Alcohol and your health: Risks, benefits, and controversies

Alcoholic cardiomyopathy (ACM) is a heart disease that occurs due to chronic alcohol consumption. It is a type of dilated cardiomyopathy since it involves dilation or enlargement of one of the heart’s chambers. Based on epidemiological evidence, ACM is recognized as a significant contributor to non-ischemic DCM in Western countries. Diagnosing ACM still relies on exclusion criteria, similar to alcoholic liver disease, as excessive alcohol consumption is observed in up to 40% of DCM patients. In a national inpatient sample study, some authors have reported ACM to be most common in white males aged between 45 and 59 2. As early as in 1915, Lian 45 reported in middle-aged French servicemen during the first world war that heavy drinking could lead to hypertension.

Direct toxic effect of ethanol

Findings from this study suggested that the presence of a moderate to high amount of dietary fat increased the production of free radicals over low-fat ethanol- containing diets. Interestingly, the amount of fat deemed high (35% of calories) is similar to the amount consumed by most Americans. Also, low to moderate daily alcohol intake was proved to be a predictor of better prognosis for both ischemic cardiomyopathy and heart failure regardless of the presence of coronary disease1,2.

Can drinking raise my blood pressure?

Alcohol-induced cardiomyopathy treatment includes a combination of lifestyle modifications, pharmacological treatment, management of arrhythmia, and supportive care. This review will provide an updated view of this condition, including its epidemiology, pathogenesis, diagnosis, and treatment (Graphical Abstract). Your doctor might prescribe ACE Substance abuse inhibitors and beta-blockers to help lower your blood pressure. If your heart is severely damaged, your doctor may recommend an implantable defibrillator or pacemaker to help your heart work. Data suggests patients with successful quitting of alcohol have improved overall outcomes with a reduced number of inpatient admissions and improvement in diameter size on echocardiogram. Many changes can be observed including premature atrial or ventricular contractions, supraventricular tachycardias, atrioventricular blocks,  bundle branch blocks, QT prolongation, non-specific ST and T wave changes and abnormal Q waves.

Histologic Findings

• Alcoholic cardiomyopathy is best managed with an interprofessional approach with the involvement of primary care physician and cardiology.
• Previous studies were conducted on rats that are fed alcohol for about eight months.
• While you don’t necessarily have to stop drinking, cutting down on drinking is “one of my first recommendations” for women in their late 30s to early 40s who are experiencing perimenopause symptoms, Kumar says.

The authors examined the prevalence of cardiomegaly by means of chest x-rays and related it to alcohol consumption among a consecutive series of Japanese males of working age. They found that 2 of the 6 individuals (33%) whose alcohol consumption exceeded 125 mL/d had cardiomegaly. In contrast, an enlarged heart was found in only 1 of 25 subjects with moderate consumption (4%), in 6 of 105 very mild consumers (5.7%), and in 4.5% of non-drinking individuals. Indeed, the first account of the possible harmful effects of alcohol specifically on heart muscle was reported in the latter half of the 19th century. Expressions referring to “the heart of a wine drinker in Tubingen” and particularly a “Munich beer heart” were used and known in Germany during this time13. The prognosis is much more favorable than for dilated cardiomyopathy that has other causes.

• Furthermore, it is now evident that mitochondria function in networks and that when mitochondria become damaged their function can possibly restored by fusion with neighboring mitochondria (55).
• It’s important to note that alcoholic cardiomyopathy may not cause any symptoms until the disease is more advanced.
• The primary treatment for ACM is complete abstinence from alcohol, which may require a combination of behavioral therapy and medication.
• A standard drink contains 10 g of alcohol, equivalent to 100 mL of wine, 300 mL of beer, or 40 mL of spirits.

Inclusion criteria encompassed articles that focused on ACM or the relationship between alcohol abuse and cardiac dysfunction, involved human subjects or https://ecosoberhouse.com/article/10-celebrities-who-died-because-of-alcoholism/ relevant animal models, were written in the English language, and were published within the last 10 years. Meanwhile, we excluded duplicates, case reports, letters, editorials, and reviews not specifically addressing ACM. We then proceeded with screening and selection based on the titles and abstracts of the initial search results. Two independent reviewers assessed each article for relevance and eligibility for full-text review. Once the 15 articles were selected (see Appendix Table 1 for the list of included articles), we extracted and organized relevant information from them. Prognosis in individuals with low or moderate consumption up to one or two drinks per day in men and one drink in women is not different from people who do not drink at all.

Basic studies on molecular mechanisms of myocardial damage

As women typically have a lower BMI than men, a similar amount of alcohol would reach a woman’s heart after consuming smaller quantities of alcohol. Data on the amount of alcohol consumption required to cause ACM are limited and controversial. In the 1989 study by Urbano-Marquez et al, a comparison of symptomatic to asymptomatic patients revealed more extensive fibrosis in patients with symptoms. 8 Other investigators have looked at immunohistologic markers and have suggested that the presence of these markers might suggest an inflammatory process such as myocarditis and that their absence may point more toward AC or an idiopathic etiology.

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However, it remains to be determined whether changes in mitochondrial function are cause or consequence. Because the cardiac myocyte relative to other cell types, including the hepatocyte, contains the highest volume of mitochondria, the critical mass of mitochondria negatively impacted by ethanol before significant mitochondrial dysfunction occurs may be higher than other tissues. Furthermore, it is now evident that mitochondria function in networks and that when mitochondria become damaged their function can possibly restored by fusion with neighboring mitochondria (55). Also, others have suggested that, in data from animal models of alcoholism, there is an interaction between chronic ethanol consumption and caloric deprivation in eliciting alterations in myocardial energy metabolism (58). Many of the studies reviewed in this section were published more than 15 years ago and used measurements of respiratory states (1-IV) and respiratory control index ratios. These studies were performed in experimental conditions in which there may be multiple mitochondrial deficits and therefore need to be interpreted with caution.

Epidemiological studies

However, no differences were found in these parameters between the sub-group of individuals who had been drinking for 5 to 14 years and the sub-group of individuals who had a drinking history of over 15 years. Kino et al22 found increased ventricular thickness when consumption exceeded 75 mL/d (60 g) of ethanol, and the increase was higher among those subjects who consumed over 125 mL/d (100 g), without specifying the duration of consumption. In another study on this topic, Lazarević et al23 divided a cohort of 89 asymptomatic individuals whose consumption exceeded 80 g/d (8 standard alcoholic cardiomyopathy units) into 3 groups according to the duration of their alcohol abuse. Subjects with a shorter period of alcohol abuse, from 5 to 10 years, had a significant increase in left ventricular diameter and volume compared to the control group.

Clinical work-up for alcoholic cardiomyopathy

Once the damage is considered irreversible, it’s difficult for the heart and rest of the body to recover. Alcoholic cardiomyopathy is most common in men between the ages of 35 and 50, but the condition can affect women as well. People with alcoholic cardiomyopathy often have a history of heavy, long-term drinking, usually between five and 15 years. Heavy drinking is alcohol consumption that exceeds the recommended daily limits.