Context: Limited evidence suggests that alcohol intake may be associated with lipoprotein subclass distribution, which could mediate its relationship with coronary heart disease.

Objectives: To determine the relationship of alcohol intake with lipoprotein particle subclasses.

Design, Setting, and Participants: Cross-sectional analysis of 1850 participants of the Cardiovascular Health Study aged 65 years and older and free of clinical cardiovascular disease.

Main Outcome Measure: Lipoprotein subclass distribution measured with nuclear magnetic resonance spectroscopy, according to self-reported alcohol intake.

Results: Alcohol intake was associated with total LDL particles in a U-shaped manner. Consumers of 1 or more drinks per week had the highest number of large LDL particles, while consumers of 7-13 drinks per week had the lowest number of small LDL particles. Alcohol intake was strongly positively associated with large and medium-sized HDL particles, but had an inverse relationship with concentrations of small HDL particles and small and medium-sized VLDL particles. Average particle sizes of all three lipoproteins were positively associated with alcohol intake. Associations were generally stronger among women than men but in similar directions. Beverage type did not consistently modify these findings.

Conclusions: Alcohol intake is associated with less total LDL particles, lower levels of small LDL, HDL, and VLDL particles, and higher levels of large LDL and medium and large HDL particles in older adults free of prevalent clinical cardiovascular disease.