In the Journals

Alcohol consumption may prompt adverse cardiac remodeling

Elevated alcohol consumption predicted several parameters of adverse cardiac remodeling after 20 years of follow-up, researchers reported.

However, alcohol consumption level did not appear to affect left ventricular ejection fraction, and wine had less of a negative effect on remodeling than other forms of alcohol.

The researchers analyzed 2,368 participants from the CARDIA cohort study (mean age, 51 years; 44% men).

All participants had no heart disorders at baseline, provided information on their drinking habits and underwent echocardiography at 5 and 25 years.

Outcomes of interest included LVEF, indexed LV mass, indexed LV end-diastolic volume and left atrial diameter. Patients were stratified by weighted-average weekly drinking habits: no drinks per week; more than none but fewer than four drinks per week; four to fewer than seven drinks per week; seven to fewer than 14 drinks per week; and 14 drinks per week or more.

Cardiac remodeling

Patricia Rodrigues, MD, who was at the department of cardiology at Barts Heart Centre, London, when the study began, and is now at the department of cardiology at Centro Hospitalar do Porto in Porto, Portugal, and colleagues found that greater alcohol consumption predicted higher indexed LV mass (P = .014) and higher indexed LV end-diastolic volume (P = .037) in men and women.

However, the researchers found no relationship between alcohol consumption and LVEF (P = .907) or left atrial diameter (P = .392).

When the researchers analyzed participants who specified that they predominantly drank beer, wine or liquor, excluding those who did not drink or who did not specify a favorite type of beverage, they found that wine consumption was associated with higher LVEF, lower indexed LV mass and smaller left atrial diameter compared with beer or liquor consumption, and that wine or liquor consumption was associated with smaller indexed LV end-diastolic volume compared with beer consumption.

Binge drinking was associated with a trend toward lower LVEF (P = .06) and larger left atrial diameter (P = .05), according to the researchers.

Risks of alcohol

In a related editorial, Laurent Fauchier, MD, PhD, from the Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France, and colleagues wrote: “Although many studies have been published about how and why moderately drinking alcohol may be associated with reduced mortality due to heart disease in some populations, it should systematically be repeated that drinking more alcohol increases the risk of alcoholism, high blood pressure, obesity, cardiomyopathy, stroke, cancer, suicide and accidents. Overall, there are still considerable knowledge gaps about how alcohol in combination with other factors may affect incidence of [alcoholic cardiomyopathy] and prognosis in HF patients. Both observational real-life analyses and interventional trials are still needed to improve the clinical management in these patients.” – by Erik Swain

Disclosures: One author reports she is an employee of Philips Healthcare. The other authors report no relevant financial disclosures. Fauchier reports he has served as a consultant or speaker for Bayer, Bristol-Myers Squibb/Pfizer, Boehringer Ingelheim, Livanova and Novartis. Another editorial writer reports he served as a speaker or consultant for Medtronic.

Elevated alcohol consumption predicted several parameters of adverse cardiac remodeling after 20 years of follow-up, researchers reported.

However, alcohol consumption level did not appear to affect left ventricular ejection fraction, and wine had less of a negative effect on remodeling than other forms of alcohol.

The researchers analyzed 2,368 participants from the CARDIA cohort study (mean age, 51 years; 44% men).

All participants had no heart disorders at baseline, provided information on their drinking habits and underwent echocardiography at 5 and 25 years.

Outcomes of interest included LVEF, indexed LV mass, indexed LV end-diastolic volume and left atrial diameter. Patients were stratified by weighted-average weekly drinking habits: no drinks per week; more than none but fewer than four drinks per week; four to fewer than seven drinks per week; seven to fewer than 14 drinks per week; and 14 drinks per week or more.

Cardiac remodeling

Patricia Rodrigues, MD, who was at the department of cardiology at Barts Heart Centre, London, when the study began, and is now at the department of cardiology at Centro Hospitalar do Porto in Porto, Portugal, and colleagues found that greater alcohol consumption predicted higher indexed LV mass (P = .014) and higher indexed LV end-diastolic volume (P = .037) in men and women.

However, the researchers found no relationship between alcohol consumption and LVEF (P = .907) or left atrial diameter (P = .392).

When the researchers analyzed participants who specified that they predominantly drank beer, wine or liquor, excluding those who did not drink or who did not specify a favorite type of beverage, they found that wine consumption was associated with higher LVEF, lower indexed LV mass and smaller left atrial diameter compared with beer or liquor consumption, and that wine or liquor consumption was associated with smaller indexed LV end-diastolic volume compared with beer consumption.

Binge drinking was associated with a trend toward lower LVEF (P = .06) and larger left atrial diameter (P = .05), according to the researchers.

Risks of alcohol

In a related editorial, Laurent Fauchier, MD, PhD, from the Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France, and colleagues wrote: “Although many studies have been published about how and why moderately drinking alcohol may be associated with reduced mortality due to heart disease in some populations, it should systematically be repeated that drinking more alcohol increases the risk of alcoholism, high blood pressure, obesity, cardiomyopathy, stroke, cancer, suicide and accidents. Overall, there are still considerable knowledge gaps about how alcohol in combination with other factors may affect incidence of [alcoholic cardiomyopathy] and prognosis in HF patients. Both observational real-life analyses and interventional trials are still needed to improve the clinical management in these patients.” – by Erik Swain

Disclosures: One author reports she is an employee of Philips Healthcare. The other authors report no relevant financial disclosures. Fauchier reports he has served as a consultant or speaker for Bayer, Bristol-Myers Squibb/Pfizer, Boehringer Ingelheim, Livanova and Novartis. Another editorial writer reports he served as a speaker or consultant for Medtronic.