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Alcohol Intake and Cardiac Remodeling
Study Questions:
What is the relationship between alcohol intake and cardiac remodeling?
Methods:
The study cohort was comprised of 5,115 patients in the CARDIA (Coronary Artery Risk Development in Young Adults) study. In this cohort, the authors studied all subjects without baseline heart disorders who provided adequate information on their drinking habits and underwent echocardiographic evaluation at years 5 and 25 of the study. The echocardiographic outcomes were left ventricular ejection fraction (LVEF), indexed LV end-diastolic volume and LV mass, and left atrial diameter. Participants were grouped according to their weighted-average weekly drinking habits. An additional analysis used the estimated cumulative alcohol consumption. Regression models and multivariable fractional polynomials were used to evaluate the association between alcohol consumption and the outcomes.
Results:
In total, 2,368 participants were included in the analysis. Their median age at the end of the study was 51 years (interquartile range, 47-53 years). In total, 44.4% (n = 1,051) were male and 57.3% (n = 1,356) were Caucasian. The majority of participants either did not consume alcohol or drank <4 standard drinks per week. The average daily ethanol intake was 10 ml, and only 8.1% (n = 192) of the participants were “at-risk” drinkers, with a weekly alcoholic intake above 14 drinks per week. The estimated mean cumulative alcohol intake was 82 ± 130 L over 20 years (mean of 13 drink-years). Among these 2,368 participants, alcohol consumption was an independent predictor of higher indexed LV mass (LV mass of 81.2 ± 20.9 g/m2 in nondrinkers vs. 92.4 ± 19.6 g/m2 if >14 drinks/week; adjusted p = 0.014) and indexed LV end-diastolic volume (53.1 ± 10.7 ml/m2 in nondrinkers vs. 58.8 ± 14.8 ml/m2 if >14 drinks/week; p = 0.037), regardless of gender. No significant relationship between alcohol intake and LVEF was found. Drinking predominantly wine was associated with less cardiac remodeling (body surface area-indexed LV mass, g/m2 with beer was 87.94 ± 23.44, wine 79.86 ± 18.15 [p = 0.001 compared to beer], and liquor 85.85 ± 23.2 [p = not significant compared to beer]), and there was a nonsignificant trend for a harmful effect of binge drinking.
Conclusions:
The authors concluded that alcohol intake was associated with adverse cardiac remodeling, although it was not related with LV systolic dysfunction after 20 years of follow-up. They also concluded that drinking predominantly wine associates with less deleterious findings in cardiac structure. There was a nonsignificant trend for a deleterious effect of binge drinking.
Perspective:
The strength of this study was the long-term follow-up, but the concern is that it did not fully reflect the effect of heavy alcohol consumption. The absolute changes in echocardiographic parameters were small, and overall, the values remained within normal limits. Therefore, these results suggest that mild alcohol consumption (<7 drinks per week) does not impact cardiac structure. Intriguing is that wine had less deleterious impact on cardiac structure. Further studies are needed to confirm these important findings.
Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Echocardiography/Ultrasound
Keywords: Alcohol Drinking, Alcoholic Beverages, Beer, Binge Drinking, Cardiomyopathy, Alcoholic, Diagnostic Imaging, Echocardiography, Ethanol, Heart Failure, Primary Prevention, Stroke Volume, Wine, Ventricular Function, Ventricular Remodeling
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