Does red wine affect cholesterol?

A little, and the way it does so belongs to alcohol rather than to wine. A 2011 meta-analysis of 44 intervention studies found HDL cholesterol rose with the amount of alcohol, by 2.8 mg/dL (0.072 mmol/L) at 1 to 2 drinks a day, with a 95 percent confidence interval of 0.024 to 0.119, and by 5.5 mg/dL (0.141 mmol/L) at 5 or more. LDL did not change at any dose, and total cholesterol did not change overall. Results for wine, beer and spirits taken separately were similar to the pooled ones.

Established. Alcohol raises HDL cholesterol slightly and does not lower LDL, in pooled intervention studies of adults without known heart disease. That higher HDL is a blood marker, and it has not been shown to cut heart events.

What the trials found

Wine studies pooled on their own

A 2025 meta-analysis pooled 29 studies of wine. In its controlled clinical trials, wine did not significantly change triglycerides, total cholesterol, LDL or HDL. Red wine lowered LDL only in studies that compared the same people before and after drinking it, with no control group, by a standardized mean difference of 0.29 and an interval of 0.05 to 0.54. A standardized difference has no units, so it cannot be read as mmol/L. Uncontrolled studies of that kind carry the only significant result in the review.

Red wine against gin

A crossover trial in 67 men at high cardiovascular risk gave each of them red wine, gin and dealcoholised red wine for 4 weeks at a time, the alcoholic drinks at 30 g of alcohol a day. HDL and the apolipoproteins A-I and A-II rose after both red wine and gin. That points to the alcohol as the active part. Lp(a) fell after red wine. The abstract gives no sizes for any of these changes.

People with type 2 diabetes

In the CASCADE trial, 224 adults with well-controlled type 2 diabetes who did not drink were assigned to 5.1 fl oz (150 mL) of red wine or water with dinner for 2 years, alongside a Mediterranean diet. Red wine raised HDL by 1.9 mg/dL (0.05 mmol/L) against water, an interval of 0.04 to 0.06, and lowered the ratio of total to HDL cholesterol by 0.27. The trial was open label, and its abstract reports no change in LDL. A 2019 meta-analysis of 9 randomized trials in type 2 diabetes found wine did not significantly change LDL, triglycerides or HDL, with only 4 to 6 trials for each lipid and high heterogeneity between them.

People with narrowed carotid arteries

In a 20 week trial in 108 patients with carotid atherosclerosis, 65 percent of them on statins, a daily glass of red wine, 3.4 fl oz (100 mL) for women and 6.8 fl oz (200 mL) for men, lowered the ratio of LDL to HDL by 13 percent. Lifestyle changes in the same trial lowered it by 8 percent. The trial was not blinded, and its abstract reports only the ratio.

What observational data add

In a Japanese cohort of 29,042 adults at yearly checkups who started drinking, LDL was 0.85 mg/dL lower in those who began with fewer than 1.5 drinks a day, 4.40 lower at 1.5 to 3 drinks and 7.44 lower at 3 or more, against people who stayed abstinent. Intake was self-reported, confounding is likely, and an LDL fall at high intake may reflect effects on the liver rather than a benefit. A 2021 narrative review noted that meta-analyses of intervention studies link wine with better cardiovascular outcomes, and that grading the quality of that evidence did not confirm it.

Who should be careful

Not for everyone. In the 2011 meta-analysis triglycerides rose by 24 mg/dL (0.274 mmol/L) above 60 g of alcohol a day, which the review counted as 5 or more drinks, in the two studies that tested that dose. WHO classes alcohol as an established carcinogen that raises the risk of breast, liver, head and neck, esophageal and colorectal cancers, and that applies to wine as much as to any other drink.

