Alcoholic cardiomyopathy

Abstract

The individual amount of alcohol consumed acutely or chronically decides on harm or benefit to a person’s health. Available data suggest that one to two drinks in men and one drink in women will benefit the cardiovascular system over time, one drink being 17.6 ml 100 % alcohol. Moderate drinking can reduce the incidence and mortality of coronary artery disease, heart failure, diabetes, ischemic and hemorrhagic stroke. More than this amount can lead to alcoholic cardiomyopathy, which is defined as alcohol toxicity to the heart muscle itself by ethanol and its metabolites. Historical examples of interest are the Munich beer heart and the Tübingen wine heart. Associated with chronic alcohol abuse but having different etiologies are beriberi heart disease (vitamin B1 deficiency) and cardiac cirrhosis as hyperdynamic cardiomyopathies, arsenic poising in the Manchester beer epidemic, and cobalt intoxication in Quebec beer drinker’s disease. Chronic heavy alcohol abuse will also increase blood pressure and cause a downregulation of the immune system that could lead to increased susceptibility to infections, which in turn could add to the development of heart failure. Myocardial tissue analysis resembles idiopathic cardiomyopathy or chronic myocarditis. In the diagnostic work-up of alcoholic cardiomyopathy, the confirmation of alcohol abuse by carbohydrate deficient transferrin (CDT) and increased liver enzymes, and the involvement of the heart by markers of heart failure (e.g., NT-proBNP) and of necrosis (e.g., troponins or CKMb) is mandatory. Treatment of alcoholic cardiomyopathy consists of alcohol abstinence and heart failure medication.

Moderate and heavy alcohol consumption are prospectively associated with decreased left ventricular ejection fraction: The Hoorn Study

“…The most likely mechanism is that alcohol causes myocardial damage due to direct toxic and dosedependent effects of alcohol and its first metabolite acetaldehyde on the myocardium [5]. Furthermore, alcohol consumption may affect the heart via blood pressure elevation [23], since previous studies showed that heavy alcohol consumption was associated with higher blood pressure [24]. However, adjustment for antihypertensive medication use and SBP did not change the results.…”

The Effect of Alcohol on Cardiovascular Risk Factors: Is There New Information?

“…Many factors have been associated with the development of hypertension, such as an elevated body mass index, occupation, socioeconomic status, tobacco use, abdominal obesity, physical activity, and alcohol consumption, among others [5,48,51]. Many studies have reported a positive, dose-dependent association between alcohol intake and hypertension, showing the J-shaped curve also described for overall cardiovascular effects [5,16,19,22,[52][53][54][55][56]. Excessive alcohol consumption accounts for about 16% of cases of hypertension worldwide [5,57].…”

Treatment options in myocarditis and inflammatory cardiomyopathy

“…This issue also holds true for alcoholic cardiomyopathy [8]. In these patients, alcohol consumption of more than 40 g/day in men and more than 20 g/day in women for more than 5 years is the somewhat arbitrary diagnostic determinant for the label of alcoholic cardiomyopathy.…”