Angiotensin-Converting Enzyme Gene Polymorphism Is Associated with Vulnerability to Alcoholic Cardiomyopathy

3 September 2002 | Volume 137 Issue 5 Part 1 | Pages 321-326

Background: Chronic alcohol abuse has a dose-dependent toxic effect on the myocardium, leading to alcoholic cardiomyopathy. The fact that only a minority of persons with chronic alcoholism have this condition suggests the possibility of a genetic vulnerability. In this context, polymorphism of the angiotensin-converting enzyme (ACE) gene has been implicated in cardiac dysfunction.

Objective: To compare the ACE genotypes of alcoholic persons who have cardiomyopathy with those of comparable alcohol abusers who have normal cardiac function.

Design: Case–control study over a 2-year period.

Setting: An academic tertiary referral hospital in Barcelona, Spain.

Patients: 30 alcoholic men with symptomatic cardiomyopathy and 27 alcoholic men with normal cardiac function.

Measurements: Ethanol intake, cardiac status, left ventricular ejection fraction (LVEF), and ACE gene polymorphism.

Results: The DD ACE genotype was present in 57% of alcoholic persons with an LVEF less than 0.50 and in 7% of those with normal cardiac function. Compared with persons who had an I allele, the odds ratio for development of left ventricular dysfunction in alcoholic persons with the DD genotype was 16.4.

Conclusions: Vulnerability to cardiomyopathy among chronic alcohol abusers is partially genetic and is related to presence of the ACE DD genotype. This finding demonstrates genetic susceptibility to alcohol-induced myocardial damage.

Editors' Notes Context Although alcoholic cardiomyopathy is a dose-dependent phenomenon, the amount of alcohol consumed accounts for only one third of the effect of alcohol. Angiotensin-converting enzyme (ACE) gene polymorphism may help explain variations in cardiac vulnerability to alcohol. Contribution ACE genotypes of alcoholic persons with cardiomyopathy were compared with those of persons who had similar alcohol intake but no evidence of cardiomyopathy. Homozygotes with the D allele were 16.4 times as likely to have cardiomyopathy as those with the I allele. Implications Cardiac vulnerability to the adverse effects of alcohol appears to be partially under genetic control. Identification of alcoholic persons with the DD genotype may lead to early and novel treatments of cardiomyopathy. –The Editors

 

Author and Article Information

Grant Support: By Fondo de Investigación Sanitaria (grants 98/0330, 99/0115, and 99/0318) and Generalitat de Catalunya (grant CUR 2001/SGR/00379).

Requests for Single Reprints: Emanuel Rubin, MD, Department of Pathology, Anatomy, and Cell Biology, Jefferson Medical College, 1020 Locust Street, Suite 279, Philadelphia, PA 19107; e-mail, emanuel.rubin{at}mail.tju.edu.

Potential Financial Conflicts of Interest:Grants Received: J. Fernández-Solà, J.M. Nicolás, E. Sacanella, R. Estruch, A. Urbano-Márquez.

Current Author Addresses: Drs. Fernández-Solà, Nicolás, Oriola, Sacanella, Estruch, and Urbano-Márquez: Alcohol Research and Cardiac Units, Department of Medicine, Hospital Clínic i Provincial, University of Barcelona, Villaroel, 170 08036, Barcelona, Spain.

Dr. Rubin: Department of Pathology and Cell Biology, Jefferson Medical College, Thomas Jefferson University, 1020 Locust Street, Suite 279, Philadelphia, PA 19107-6799

Author Contributions: Conception and design: J. Fernández-Solà, J. María Nicolás, E. Rubin, A. Urbano-Márquez.

Analysis and interpretation of the data: J. Fernández-Solà, J. María Nicolás, E. Rubin.

Drafting of the article: J. Fernández-Solà, J. María Nicolás, E. Rubin, A. Urbano-Márquez.

Critical revision of the article for important intellectual content: E. Rubin

Final approval of the article: A. Urbano-Márquez.

Provision of study materials or patients: E. Sacanella, R. Estruch.

Statistical expertise: J. María Nicolás.

Obtaining of funding: J. Fernández-Solà, J. María Nicolás, R. Estruch, E. Rubin.

Administrative, technical, or logistic support: J. Oriola.

Collection and assembly of data: E. Sacanella.