The effect of controlled drinking in alcoholic cardiomyopathy

Abstract

Background: Cardiomyopathy is a potentially fatal complication of alcohol abuse. In alcoholic persons who develop cardiac dysfunction, abstinence is thought to be essential to halt further deterioration of cardiac contractility. Some evidence indicates that reducing alcohol intake may also be beneficial.

Objective: To evaluate the effect of moderate "controlled" drinking on cardiac function in patients with alcoholic cardiomyopathy.

Design: 4-year prospective cohort study.

Setting: A university hospital in Barcelona, Spain.

Patients: 55 alcoholic men with cardiomyopathy who had been drinking a minimum of 100 g of ethanol per day for at least 10 years.

Measurements: Evaluation of ethanol intake and nutrition, clinical assessment of cardiac status, and sequential echocardiography and radionuclide cardiac angiography.

Results: After the first year of evaluation, all patients with cardiomyopathy who abstained from alcoholic beverages demonstrated significant improvement in left ventricular function (average increase in left ventricular ejection fraction, 0.131 [95% CI, 0.069 to 0.193]). Patients who drank 20 to 60 g of ethanol per day showed a comparable mean improvement of 0.125 (CI, 0.082 to 0.168). In contrast, left ventricular ejection fraction deteriorated further in most patients who continued to abuse alcohol (>80 g/d). After 4 years, left ventricular ejection fraction had continued to improve in both abstinent patients and those who controlled their drinking. Ten patients who had continued to consume more than 80 g of ethanol per day died during the study.

Conclusion: In patients with alcoholic cardiomyopathy, both abstinence and controlled drinking of up to 60 g of ethanol per day (four standard drinks) were comparably effective in promoting improvement in cardiac function.