Cardiovascular medicine
Dose dependent but non-linear effects of alcohol on the left and
right ventricle
O A Kajandera, M Kuparib, P Laippalaa, V Savolainena, J Pajarinenc, A Penttiläd, P J Karhunena
a Medical School,
University of Tampere and Tampere University Hospital, Tampere, Finland, b Division of Cardiology, Department of
Medicine, Helsinki University Central Hospital, Helsinki, Finland, c Department of Traumatology,
Helsinki University Central Hospital, Helsinki, Finland, d Department
of Forensic Medicine, University of Helsinki, Helsinki, Finland
Correspondence to: Dr Kajander ok53068{at}uta.fi
Accepted 18 June 2001
OBJECTIVE
To assess how left (LV) and
right ventricular (RV) size, wall thickness, and mass depend on daily
alcohol consumption. Among alcoholics, most common findings have been
LV hypertrophy and mild systolic or diastolic dysfunction, accompanied
occasionally by ventricular dilatation resembling dilated
cardiomyopathy. Although it is commonly agreed that chronic heavy
alcohol use is injurious to the heart, the dose-injury relation remains
a matter of dispute.
DESIGNProspective series of 700 Finnish men aged 33-70 years who died out of hospital and underwent a
medicolegal necropsy.
METHODS AND RESULTSData on alcohol
use and other risk factors were obtained from the spouse. At necropsy,
a transversal slice of the heart was traced on a transparent sheet and
analysed later for LV and RV cavity areas and wall thicknesses.
Coronary artery stenoses were measured from silicone casts of the
arteries. In analyses of all men, daily alcohol dose predicted heart
weight (
= 0.17, p < 0.001) and RV cavity area ( = 0.14,
p = 0.007) independent of body size, age, coronary artery disease,
hypertension, diabetes, and smoking. In the subgroup of men free of
significant coronary artery disease, LV area averaged (SEM) 11.0 (1.0) cm2 in men drinking < 12 g/day, 7.7 (0.7) cm2 in those drinking 72-180 g/day, and 10.0 (0.9) cm2 in those drinking > 180 g/day (p = 0.054).
Very heavy drinking (> 180 g/day) was associated with an increase in
RV cavity area (p = 0.005).
CONCLUSIONSThe effects of alcohol on
the heart in middle aged men are dose dependent but partly non-linear.
In the absence of coronary artery disease, LV size shows a U shaped
reduction with increasing daily alcohol use accompanied by an increase
in RV size with very heavy drinking. These findings question the idea
of progressive LV dilatation with increasing alcohol consumption among
male victims of sudden death.
Keywords: alcohol; cardiomyopathy; remodelling; sudden death
© 2001 by Heart
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