Led by Alexandra Goncalves, MD, PhD, a postdoctoral research fellow at Brigham and Women's Hospital in Boston, the analysis correlated weekly alcohol consumption in almost 4,500, mainly white, subjects -- average age 76, 60% women, 20% black -- to the size, structure, and function of the heart. While excessive alcohol consumption is clearly associated with cardiomyopathy, the influence of moderate alcohol use on cardiac structure and function is largely unknown.
Study participants, drawn from visit five in the prospective observational Atherosclerosis Risk in Communities study, underwent transthoracic echocardiography. (Former drinkers, who may have quit for health reasons, and people with significant valvular disease were excluded.) The investigators classified subjects into four consumption categories based on self-reported alcohol intake: nondrinkers and drinkers of ≤7, ≥7-14, and ≥14 drinks per week. Over half of the cohort were nondrinkers.
Nondrinkers were more likely to be women with higher body mass index, and nondrinkers of both sexes were older, with lower education levels and annual incomes. They were also more likely to have diabetes, lower low-density lipoprotein (LDL) cholesterol and high-density (HDL) cholesterol, and a higher triglyceride/HDL ratio. Drinkers of ≥14 drinks per week of both sexes were more frequently smokers and had higher LDL and HDL.
The relationship between alcohol consumption and hypertension was U-shaped in both sexes, with hypertension being more frequent among nondrinkers and in those drinking ≥14 drinks per week. There was no significant trend in the prevalence of coronary artery disease by intake category.
The investigators reported subtle cardiac alterations in both genders. In women and men, escalating alcohol intake was associated with larger left ventricular (LV) diastolic and systolic diameters and larger left atrial diameter (P<0.05). In men, increasing alcohol intake correlated with greater LV mass (8.2 + 3.8 g per category, P=0.029), a higher tricuspid annulus peak systolic velocity, and a higher E/E' ratio (0.82 + 0.33 per category, P=0.014), suggesting increasing diastolic pressures.
In women, increasing alcohol intake was associated linearly with a modestly lower LV ejection fraction (-1.9 + 0.6% per category, P=0.002) and a propensity toward worse LV peak global longitudinal strain (0.45 + 0.25% per category, P=0.07).
"In spite of increasing LV end-diastolic diameter, no significant increase in LV volumes was observed in either men or women according to alcohol intake," the authors wrote. While the number of black participants was relatively small, especially at the higher end of the consumption spectrum, they observed a significant interaction between race and alcohol intake in men for LV end-diastolic diameter, with greater increases in black men than white at the same consumption level (P=0.008).
"Women appear more susceptible than men to the cardiotoxic effects of alcohol, which might potentially contribute to a higher risk of alcoholic cardiomyopathy, for any given level of alcohol intake," said senior author Scott Solomon, MD, a professor of medicine at Harvard Medical School, in an American Heart Association news release.
Added Goncalves, "In spite of potential benefits of low alcohol intake, our findings highlight the possible hazards to cardiac structure and function by increased amounts of alcohol consumption in the elderly, particularly among women. This reinforces the U.S. recommendations stating that those who drink should do so with moderation." Moderate drinking is generally defined as two alcoholic beverages a day for men and one for women.
As for limitations, the authors note the study's confounding-prone observational design, which cannot establish causality between alcohol and cardiac alterations, as well as its self- and hence perhaps under-reported use of alcohol. In addition, its findings may not apply to younger and nonwhite populations.
The study was funded by the National Heart, Lung and Blood Institute.
The authors disclosed no competing interests.
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