Moderate Alcohol Consumption Is Associated With Left Ventricular Diastolic Dysfunction in Nonalcoholic Hypertensive Patients

Abstract

D iastolic heart failure is a frequent complication of hypertension 1 and is preceded by changes in left ventricular (LV) filling characteristics that reflect decreased compliance of the ventricular wall. In hypertension, changes in LV diastolic function occur even in the absence of ventricular hypertrophy and are associated with increased morbidity and mortality. 2 Therefore, early identification of hypertension-related LV filling changes is important to forestall subsequent cardiac deterioration leading to diastolic heart failure. 3 Sensitivity of conventional echocardiography in detection of early changes in LV filling properties is limited, 4 whereas pulsed tissueDoppler imaging (TDI) with measurement of myocardial velocities at several segments of the LV wall allows more sensitive and reproducible 5 detection of LV diastolic impairment.Many factors beyond the blood pressure-related cardiac workload could contribute to the development of diastolic abnormalities of the hypertensive heart. These factors include ageing, 6 obesity, 7 hyperglycemia with insulin resistance, 8 and a prothrombotic state. 9 Moreover, dietary factors such as caloric, 10 electrolyte, 11 and ethanol intake 12 might affect LV diastolic properties. Chronic alcoholic subjects are at risk for the development of nonischemic dilated cardiomyopathy and heavy ethanol consumption (>90 g/d of ethanol; ≈7-8 standard drinks per day) is associated with impairment of LV systolic function. Animal studies have demonstrated that longterm ethanol exposure produces a variety of tissue and cellular changes. These changes can impair cardiomyocyte function leading to heart failure and include either necrosis or apoptosis of myocytes, mitochondrial and sarcoplasmic reticulum dysfunction, changes in isoforms of myofilament proteins, and defective intracellular calcium transport. 13 Previous studies conducted with conventional echocardiography indicated that, in addition to the well-known untoward effects on LV systolic function, LV filling properties are impaired in chronic asymptomatic alcoholics. 14,15 However, information on the association of moderate (≤14 Abstract-Ethanol consumption is associated with left ventricular dysfunction in heavy ethanol drinkers. The effect of moderate ethanol intake on left ventricular function in hypertension, however, is unknown. We investigated the relationship between ethanol consumption and cardiac changes in nonalcoholic hypertensive patients. In 335 patients with primary hypertension, we assessed daily ethanol consumption by questionnaires that combined evaluation of recent and lifetime ethanol exposure and examined cardiac structure and function by echocardiography. Patients with abnormal liver tests, previous cardiovascular events, left ventricular ejection fraction <50%, and creatinine clearance <30 mL/min 1.72 m 2 were excluded. Left ventricular hypertrophy was found in 21% of hypertensive patients and diastolic dysfunction was detected in 50% by tissue-Doppler imaging. Ethanol consumption was comparable in hyperten...

Impacts of unfavourable lifestyle factors on biomarkers of liver function, inflammation and lipid status

“…Previous studies have suggested possible mechanistic links between hepatic and extrahepatic disease outcomes, as supported by findings indicating that GGT enzyme is able to fuel LDL oxidation in coronary plaques [37]. In accordance with this view, alcohol and its reactive metabolites are known to exert toxic effects virtually in all tissues and even relatively low levels of chronic drinking may increase the risk for carcinogenesis [38–40], cognitive decline [41, 42], cardiac dysfunction [43–45] and all-cause mortality [28, 46], which may also associate with abnormalities in blood lipid profiles and indices of inflammation [47–49]. Based on the present data abnormalities in serum CRP, a widely used clinical biomarker of inflammation, and lipid profiles appear to follow the burden of unfavourable risk factors and abnormalities in markers of liver function in a sensitive manner.…”

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

“…On the other hand, the null association between alcohol and LAVI, a measure of diastolic function, implicates a less important role of alcohol consumption in the pathophysiology of HFpEF, the other subtype of HF that is often characterized by diastolic dysfunction. Nevertheless, prospective studies using Tissue Doppler Imaging measures for diastolic function are still needed to confirm this implication, as two previous cross-sectional studies suggested a harmful association between moderate and heavy alcohol consumption and diastolic function measured with Tissue Doppler Imaging [26,27].…”

Where should the safe limits of alcohol consumption stand in light of liver enzyme abnormalities in alcohol consumers?

“…The present data supports the view that biochemical responses in the sequence of events leading to health problems may be expected to occur even in association with light to moderate drinking levels especially in those with precipitating risk factors. Recent findings by other groups of investigators have also emphasized the view that light to moderate drinking could be associated with an elevated risk of cancer [ 6 – 8 ], atrial fibrillation [ 37 ], left ventricular diastolic dysfunction [ 38 ], adverse brain outcomes [ 9 ] and an increase in all-cause mortality [ 39 ]. Although reductions in alcohol-attributable disease burden may obviously be expected to be achieved through a more efficient identification of high-risk individuals, alcohol-consuming patients seem rarely receive specific intervention in current clinical practice unless the situation is complicated by comorbidity.…”