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Alcohol abuse and dilated cardiomyopathy in men
A Gavazzi1, R De Maria, M Parolini
1Divisione di Cardiologia, IRCCS Policlinico San Matteo, Pavia, Italy. agavazzi@ospedaliriuniti.bergamo.it On behalf of the Italian Multicenter Cardiomyopathy Study Group.
Insights
Excessive alcohol intake is common in idiopathic dilated cardiomyopathy (IDC). Continued alcohol abuse in IDC patients significantly worsens prognosis and cardiac function, even with treatment.
Area of Science:
- Cardiology
- Toxicology
Background:
- Idiopathic dilated cardiomyopathy (IDC) affects 3-40% of patients with excessive ethanol intake.
- Historically, alcoholic cardiomyopathy had a better prognosis than IDC, but this was limited to abstinent patients.
- Large-scale studies on IDC patients treated with ACE inhibitors and alcohol abuse are limited.
Purpose of the Study:
- To analyze the long-term outcomes of male patients with IDC based on alcohol abuse status.
- To evaluate the impact of continued versus stopped alcohol abuse on prognosis and cardiac function in IDC patients treated with ACE inhibitors.
Main Methods:
- Prospective, multicenter registry of 338 male IDC patients.
- Classification of patients into alcohol abusers (79/338, 23%) and non-abusers.
- Further classification of alcohol abusers into those who stopped (AAS) or continued (AAC) abuse during follow-up (mean 59 months).
Main Results:
- Alcohol abusers had significantly lower 7-year transplant-free survival (41%) compared to non-abusers (53%).
- Continued alcohol abuse (AAC) was associated with the worst survival (27%) compared to AAS (45%) and non-abusers.
- While IDC patients showed improved left ventricular function, only AAS patients had a significant increase in ejection fraction.
Conclusions:
- Excessive alcohol intake is prevalent in approximately one-fourth of IDC patients.
- Persistent alcohol abuse in IDC patients correlates with a poorer prognosis and impaired cardiac function, despite ACE inhibitor treatment.
- Abstinence from alcohol in IDC patients is associated with improved ejection fraction and better long-term outcomes.
Abstract:
Excessive ethanol intake is reported in 3% to 40% of patients with idiopathic dilated cardiomyopathy (IDC). In the prevasodilator era, the prognosis was reportedly better in alcoholic than in IDC patients, an advantage limited to abstinent patients. No large series of patients systematically treated with angiotensin-converting enzyme inhibitors has since been described. We analyzed long-term outcome according to alcohol abuse in male patients with IDC. Among 338 men who had been prospectively enrolled in a multicenter registry, 79 (23%) were defined as alcohol abusers and further classified at follow-up as having stopped (AAS) or continued (AAC) abuse. AAC subjects at enrollment reported a higher daily alcohol intake than AAS subjects (178 +/- 113 vs 127 +/- 54 g/day, p = 0.012). During a mean of 59 +/- 35 months, 102 patients died and 45 underwent transplantation. Seven-year transplant-free survival was significantly lower in alcohol abusers (41%) than in patients with IDC (53%, p = 0.026), and significantly lower in AAC subjects (27%) than in either patients with IDC or AAS (45%) (p = 0. 018). Although IDC patients had beneficial changes in left ventricular function at follow-up, only AAS patients had significant improvement in ejection fraction. In this large series of patients treated with angiotensin-converting enzyme inhibitors and prospectively followed up, excessive alcohol intake was found in about one fourth of cases and persistent alcohol abuse correlated with a worse prognosis and function at follow-up.