@article {Tayalheartjnl-2021-319418, author = {Upasana Tayal and John Gregson and Rachel Buchan and Nicola Whiffin and Brian P Halliday and Amrit Lota and Angharad M Roberts and A John Baksi and Inga Voges and Julian W E Jarman and Resham Baruah and Michael Frenneaux and John G F Cleland and Paul Barton and Dudley J Pennell and James S Ware and Stuart A Cook and Sanjay K Prasad}, title = {Moderate excess alcohol consumption and adverse cardiac remodelling in dilated cardiomyopathy}, elocation-id = {heartjnl-2021-319418}, year = {2021}, doi = {10.1136/heartjnl-2021-319418}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objective The effect of moderate excess alcohol consumption is widely debated and has not been well defined in dilated cardiomyopathy (DCM). There is need for a greater evidence base to help advise patients. We sought to evaluate the effect of moderate excess alcohol consumption on cardiovascular structure, function and outcomes in DCM.Methods Prospective longitudinal observational cohort study. Patients with DCM (n=604) were evaluated for a history of moderate excess alcohol consumption (UK government guidelines; \>14 units/week for women, \>21 units/week for men) at cohort enrolment, had cardiovascular magnetic resonance and were followed up for the composite endpoint of cardiovascular death, heart failure and arrhythmic events. Patients meeting criteria for alcoholic cardiomyopathy were not recruited.Results DCM patients with a history of moderate excess alcohol consumption (n=98, 16\%) had lower biventricular function and increased chamber dilatation of the left ventricle, right ventricle and left atrium, as well as increased left ventricular hypertrophy compared with patients without moderate alcohol consumption. They were more likely to be male (alcohol excess group: n=92, 94\% vs n=306, 61\%, p=\<0.001). After adjustment for biological sex, moderate excess alcohol was not associated with adverse cardiac structure. There was no difference in midwall myocardial fibrosis between groups. Prior moderate excess alcohol consumption did not affect prognosis (HR 1.29, 95\% CI 0.73 to 2.26, p=0.38) during median follow-up of 3.9 years.Conclusion DCM patients with moderate excess alcohol consumption have adverse cardiac structure and function at presentation, but this is largely due to biological sex. Alcohol may contribute to sex-specific phenotypic differences in DCM. These findings help to inform lifestyle discussions for patients with DCM.Data are available on reasonable request. The data and analysis methods that support the findings of this study are available from the corresponding author, (UT) on reasonable request. Data will be shared after review and approval by our Biobank scientific board, and terms of collaboration will be reached together with a signed data access agreement.}, issn = {1355-6037}, URL = {https://heart.bmj.com/content/early/2021/08/10/heartjnl-2021-319418}, eprint = {https://heart.bmj.com/content/early/2021/08/10/heartjnl-2021-319418.full.pdf}, journal = {Heart} }