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Stirred, Not Shaken
The effect of alcohol on the cardiovascular system has been studied and debated for over 150 years (1), but a specific cardiomyopathy related to excessive alcohol consumption has been recognized only for the past half century (2). The putative effect of alcohol on the heart has been clouded and confounded by cardiovascular damage due to simultaneous nutritional deficiency as a consequence of beriberi, the toxic effects of additives such as cobalt, and the lack of a good large-animal model of alcoholic cardiomyopathy (3). We now know that alcohol can directly affect the cardiovascular system, but the precise mechanism of damage remains controversial (4, 5). Two studies in this issue (6, 7) add to our understanding of this association. While they may raise almost as many questions as they answer, taken together they can be stirred into our understanding of alcohol's effects on the heart without fundamentally shaking the foundations of our knowledge.
That alcohol can affect the heart in humans would seem to be beyond doubt, although some would argue that a firm causal relationship has not been proven (8). Clear and persuasive data show that long-term alcohol use may be associated with left ventricular dysfunction and overt congestive heart failure, a variety of supraventricular and ventricular arrhythmias, sudden death, and hypertension. Alcohol is believed to be the causal agent in 3% to 40% of all patients with otherwise unexplained (idiopathic) dilated cardiomyopathy (9). Even short-term, acute ingestion of alcohol may result in transient left ventricular dysfunction and arrhythmias (10, 11). The cessation of alcohol …
