A LARGE cohort study in Japan has revealed that stopping alcohol consumption is associated with increased LDL (“bad” cholesterol) and decreased HDL (“good” cholesterol), while starting moderate drinking modestly improves lipid profiles, challenging assumptions about alcohol abstinence and cardiovascular risk.
The relationship between alcohol consumption and cholesterol levels remains contentious, with previous studies suggesting moderate intake may benefit HDL levels but heavy drinking worsens lipid profiles. This study aimed to clarify how initiating or stopping alcohol affects cholesterol in real-world settings outside controlled interventions. As debates continue over alcohol’s role in heart health, these findings highlight the need for nuanced approaches to lipid management when individuals alter drinking habits.
The decade-long study analysed 328,676 annual health check-ups from 57,691 Japanese adults (mean age 46.8; 53% female) between 2012–2022. Participants on lipid-lowering medications were excluded. Researchers tracked LDL and HDL changes following alcohol initiation or cessation, defining one standard drink as 10g of ethanol. Among 25,144 participants who stopped drinking, those previously consuming ≥3 drinks/day saw LDL rise by 6.53 mg/dL (95% CI: 5.14–7.91) and HDL fall by 5.65 mg/dL (95% CI: -6.28 to -5.01). Light drinkers (≤1.5 drinks/day) experienced smaller LDL increases (1.10 mg/dL) and HDL declines (-1.25 mg/dL). Conversely, alcohol initiation correlated with LDL reductions up to 4.2 mg/dL and HDL gains of 3.8 mg/dL in new moderate drinkers. The dose-dependent effects were consistent across consumption levels.
These results underscore the complexity of alcohol’s impact on lipid metabolism. For clinical practice, the findings suggest lipid monitoring is crucial for patients altering alcohol intake, particularly abstainers, who may require proactive cholesterol management despite overall health benefits of quitting. However, experts caution that former heavy drinkers in the cessation group could skew results, as prior alcohol-related damage might confound lipid changes. Future research should explore long-term cardiovascular outcomes and differentiate between voluntary abstinence and health-driven cessation. Clinicians must balance these findings against alcohol’s well-documented risks, including liver disease and cancer, emphasising that no level of consumption is entirely safe.
Katrina Thornber, EMJ
Reference
Suzuki T et al. Lipid profiles after changes in alcohol consumption among adults undergoing annual checkups. JAMA Netw Open. 2025;8(3):e250583.
