Alcohol consumption affects a number of steps in plasma lipoprotein metabolism: it serves as a substrate for lipoprotein triglyceride synthesis, alters synthesis of apolipoproteins, and affects the activity of the key enzymes of lipoprotein metabolism, namely lipoprotein lipase and hepatic lipase, and cholesterol ester transfer protein. In addition, alcohol consumption may increase tissue sensitivity to insulin. The specific effects of alcohol consumption vary and depend on the amount ingested, type of drinking (as opposed to moderate regular alcohol consumption, binge drinking results in an unfavourable serum lipoprotein profile), body composition of the drinkers and a number of gene/environment interactions. Modification of lipoproteins by acetaldehyde, the product of ethanol metabolism or by antioxidants present in some alcoholic beverages also influences the lipoprotein alterations due to alcohol consumption. Moderate alcohol consumption increases serum high density lipoprotein cholesterol and may decrease the concentration of lipoprotein(a).