What is the role of alcohol in the etiology of dilated cardiomyopathy?

Updated: Mar 02, 2021
  • Author: Vinh Q Nguyen, MD, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Low to moderate levels of alcohol consumption have been shown to have positive cardiovascular benefits, but excessive, chronic use may lead to myocardial dysfunction. [27]  According to the 2013 American College of Cardiology Foundation and American Heart Association (ACCF/AHA) heart failure guidelines, the clinical diagnosis of alcoholic cardiomyopathy is suspected in the presence of biventricular dysfunction and dilation in the setting of excessive alcohol use. [13]  The risk is increased in individuals who consume more than 90 g of alcohol daily (approximately 7-8 drinks/day) for longer than 5 years.

The natural evolution of alcoholic cardiomyopathy has not adequately been assessed in light of the currently available heart failure therapy. A number of studies dating back to the 1970s show rates of overall mortality or the need for transplant ranging from 19% to 73%. Differences were due to different cut-offs in LVEF, variation in the use of beta-blockers/angiotension converting enzyme (ACE) inhibitors/spironolactone, and the use of implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy. [27]  Thus, the evolution of alcoholic cardiomyopath,y taken in consideration of contemporary therapy, requires further investigation for better understanding. Myocardial recovery has also been described with the cessation of alcohol intake. [28]

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