To establish whether there is any significant relationship between high-density lipoprotein cholesterol (HDLC) concentrations and biopsy-documented liver disease, 169 patients had needle biopsies, serum cholesterol, and HDLC evaluated. Twenty-four patients had serial cholesterol, HDLC, prothrombin, and aminotransferase levels and activities examined. In both men and women, HDLC decreased strikingly and significantly in acute alcoholic hepatitis and in acute viral hepatitis, compared to controls (p < 0.001). Men and women with inactive alcoholic liver disease and chronic active hepatitis showed moderate decreases in HDLC (p < 0.001). Patients with primary and metastatic hepatic neoplasms also had strikingly decreased HDLC (p < 0.001). Serial testing showed an excellent direct correlation between HDLC and prothrombin activity, r values ranging from 0.71 to 0.98. Although alcohol intake is known to correlate positively with HDLC concentrations, our data shows that this association is not absolute, and in most cases is reversed once liver disease becomes apparent.
Ever since high-density lipoprotein cholesterol (HDLC) was shown to be inversely correlated with coronary heart disease (1-4), extensive epidemiologic studies have been performed to establish what physical, dietary, social, etc., factors will raise HDLC and, hence, possibly decrease the incidence of coronary heart disease (5). Recently, investigators have recognized the positive correlation between ethanol consumption and HDLC (6- 9). Chronic alcoholics might therefore have some protection from coronary heart disease, although any such benefit might be negated by health risks associated with alcoholism (10, 11).
Unfortunately, chronic alcoholism often leads to chronic liver disease. Since high-density lipoprotein (HDL) is in large measure synthesized in the liver (12-14), any elevated HDLC might be affected in some way. Scattered reports over the past few decades have examined the relationship between HDLC and liver disease (10, 11,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), but there is very little biopsy documentation of the type and degree of associated liver disease. This report examines and correlates the liver biopsies in alcoholic and nonalcoholic liver diseases with HDLC concentrations, and aminotransferase and prothrombin