CDC states there is no known safe amount of alcohol during pregnancy, and that red and white wine are no exception. Wine can also change how some medicines are handled. In a crossover trial in 12 men, a 8.5 fl oz (250 mL) glass of red wine raised exposure to the drug cisapride by a non-significant 15 percent, and one participant's exposure doubled. The size of a drink matters for all of this. US survey data count a glass of red wine as 180 g, roughly 19 g of alcohol.

What expert bodies say

WHO says no form of alcohol consumption is risk-free and that even low levels can cause harm. CDC advises people who do not drink not to start for any reason. We could not open the American Heart Association page on wine and cholesterol, so its position is not reported here.

How we searched

What would change this answer

• A long blinded trial that compares wine with dealcoholised wine and measures LDL and heart events. We found none registered.
• Evidence on whether the HDL rise from alcohol lowers heart disease. It has not been shown, and genetic studies that test this question were not part of this search.
• The numbers by drink type from the 2011 review, which would show how closely wine matches beer and spirits.

More on the drink itself is on the red wine page and the wine page.

Sources

1. ev-wnchol-01 · Observational data · systematic review and meta-analysis of clinical trials and pre-post studies (PROSPERO CRD42023396666) · n = 29 studies
   Using the DerSimonian and Laird random effects model, the pooled ES for the effect of red wine consumption on triglycerides was 0.05 (95% CI: −0.10, 0.20), that for total cholesterol was −0.10 (95% CI: −0.25, 0.05), that for LDL was −0.29 (95% CI: −0.54, −0.05), that for HDL was 0.23 (95% CI: −0.02, 0.48), and that for fibrinogen was −0.60 (95% CI: −1.43, 0.24).
   
   Who: adults in 29 pooled wine intervention studies (pre-post designs, red wine)
   Effect: pre-post red wine: LDL SMD -0.29 (95% CI -0.54 to -0.05); HDL 0.23 (-0.02 to 0.48); total cholesterol -0.10 (-0.25 to 0.05); triglycerides 0.05 (-0.10 to 0.20)
   Certainty: Uncontrolled before-after studies carry the only significant result, so this pooled estimate is not a synthesis of randomized trials and is graded C; effect sizes are standardized, not mmol/L.
   J Nutr Health Aging, 2025, The effects of wine consumption and lipid profile: a systematic review and meta-analysis of clinical trials · checked 2026-10-07 · we read the fulltext
2. ev-wnchol-02 · Meta-analysis or systematic review · systematic review and meta-analysis of clinical trials · n = —
   Using the DerSimonian and Laird random effect models, the pooled ES for the effect of wine consumption on triglycerides was −0.15 (95% CI: −0.40, 0.11), that for total cholesterol was −0.11 (95% CI: −0.60, 0.38), that for LDL was −0.13 (95% CI: −0.31, 0.06), that for HDL was 0.43 (95% CI: −0.06, 0.92), and that for fibrinogen could not be determined because the number of studies, but the trend of SEs was less than 0.
   
   Who: adults in controlled clinical trials of wine
   Effect: triglycerides -0.15 (95% CI -0.40 to 0.11); total cholesterol -0.11 (-0.60 to 0.38); LDL -0.13 (-0.31 to 0.06); HDL 0.43 (-0.06 to 0.92), all not significant
   Certainty: Few controlled trials, substantial heterogeneity for total cholesterol and HDL.
   J Nutr Health Aging, 2025, The effects of wine consumption and lipid profile: a systematic review and meta-analysis of clinical trials · checked 2026-10-07 · we read the fulltext
3. ev-wnchol-03 · Meta-analysis or systematic review · systematic review and meta-analysis of interventional studies · n = 44 studies meta-analyzed
   A significant dose-response was observed between alcohol consumption and high density lipoprotein cholesterol levels (fig 2): 12.5-29.9 g/day (1-2 drinks, n=7), mean difference of 0.072 mmol/L (95% confidence interval: 0.024 to 0.119); 30-60 g/day (2-4 drinks, n=24), mean difference of 0.103 mmol/L (0.065 to 0.141); and >60 g/day (≥5 drinks, n=2), mean difference of 0.141 mmol/L (0.042 to 0.240; P for trend 0.013).
   
