High-density lipoprotein (HDL) as an indicator for alcohol use in a psychiatrically ill population

Abstract

Aims: To examine the cross sectional and longitudinal associations between the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) and differences in high-density lipoprotein (HDL) in a psychiatrically ill population.

Methods: Retrospective observational study using electronic health record data from a large healthcare system, of patients hospitalized for a mental health/substance use disorder (MH/SUD) from 1 July 2016 to 31 May 2023, who had a proximal AUDIT-C and HDL (N = 15 915) and the subset who had a repeat AUDIT-C and HDL 1 year later (N = 2915). Linear regression models examined the association between cross-sectional and longitudinal AUDIT-C scores and HDL, adjusting for demographic and clinical characteristics that affect HDL.

Results: Compared with AUDIT-C score = 0, HDL was higher among patients with greater AUDIT-C severity (e.g. moderate AUDIT-C score = 8.70[7.65, 9.75] mg/dl; severe AUDIT-C score = 13.02 [12.13, 13.90] mg/dL[95% confidence interval (CI)] mg/dl). The associations between cross-sectional HDL and AUDIT-C scores were similar with and without adjusting for patient demographic and clinical characteristics. HDL levels increased for patients with mild alcohol use at baseline and moderate or severe alcohol use at follow-up (15.06[2.77, 27.69] and 19.58[2.77, 36.39] mg/dL[95%CI] increase for moderate and severe, respectively).

Conclusions: HDL levels correlate with AUDIT-C scores among patients with MH/SUD. Longitudinally, there were some (but not consistent) increases in HDL associated with increases in AUDIT-C. The increases were within range of typical year-to-year variation in HDL across the population independent of alcohol use, limiting the ability to use HDL as a longitudinal clinical indicator for alcohol use in routine care.

Keywords: alcohol use; population health; screening/monitoring.

Figure 1

Study cohort creation. Notes: AUDIT-C: Alcohol Use Disorders Identification Test-Concise; HDL: high-density lipoprotein

Figure 2

Longitudinal cohort: changes in HDL associated with changes in AUDIT-C 1-year following index AUDIT-C and HDL, stratified by index AUDIT-C category. Note: Figures provide results after adjusting for demographic and clinical factors. Changes in HDL from index HDL with each AUDIT-C category assessed at 1-year follow-up, stratified by index AUDIT-C category. Arrows indicate follow-up AUDIT-C category that represents no change from index AUDIT-C category. To the left of arrows indicate changes in HDL for patients with follow-up AUDIT-C category lower than the index AUDIT-C; to the right of arrows indicate changes in HDL for patients with follow-up AUDIT-C category that is higher than index AUDIT-C. Underlying brackets indicate the index vs. follow-up AUDIT-C increases for which contrasts were examined (Supplementary Appendix Table A6). HDL = high-density lipoprotein; AUDIT-C = Alcohol Use Disorders Identification Test-Concise.