Influence of Gender and Reported Alcohol Intake on Mortality in Nonischemic Dilated Cardiomyopathy

Abstract

Between 1994-1998, we retrospectively studied a cohort of 396 consecutive patients with dilated cardiomyopathy, mean age 53 +/- 15 years, 74% men. The history of alcohol intake was abstracted from the medical records. During a follow-up period of 42 +/- 26 months, 83 (76% men) patients died and 15 (80% men) underwent cardiac transplantation. Men were younger and more likely to have a history of excessive alcohol intake compared with women. Gender significantly modified the risk of alcohol consumption on mortality. Although alcohol intake increased the mortality risk in women, it was protective toward death in men (hazards ratios for death were 7.3 vs. 0.44). The effect of alcohol intake on outcome was reassessed after classifying the patients into 4 groups: group 1: life-long nondrinkers; group 2: former drinkers; group 3: moderate drinkers; and group 4: heavy drinkers. Similar findings were seen. This study demonstrated that the risk of reported alcohol intake on mortality is related to gender in patients with nonischemic heart failure. Our findings deserve further study, including a larger number of females, as a possible way to improve outcome in such patients.

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

“…88 Death rates related to alcoholic cardiomyopathy are greater in men than women because of the higher prevalence of alcohol consumption in men, but alcohol intake is associated with a higher mortality risk in women than in men with DCM. 90 The risk of developing alcoholic cardiomyopathy appears to be related to mean daily alcohol intake, duration of drinking, and individual patient characteristics, including genetic susceptibility. In general, alcoholic patients consuming alcohol for >5 years are at risk for the development of alcoholic cardiomyopathy.…”

“…In patients with alcoholic cardiomyopathy, total abstinence is recommended (Level of Evidence C). [88][89][90][91]94,95 Cocaine-related Cardiomyopathy…”

Alcohol consumption and prognosis in patients with left ventricular systolic dysfunction after a myocardial infarction

“…In contrast, in a study of 753 patients admitted to a Veterans Administration facility with HF, the majority of whom had nonischemic LV dysfunction, alcohol consumption was an independent predictor of multiple readmissions for HF (32). Additionally, a study of alcohol consumption in 396 patients with nonischemic LV dysfunction demonstrated a hazard in women, but not in men (33). Some potential limitations of this analysis should be noted.…”

The Effects of Biological Sex and Diet on the Development of Heart Failure

“…For example, the impact of alcohol intake on death rate in patients with dilated cardiomyopathy is greater in females than in males. 109 As a tool to identify mechanisms behind this difference, transgenic models exist in which females develop worse cardiac phenotypes than males. For example, both sexes of mice with cardiac-restricted overexpression of platelet-derived growth factor C develop hypertrophy, but only female animals showed dilated cardiomyopathy, heart failure, and sudden death.…”