   Who: adults without known cardiovascular disease in interventional studies, searched to October 2009
   Effect: HDL mean difference 2.8 mg/dL (95% CI 0.93 to 4.6; metric: 0.072 mmol/L, 0.024 to 0.119) at 12.5-29.9 g/day; 0.103 (0.065 to 0.141) at 30-60 g/day; 0.141 (0.042 to 0.240) above 60 g/day; P for trend 0.013
   Certainty: Short interventions, mixed crossover and before-after designs; HDL rise is a biomarker, not shown to cut heart events.
   BMJ, 2011, Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies · checked 2026-10-07 · we read the fulltext
4. ev-wnchol-04 · Meta-analysis or systematic review · systematic review and meta-analysis of interventional studies · n = 24 studies (LDL)
   In contrast, alcohol consumption did not significantly change levels of total cholesterol, low density lipoprotein cholesterol, triglycerides, or Lp(a) lipoprotein (table 2).
   
   Who: adults without known cardiovascular disease; 24 studies reported LDL
   Effect: no significant change in total cholesterol, LDL, triglycerides or Lp(a) overall; no LDL effect at any dose
   Certainty: Pooled across beverages; LDL heterogeneous, random effects.
   BMJ, 2011, Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies · checked 2026-10-07 · we read the fulltext
5. ev-wnchol-05 · Meta-analysis or systematic review · systematic review and meta-analysis of interventional studies, sensitivity analysis · n = 44 studies meta-analyzed
   The results were similar to the combined analyses of all beverage types (see web extra appendix 3).
   
   Who: adults in interventional studies of wine, beer or spirits
   Effect: beverage-specific results similar to combined analyses
   Certainty: Stratified numbers are in a web appendix not read here.
   BMJ, 2011, Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies · checked 2026-10-07 · we read the fulltext
6. ev-wnchol-06 · Meta-analysis or systematic review · systematic review and meta-analysis of interventional studies, dose subgroup · n = 2 studies
   Pooled analysis of the impact of alcohol by dose on triglycerides showed a significant increase at the highest dose of alcohol (>60 g/day) in the two studies reporting alcohol consumption at this dose: mean difference 0.274 mmol/L (0.043 to 0.505), test for heterogeneity P=0.763 (fig 3).
   
   Who: adults in 2 interventional studies at more than 60 g alcohol per day
   Effect: triglycerides mean difference 24 mg/dL (95% CI 3.8 to 45; metric: 0.274 mmol/L, 0.043 to 0.505) above 60 g/day
   Certainty: Only two studies at this dose; the review counted more than 60 g a day as 5 or more drinks.
   BMJ, 2011, Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies · checked 2026-10-07 · we read the fulltext
7. ev-wnchol-07 · Meta-analysis or systematic review · meta-analysis of randomized interventional trials · n = 9 trials
   However, no significant differences in the other 3 lipid-associated measurements and the results are as follows: LDLC, WMD = −0.02, 95% CI: −0.25 to 0.21, P = .86, I2 = 54%, Figure 4B; TG, WMD = −0.34, 95% CI: −1.31 to 0.64, P = .50, I2 = 99%, Figure 4C; HDLC, WMD = 0.22, 95% CI: −0.08 to 0.53, P = .15, I2 = 95%, Figure 5.
   
