The recent identification of myocardial metabolites ofethanol-fatty acid ethyl esters-suggests that some ofthe pathophysiological derangements associated with alcohol-induced heart muscle disease may be a consequence ofproducts ofmyocardial ethanol metabolism. The donor of the fatty acid moiety in the formation offatty acid ethyl esters has been identified as nonesterified fatty acid. Fatty acid esterification with ethanol is shown to be mediated by cholesterol esterase (sterol-ester acylhydrolase, EC 3.1.1.13), a finding that identifies a singular nonoxidative ethanol metabolism by an enzyme. A potential basis for the protective effect of ethanol ingestion on atherogenesis is also suggested because fatty acid ethyl esters inhibit cholesterol esterification catalyzed by pancreatic cholesterol esterase and hepatic and aortic microsomal fatty acyl-CoA:cholesterol O-acyltransferase (EC 2.3.1.26).Although an association between alcohol and heart disease was first described by Walshe in 1873 (1), the recognition of alcoholism as an important component in the history ofpatients with noncoronary myocardial disease was not made frequently until 1964 (2). Approximately 1-2% ofchronic abusers develop overt signs of cardiac dysfunction (3); among the cardiomyopathic disorders, alcohol-induced heart muscle disease (AIHMD) is the most common, accounting for 3% of cardiac admissions to Veterans Administration or city hospitals (4).AIHMD is associated with chronic alcohol abuse in the absence of vitamin or caloric deprivation (5, 6). However, the bases for the depression of myocardial contractility (7, 8), development of cardiac arrhythmias (9, 10), accumulation of triacylglycerides (11-13), and decreased /&oxidation of fatty acids (11-14) have not been elucidated. Because 14Co2 has not been detected in hearts perfused with [14C]ethanol (11,15) (23) were prepared containing egg phosphatidylcholine (5.0 umoV ml), cholesterol (2.0 ,umol/ml), and [14C]oleic acid (from 0.1 Abbreviations: AIHMD, alcohol-induced heart muscle disease; FAEE, fatty acid ethyl esters.
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