Alcoholic cardiomyopathy: Treatments, outlook, and more

Prompt treatment can help prevent the disease from https://ecosoberhouse.com/ getting worse and developing into a more serious condition, such as congestive heart failure (CHF). 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. In spite of the high prevalence of excessive alcohol consumption and of its consideration as one of the main causes of DCM, only a small number of studies have analysed the long-term natural history of ACM.

NATURAL HISTORY OF ALCOHOLIC CARDIOMYOPATHY

Commonly seen cellular structural alterations include changes in the mitochondrial reticulum, cluster formation of mitochondria and disappearance of inter-mitochondrial junctions. In the study by Gavazzi et al10, ACM patients who continued drinking exhibited worse transplant-free survival rates after 7 years than those who stopped drinking alcohol (27% vs 45%)10. From the data provided in the available ACM studies, it appears that patients who received an ACEI globally showed improved prognosis. In contrast, beta-blockers, similar to aldosterone inhibitors, however beneficial they may be, have thus far not yielded sufficient data on their efficacy in relation to this disease. In the second study, Gavazzi led a multicentre study in which, from 1986 to 1995, 79 patients with ACM and 259 patients with DCM were recruited10. Transplant-free survival after 7 years was worse among patients with ACM than among those with DCM (41% vs 53%).

• Abnormal heart sounds, murmurs, ECG abnormalities, and enlarged heart on chest x-ray may lead to the diagnosis.
• This activity examines when this condition should be considered on differential diagnosis.
• Therefore, the only safe ethanol dose for the cardiovascular system is zero 41,45,49,50,51.
• Although there is beneficial potential in some patients, the coexistence of increased risk of cancer, neurological brain damage, and the high risk of ethanol addiction makes it necessary to discourage this low-dose consumption in the general population 19,41,45.
• In fact, patients with ACM who abstain from alcohol have a better long-term prognosis than subjects with idiopathic dilated CMP 54.
• Data on the amount of alcohol consumption required to cause ACM are limited and controversial.

Symptoms

One of the relevant facts in ACM is the existence of a clear gender difference, women being more susceptible to the toxic effects of alcohol than men at the same level of lifetime ethanol consumption 93,94. This fact has been assessed with echocardiographic monitoring in women consuming high doses of ethanol both in the subclinical period of disease 46 as well as in the clinical period when congestive heart failure appears 95. At the experimental level, some gender differences also are evident in functional proteomic analysis, with sex-dependent differences in structural and energy-producing myocardial proteins in a rat model of alcoholic cardiomyopathy 96. The biological reason for drug addiction treatment this gender difference is based on different ethanol absorption rates, distribution pattern, and metabolism in women compared to men 52.

Health Conditions

Therefore, physicians should be aware of the risk of new cardiomyopathy in patients with these overlapping diagnoses 144. Control of these alcohol-related systemic diseases, as well as the strict control of the presence of other heart risk factors (tobacco, cocaine, arterial hypertension, diabetes mellitus, or anemia) contributes to ACM improvement 10,20,23,37,52. Atrial fibrillation should be controlled with chronotropic drugs such as digoxin alcoholic cardiomyopathy or diltiazem and anticoagulant treatment to avoid arterial embolisms 60,145. Symptoms of ACM are not specific and overlap with other forms of heart failure 30,41,58. They appear when ventricle dilatation, hypertrophy, and dysfunction are established.

• 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.
• Therefore, efforts to prevent ACM development in women should be specifically addressed 97.
• When it comes to wine, one drink is defined as a 5-ounce (148 ml) serving, which typically contains about 12% ABV.
• People with alcoholic cardiomyopathy often have a history of heavy, long-term drinking, usually between five and 15 years.
• The sarcomere complex is early affected by ethanol, decreasing the titin content, a protein that is responsible for sarcomere relaxation and LV distensibility 130.

Although some studies have detailed structural and functional damage in proportion to the amount of alcohol consumed during a patient’s lifetime24, a large majority of authors have discarded this theory21-23,25. Both the absence of a direct correlation and the theory of the existence of a threshold dose (above which some alcoholics develop ACM) require the presence of individual susceptibility to alcohol induced cardiac damage63. It is unknown whether individual susceptibility would be related to increased vulnerability at the myocardial level and/or to impaired alcohol metabolism. Experimental studies analysing the depressive properties of alcohol on the cardiac muscle invariably use similar approaches31-39. Accordingly, a given amount of alcohol is administered to volunteers or alcoholics, followed by the measurement of a number of haemodynamic parameters and, in some cases, echocardiographic parameters. Generally, following alcohol intake, healthy, non-drinking individuals showed an increase in cardiac output due to a decline in peripheral arterial resistance and an increase in cardiac frequency31.

Therefore, complete abstinence from ethanol is the most useful measure to control the natural course of ACM 51,56,135. In fact, patients with ACM who abstain from alcohol have a better long-term prognosis than subjects with idiopathic dilated CMP 54. Out of end-stage cases, the majority of subjects affected by ACM who achieve complete ethanol abstinence functionally improve 33,82,135. The percentage of effective abstinence achievement on these patients submitted to specific programs ranges from 50% to 60% 8,9.

AMOUNT OF ALCOHOL REQUIRED TO PRODUCE ACM

Once the 15 articles were selected (see Appendix Table 1 for the list of included articles), we extracted and organized relevant information from them. Since ethanol consumption of the global population is not currently under control 2, the incidence of alcoholic cardiomyopathy is expected to be maintained in the future, especially in specific population groups, such as adolescents and young people 3. Therefore, efforts for the prevention, early detection, and specific treatment in this relevant disease should be established 45.

Structurally, hypertrophy of myocytes is seen in the early stages to avoid contractile depression 52,107,125. The heart output is progressively lower in a dose-dependent relationship with the lifetime accumulated total dose of alcohol consumed 38. Several growth factors and cardiomyokines exert an autocrine or paracrine effect that tries to compensate for this heart damage 119,133. Antioxidant, anti-inflammatory, anti-apoptotic, and antifibrogenic mechanisms try to avoid myocyte necrosis and heart fibrosis 14,30,58. The final result is that achieved from the equilibrium between the degree of damage and the capacity of heart repair mechanisms in each specific individual 31,56.