   Who: patients with type 2 diabetes in randomized interventional trials, searched to November 2018
   Effect: LDL WMD -0.02 (95% CI -0.25 to 0.21); triglycerides -0.34 (-1.31 to 0.64); HDL 0.22 (-0.08 to 0.53), all not significant
   Certainty: Only 4 to 6 trials per lipid outcome, high heterogeneity; total cholesterol reported inconsistently (sign of WMD and CI disagree).
   Medicine (Baltimore), 2019, Effects of wine on blood pressure, glucose parameters, and lipid profile in type 2 diabetes mellitus: a meta-analysis of randomized interventional trials · checked 2026-10-07 · we read the fulltext
8. ev-wnchol-08 · Randomized controlled trial(s) · 2-year randomized controlled trial (CASCADE, NCT00784433) · n = 224
   In addition to the changes in the water group (Mediterranean diet only), red wine significantly increased high-density lipoprotein cholesterol (HDL-C) level by 0.05 mmol/L (2.0 mg/dL) (95% CI, 0.04 to 0.06 mmol/L [1.6 to 2.2 mg/dL]; P < 0.001) and apolipoprotein(a)1 level by 0.03 g/L (CI, 0.01 to 0.06 g/L; P = 0.05) and decreased the total cholesterol-HDL-C ratio by 0.27 (CI, -0.52 to -0.01; P = 0.039).
   
   Who: alcohol-abstaining adults with well-controlled type 2 diabetes, Israel, Mediterranean diet
   Effect: HDL +0.05 mmol/L (2.0 mg/dL; 95% CI 1.5 to 2.3 mg/dL (0.04 to 0.06 mmol/L)); apoA1 +0.03 g/L; total-to-HDL cholesterol ratio -0.27
   Certainty: Open label; no LDL change reported in the abstract; well-controlled diabetes only.
   Ann Intern Med, 2015 · checked 2026-10-07 · we read the abstract
9. ev-wnchol-09 · Randomized controlled trial(s) · prospective randomized unblinded trial, 2 x 2 design · n = 108
   Lifestyle changes lowered the LDL/HDL ratio after 20 weeks by 8% (p = 0.0242) and red wine independently by 13% (p = 0.0049).
   
   Who: patients with carotid atherosclerosis, 65% on statins; 3.4 fl oz (100 mL) (women) or 6.8 fl oz (200 mL) (men) red wine daily
   Effect: LDL/HDL ratio -13% with red wine (p = 0.0049); -8% with lifestyle changes
   Certainty: Unblinded; ratio outcome only in the abstract.
   Nutr J, 2013 · checked 2026-10-07 · we read the abstract
10. ev-wnchol-10 · Randomized controlled trial(s) · randomized crossover trial · n = 67
    HDL cholesterol, Apolipoprotein A-I and A-II increased after red wine and gin.
    
    Who: men at high cardiovascular risk, 4-week periods of red wine, dealcoholised red wine and gin
    Effect: HDL, apoA-I and apoA-II increased after red wine and gin; Lp(a) decreased after red wine
    Certainty: Abstract gives no sizes; 4-week periods.
    Clin Nutr, 2013 · checked 2026-10-07 · we read the abstract
11. ev-wnchol-11 · Observational data · retrospective cohort, repeated annual checkups · n = 29042
    When alcohol intake changes were categorized, the adjusted mean changes in LDL-C levels with alcohol initiation were −0.85 mg/dL (95% CI, −1.18 to −0.52 mg/dL) in participants initiating fewer than 1.5 alcohol drinks/d, −4.40 mg/dL (95% CI, −5.52 to −3.29 mg/dL) with 1.5 to 3.0 drinks/d, and −7.44 mg/dL (95% CI, −9.29 to −5.60 mg/dL) with 3.0 or more drinks/d compared with noninitiators.
    
    Who: adults at annual health checkups in Japan, 2012-2022 (cohort 1, initiators)
    Effect: LDL -0.85 mg/dL (<1.5 drinks/d), -4.40 (1.5-3.0), -7.44 (3.0 or more) vs non-initiators
    Certainty: Self-reported intake, residual confounding; LDL fall at high intake may reflect liver effects, not benefit.
    JAMA Netw Open, 2025, Lipid Profiles After Changes in Alcohol Consumption Among Adults Undergoing Annual Checkups · checked 2026-10-07 · we read the fulltext
12. ev-wnchol-12 · Position of an expert body · agency fact sheet · n = —
    Alcohol is an established carcinogen and alcohol consumption increases the risk of several cancers, including breast, liver, head and neck, oesophageal and colorectal cancers.
    
