Alcohol’s Impact on Heart Failure After MI

While patients with myocardial infarction
(MI) may benefit from alcohol consumption (e.g., protection against
coronary artery disease progression), they might also be more vulnerable
to alcohol’s cardiotoxic effects. This study aimed to assess the
influence of alcohol intake on the development of symptomatic heart
failure (hospitalization for heart failure or need for an angiotensin-converting
enzyme inhibitor) in 2231 patients with a left ventricular ejection
fraction <40% following MI. Three weeks prior to MI, 32% of
these patients consumed 1–10 drinks per week while 11% consumed >10;
two weeks after MI, 15% consumed 1–10 drinks per week while
1% consumed >10.

In analyses adjusted for various demographic,
behavioral, and clinical factors, drinking before or after MI did
not significantly affect risk of heart failure. However, despite
this lack of statistical significance, hazard ratios for those consuming
>10 drinks per week before MI indicated greater risk of all the
cardiovascular outcomes examined (e.g., heart failure, total mortality,
cardiovascular mortality).

Comments:

Unlike most previous
studies, this study did not find reductions in heart failure and death
from moderate drinking among patients with MI and left ventricular
dysfunction. However, because only 1% of those studied consumed >10
drinks per week, there were too few patients to test for either benefits
or adverse consequences of drinking. The true balance of benefits and
risks of alcohol use following MI remains unclear from observational
studies and may be clarified only through clinical trials.

R.
Curtis Ellison, MD

Reference:

Aguilar D, Skali H,
Moyé LA, et al. Alcohol consumption and prognosis in patients
with left ventricular systolic dysfunction after a myocardial infarction. J
Am Coll Cardiol. 2004;43(11):2015–2021.
(view
abstract)