Long-term alcohol intake linked to poor cardiac remodeling in later years

A Journal of the American College of Cardiology study this week linked long-term alcohol consumption to adverse cardiac remodeling in patients who were initially young and healthy—something the paper’s authors said might be offset by drinking predominantly wine.

The study, led by Patricia Rodrigues, MD, of Barts Heart Center in London and Centro Hospitalar do Porto in Porto, Portugal, also found that while increased alcohol use was associated with poorer cardiac remodeling down the road, it didn’t seem to have much bearing on left ventricular (LV) ejection fraction or functionality. That stands in contrast to previous research, which has suggested LV systolic dysfunction and increased LV volumes contribute to the development of alcoholic cardiomyopathy.

But the evidence works both ways, and Rodrigues and her team said the relationship between alcohol and heart health “does not seem to be linear.” In fact, they wrote, mild-to-moderate alcohol intake is now widely accepted as heart-healthy.

“We lack information about the long-term effect of alcohol intake in young adults, and there is still controversy about the impact of other patients’ characteristics or the pattern of alcohol intake regarding the threshold level for being injurious,” the authors said. “Clarifying these issues related to alcohol’s cardiotoxicity could have a significant impact on public health.”

In their attempt to clarify those gray areas, the researchers drew data from 2,368 participants enrolled in the CARDIA cohort. Eligible patients had no baseline heart disorders, provided information about their drinking habits and underwent echocardiography at years 5 and 25 of the study.

Among the participants, Rodrigues et al. said alcohol consumption was an independent predictor of higher indexed LV mass and indexed LV end-diastolic volume, regardless of gender. They didn’t find any significant relationships between alcohol intake and LV ejection fraction, though the authors did say drinking mostly wine—as opposed to beer or liquor—was linked to less cardiac remodeling.

“The findings on type of drinks and cardiac measures were interesting, because they are regularly discussed elsewhere with low level of evidence,” Laurent Fauchier, MD, PhD, and colleagues at Centre Hospitalier Universitaire Trousseau et Faculté de Médicine in Tours, France, wrote in a related JACC editorial. “Wine has been reported to be associated with less coronary events, but very few studies have examined the association between beverage types and the risk of heart failure.”

They said Rodrigues and her team’s results might be confounded without the consideration of other factors, like diet. For that reason and others, Fauchier and his coauthors recommended further observational real-life analyses and interventional trials to improve clinical knowledge on the subject.

“Although many studies have been published about how and why moderately drinking alcohol may be associated with reduced mortality due to heart disease in some populations, it should systematically be repeated that drinking more alcohol increases the risk of alcoholism, high blood pressure, obesity, cardiomyopathy, stroke, cancer, suicide and accidents,” they wrote. “Overall, there are still considerable knowledge gaps about how alcohol, in combination with other factors, may affect incidence of alcoholic cardiomyopathy and prognosis in heart failure patients.”