However, a possible confusion factor was identified because the group with clinical improvement also exhibited a shorter evolution of the symptoms and the disease. Complete alcohol withdrawal is usually recommended to all patients with ACM. For tens of years, the literature has documented many clinical cases or small series of patients who have undergone a full recovery of ejection fraction and a good clinical evolution after a period of complete alcoholic abstinence. The suspicion that there may be an individual susceptibility to this disease is underscored by the finding that only a small group of alcoholics develop ACM, and that a proportional relationship between myocardial damage and alcohol intake has not been proven. In spite of numerous studies, the sequence of events that occur in alcohol-induced myocardial damage is still highly controversial.
- What you should expect with this condition depends strongly on several factors.
- It’s important to note that alcoholic cardiomyopathy may not cause any symptoms until the disease is more advanced.
- This influences the maintenance of cardiac geometry and contractile function, increasing the development of ACM [121].
- It is largely unknown which factors determine cardiac toxicity on exposure to alcohol.
Ways to stay healthy
Men between 35 and 50 have a higher risk of developing alcohol-induced cardiomyopathy. As pointed out before, the current accepted definition of ACM probably underestimates the number of women affected by the disease. Alcohol affects heart function and is dependent on the quantity of alcohol that the heart is exposed to. Women typically have a lower BMI than men, and therefore the same alcohol alcoholic cardiomyopathy exposure can be achieved with lower alcohol intake. Demakis et al[70] in 1974 divided a cohort of 57 ACM patients according to the evolution of their symptoms during follow-up. The sub-group of patients in whom symptoms improved was made up of a larger proportion of non-drinkers (73%), compared to 25% in the group who did not improve, or 17% in the group whose condition worsened.
Alcoholic cardiomyopathy: Cytotoxicity of alcohol on heart muscle
According to the American Heart Association (AHA) and other US-based guidelines, alcohol intake recommendations are provided to promote responsible drinking habits and maintain overall health. The AHA suggests moderate alcohol consumption for those who choose to drink, defining moderation as up to one drink per day for women and up to two drinks per day for men. It is important to note that these guidelines apply to healthy adults and should be adjusted for individuals with certain health conditions or those taking specific medications. In addition, the AHA advises against starting to drink alcohol solely for potential health benefits, as the risks can outweigh the advantages.
- In recent years, basic and clinical research has shed light on its pathogenesis, which includes direct toxic effects of alcohol on the myocardium, oxidative stress, mitochondrial dysfunction, and genetic susceptibility.
- The existence of a direct causal link between excessive alcohol consumption and the development of DCM is a controversial issue.
- The AHA suggests moderate alcohol consumption for those who choose to drink, defining moderation as up to one drink per day for women and up to two drinks per day for men.
- 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.
Differential Diagnosis
Despite the key clinical importance of alcohol as a cause of DCM, relatively few studies have investigated the effects of alcohol on the heart and the clinical characteristics of DCM caused by excessive alcohol consumption (known as https://ecosoberhouse.com/). New strategies to improve the natural course of ACM have been proposed as promising agents in this field [112,147]. Since ethanol has multiple cell targets with different pathological mechanisms implicated, those different strategies to directly target alcohol-induced heart damage are only partially effective and can only be used as support medication in a multidisciplinary approach [112]. They try to control myocardial remodeling to avoid the progression of myocyte hypertrophy [39,148] or fibrosis [149] and ventricle dysfunction and dilatation, as well as to increase the degree of myocyte regeneration [150]. Recently, new cardiomyokines (FGF21, Metrnl) and several growth factors (myostatin, IGF-1, leptin, ghrelin, miRNA, and ROCKs inhibitors) have been described as being able to regulate cardiac plasticity and decrease cardiac damage, improving cardiac repair mechanisms [112,119]. They aim to control oxidative damage, myocyte hypertrophy, interstitial fibrosis, and persistent apoptosis.
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Therefore, based on the existence or absence of congestive heart failure symptoms and signs, individuals may be classified as asymptomatic (preclinical phase) or symptomatic (clinical phase). The left ventricular end-diastolic diameters show a significant increase in such patients compared to healthy individuals in the same age and weight. Moreover, there is a decrease in the left ventricular mass index and ejection fraction, falling below the normal range. Diastolic dysfunction, characterized by impaired left ventricular relaxation and reduced diastolic filling capacity, serves as an early indicator of ACM. Ventricular dilatation is the first echocardiographic change seen in alcohol use disorder patients, coming before diastolic dysfunction and hypertrophy.
In all ACM studies, inclusion of patients is based on patients’ self-reported alcohol drinking habits, which may lead to an underestimation of the prevalence of ACM together with problematic identification of patients who abstain and those who continue drinking. Although analytical markers of alcohol consumption, such as average erythrocyte volume and serum gamma-glutamyltranspeptidase levels, could be an aid to establish abstinence or persistence of alcohol intake in patients, the quantity of alcohol intake is dependent on the patients’ report. Furthermore, in many of these reports, comorbid conditions, especially myocarditis and other addictions such as cocaine and nicotine, were not reported. 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 disease[1,2]. Ballester specifically analysed the effects of alcohol withdrawal on the myocardium using antimyosin antibodies labelled with Indium-111[72].
Coronary artery disease and atherosclerosis
Who is At Risk of Alcoholic Cardiomyopathy?
