Alcohol abuse and dilated cardiomyopathy in men

Excessive ethanol intake is reported in 3% to 40% of patients with idiopath ic dilated cardiomyopathy (IDC). In the prevasodilator era, the prognosis w as reportedly better in alcoholic than in IDC patients, an advantage limite d to abstinent patients. No large series of patients systematically treated with angiofensin-converting enzyme inhibitors has since been described. We analyzed long-term outcome according to alcohol abuse in male patients wit h IDC. Among 338 men who had been prospectively enrolled in a multicenter r egistry, 79 (23%) were defined as alcohol abusers and further classified at follow-up as having stopped (AAS) or continued (AAC) abuse. AAC subjects a t enrollment. reported a higher daily alcohol intake than AAS subjects (178 +/- 113 vs 127 +/- 54 g/day, p = 0.012). During a mean of 59 +/- 35 months , 102 patients died and 45 underwent transplantation. Seven-year transplant -free survival was significantly lower in alcohol abusers (41% than in pati ents with IDC (53%, p = 0.026), and significantly lower in AAC subjects (27 %) than in either patients with IDC or AAS (45%) (p = 0.018). Although IDC patients herd beneficial changes in left ventricular function at followup, only AAS patients herd significant improvement in ejection fraction. In thi s large series of patients treated with angiotensin-converting enzyme inhib itors and prospectively followed up, excessive alcohol intake was found in about one fourth of cases and persistent alcohol abuse correlated with a wo rse prognosis and function at follow-up. (C) 2000 by Excerpta Medica, Inc.