heart disease attributed to moderate drinking.

Serum lipids and acyl group composition of alcoholic patients

The lipid content and acyl group composition of serum from a group of alcoholic patients at a VA Medical Center were compared to control subjects sampled either from University of Missouri personnel or from subjects who were undergoing a preemployment physical examination at the same VA Medical Center. Plasma of alcoholic patients indicated an elevated triacylglycerol level (24-35%) as compared to both control groups. In addition, the acyl groups of triacylglycerols of alcoholic patients showed a markedly lower proportion of 18:2 and a higher proportion of 18:0 and 18:1 as compared to the control groups. The level of phosphatidylcholines in the plasma of alcoholic patients was not different from controls. However, acyl group composition of phosphatidylcholines from alcoholics indicated a lower proportion of 22:6 (n-3) as compared to controls. Although the cholesteryl ester level in serum was higher in alcoholics than in controls, the difference did not reach a level of significance. There was a similar decrease in 18:2 and an increase in 18:0 in cholesteryl esters of alcoholics as compared to controls. Results indicate that alcoholics in the United States show a similar change in certain serum lipids as reported for the Swedish alcoholics. This study also shows the complexities involved in selecting appropriate control groups to be compared with alcoholic patients.

Accelerated turnover of very low density lipoprotein triglycerides in chronic alcohol users. A possible mechanism for the up-regulation of high density lipoprotein by ethanol

The concentration of high density lipoproteins (HDL) is related to the catabolism of triglyceride-rich lipoproteins. In order to elucidate the mechanisms by which alcohol increases plasma HDL levels we measured the turnover kinetics of very low density lipoprotein (VLDL) triglycerides in 10 alcoholic men without liver disease and in nonalcoholic control men matched for age, weight and plasma VLDL triglyceride level. The study was repeated in the alcoholics after a 2-week abstinence period. The alcoholic men had elevated HDL cholesterol but reduced low density lipoprotein (LDL) cholesterol as compared to the controls. The fractional catabolic rate and the total turnover (production) rate of VLDL triglycerides were both significantly increased (P less than 0.05) in the alcoholic men before abstinence. After withdrawal of alcohol both the synthetic rate and the catabolic rate of VLDL triglycerides returned to normal and the HDL (HDL2 and HDL3) cholesterol fell. The per cent decrease in HDL2 cholesterol during abstinence was positively correlated to the respective fall of VLDL triglyceride fractional catabolic rate (r = +0.51). The results suggest that the absence of hypertriglyceridemia and the elevated levels of HDL in regular alcohol users may be partly based on increased metabolic clearance of VLDL particles and on subsequent accelerated transfer of the VLDL surface components to HDL.

Post-heparin lipolytic activities and alterations of the chemical composition of high density lipoproteins in alcohol-induced type V hyperlipidemia

In order to study the effects of chronic alcoholism, 3 groups of patients were investigated and compared to 10 healthy controls. Group I consisted of 9 heavy drinkers, who exhibited type V hyperlipidemia (HLP) under alcohol intake. Group II consisted of 7 patients, who previously had type V HLP under the influence of alcohol. At the time of the investigation, however, they had ceased alcohol drinking for at least 6 months and were normolipidemic. Group III consisted of 7 heavy drinkers without hyperlipidemia. Compared to controls, group I had significantly decreased plasma concentrations of high density lipoproteins2 (HDL2) and HDL3 (both P less than 0.01); activities of post-heparin lipoprotein lipase (LPL) and hepatic lipase (HTGL) as well were excessively decreased (both P less than 0.01). In group III LPL was also decreased (P less than 0.01), but HTGL was distinctly (P less than 0.01) higher than in controls. No such differences could be demonstrated for the patients of group II. Acute alcohol withdrawal from a patient suffering from alcoholism with HLP led to a sharp increase of LPL with a simultaneous decrease of VLDL within 2 days and a more delayed increase of LDL, HDL2 and HTGL, all reaching normal values within 12 days after cessation of alcohol drinking. With respect to the apolipoprotein (apo) composition of HDL2, patients of group I and group III exhibited a significantly lower percentual content of apo C-I at the expense of a significantly higher content of apo A-II as compared to controls and patients of group II. In group I and II, the percentual content of apo D in HDL2 was significantly higher than in controls and in group III. It is concluded that severe alcohol intake strongly impairs LPL in patients with HLP. The pronounced increase of HTGL in some patients (group III) may protect these individuals from HLP. The increased content of apo D in HDL2 may be a possible primary trait for alcohol-inducible HLP.

[Reduction of post-heparin lipoprotein lipase activity by acidotic blood pH]

Diseases associated with acidotic blood-pH, such as chronic renal disease, diabetes mellitus or chronic alcoholism, show a marked impairment of lipoprotein lipase. Therefore we influenced blood-pH in 3 healthy subjects by infusions to get alkalotic, neutral and acidotic blood-pH on three days in series. On each day blood-pH from capillary blood and post-heparin lipoprotein lipase from fasting plasma was determined. In comparison to neutral blood-pH in vivo, alkalosis did not influence lipoprotein lipase. In contrast, during artificial acidosis, lipoprotein lipase was impaired significantly (p less than 0.01). Therefore, it seems, that acidosis inhibits lipoprotein lipase in vivo.

Serum lipids and lipoproteins during abstinence after heavy alcohol consumption in chronic alcoholics

Serum lipids, liver function tests and liver histology were studied during a withdrawal period in sixty-one male chronic alcoholics with a well-documented earlier clinical history. In these alcoholics with a mean daily ethanol consumption of 340 g during the débauche, the FFA were initially high and decreased during the first week, concomitantly with an increase in serum triglycerides. 38% of the patients had a type IV hyperlipoproteinaemia with elevated serum triglycerides still after 17 days of abstinence. 51% were normolipidaemic at that time. The cholesterol content in the alpha-lipoproteins were initially elevated and normalized during the first week of abstinence. No relationships were observed between serum lipids and liver function tests or degree of liver steatosis or alcohol consumption. The present findings stress the importance of stating the duration of abstinence in studies of biochemical changes after withdrawal.

Coffee, alcohol and risk of coronary heart disease among Japanese men living in Hawaii

We examined the relation of coffee and alcohol consumption to the risk of coronary heart disease during a six-year period in a cohort of 7705 Japanese men living in Hawaii. The analysis was based on 294 new cases of coronary heart disease. There was a positive association between coffee intake and risk, but it became statistically insignificant when cigarette smoking was taken into account. There was a strong negative association between moderate alcohol consumption (up to 60 ml per day), mainly from beer, and the risk of nonfatal myocardial infarction and death from coronary heart disease. This association remained significant in multivariate analysis, taking into account smoking and other risk factors. The correlation of alcohol consumption with the level of alpha cholesterol (positive) and beta cholesterol (negative) may partly account for the observed negative association between alcohol and coronary heart disease.