The effect of ethanol on lipoprotein metabolism

A major effect of ethanol on lipoprotein metabolism is the development of hypertriglyceridemia. Triglyceride-rich lipoproteins are secreted by the liver and intestine and undergo a two-stage sequential catabolism--first in peripheral tissues, and second in the liver--mediated in part by the associated apolipoproteins. The arguments for increased very low density lipoprotein production as an explanation for the hypertriglyceridemia are reviewed and found to be unconvincing. Experiments investigating the catabolism of chylomicrons are conflicting but appear on balance to suggest a catabolic defect. A potential relationship between plasma triglyceride-rich lipoprotein metabolism and hepatic steatosis is considered. The lack of knowledge of the status of apolipoproteins in the setting of ethanol precludes definite conclusions, but defects in the incorporation or dissociation of the apolipoproteins on the triglyceride-rich lipoproteins could explain some of the ethanol-induced metabolic derangements.