    Who: general population
    Effect: carcinogen; several cancer sites
    Certainty: Applies to all alcoholic drinks, wine included.
    WHO, Alcohol (fact sheet), 28 June 2024 · checked 2026-10-07 · we read the section
13. ev-wnchol-13 · Position of an expert body · agency fact sheet · n = —
    There is no form of alcohol consumption that is risk-free. Even low levels of alcohol consumption carry some risks and can cause harm.
    
    Who: general population
    Effect: no risk-free level
    Certainty: Position statement; weighs all harms, not lipids.
    WHO, Alcohol (fact sheet), 28 June 2024 · checked 2026-10-07 · we read the section
14. ev-wnchol-14 · Position of an expert body · agency web page · n = —
    If you don't currently drink, don't start for any reason.
    
    Who: adults who do not drink
    Effect: do not start drinking for health
    Certainty: US guidance; moderate drinking defined as up to 2 drinks a day for men and 1 for women.
    CDC, About Moderate Alcohol Use, last reviewed January 14, 2025 · checked 2026-10-07 · we read the section
15. wnb3-16 · Position of an expert body · narrative review · n = —
    Our narrative review has shown that in meta-analyses of intervention studies, consumption of chocolate and wine was positively associated with the beneficial outcomes associated with the cardiovascular system. In contrast, the assessment with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) scale did not confirm this phenomenon.
    
    Who: literature 2010-2021
    Effect: benefit not confirmed by GRADE
    Certainty: narrative review, no own pooled analysis
    Nutrients, 2021 · checked 2026-09-23 · we read the abstract
16. rwine-daily-r2-05 · Randomized controlled trial(s) · randomized 3-way crossover trial · n = 12
    Cisapride AUC and C(max) with red wine were 115% (difference not statistically significant) and 107% (difference not statistically significant), respectively, of those with water...However, even this amount of red wine may cause a marked interaction similar to that for grapefruit juice in individuals with a preexisting high intestinal CYP3A4 content.
    
    Who: 12 healthy men, cisapride 10 mg with 8.5 fl oz (250 mL) red wine, grapefruit juice or water
    Effect: cisapride AUC 115% with red wine (not significant) vs 151% with grapefruit juice; one subject doubled
    Certainty: one dose; cisapride has been withdrawn from many markets, the CYP3A4 mechanism is general
    Clin Pharmacol Ther, 2001 · checked 2026-09-29 · we read the abstract
17. rwine-daily-r2-14 · Position of an expert body · agency consumer guidance · n = —
    There is no known safe amount of alcohol use during pregnancy. ... All types of alcohol can be harmful, including red or white wine, beer, and liquor.
    
    Who: Pregnant women
    Effect: guidance; no effect size
    Certainty: T2; two independent samples of the page
    US CDC, About Alcohol Use During Pregnancy · checked 2026-09-29 · we read the section
18. rwine-daily-r2-16 · Position of an expert body · food portion dataset · n = 1 record
    Wine, red (FNDDS 93401010, fdc 2710688, WWEIA Wine): 1 fl oz = 30 g, 1 glass = 180 g, 1/2 bottle = 375 g, quantity not specified = 180 g
    
    Who: FNDDS Wine, red, food code 93401010 (fdc 2710688)
    Effect: 1 glass = 180 g; 1 fl oz = 30 g; half bottle = 375 g
    Certainty: conversion: 180 g x 10.7 g/100 g ≈ 19 g of alcohol; US standard drink is 14 g
    USDA FNDDS, food code 93401010 Wine, red (FDC 2710688) · checked 2026-09-29 · we read the dataset