Alcoholic Cardiomyopathy: Where do we stand?

Main Article Content

Andrea M.P. Romani


The effect of alcohol consumption on cardiac and cardiovascular functions remains a point of contention in the medical field. The consumption of low or moderate amounts of alcohol has been largely associated with having beneficial effect on cardiac contractility and the cardiovascular system as a whole, owing to the detected vasodilatory effect exerted by the alcohol, and the reduction in mortality documented by several studies. In contrast, excessive alcohol consumption results in negative outcomes in both men and women, with cardiac arrhythmias and atrial fibrillation, abnormality in cardiac contraction leading to heart failure, and dilated cardiomyopathy, and overall cardiovascular dysfunctions, including hypertension. The main points of contention are two-fold: the dose of alcohol at which its perceived beneficial effects disappear and proper cardiac and cardiovascular functions become progressively impaired, and how to clinical and therapeutically address cardiac and cardiovascular pathologies in chronic alcoholics to ameliorate their general conditions and their prognosis. The present review aims at providing the reader with a general understanding of the effects of alcohol on the cardiovascular system and the pathophysiological mechanisms that lead to the most common cases of cardiac dysfunction, and highlight the current guidelines for treatment of alcoholic cardiomyopathy to ameliorate clinical presentation and prognosis in alcoholic patients.

Keywords: Alcohol, cytP4502E1, alcohol metabolism, cardiac ventricular myocytes, alcoholic cardiomyopathy, acetaldehyde, magnesium

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How to Cite
ROMANI, Andrea M.P.. Alcoholic Cardiomyopathy: Where do we stand?. Medical Research Archives, [S.l.], v. 10, n. 6, june 2022. ISSN 2375-1924. Available at: <>. Date accessed: 29 may 2023. doi:
Research Articles


1. Shanoff HM. Alcoholic cardiomyopathy: an introductory review CMA Journal; 1972;106(1):55-62.
2. Meister HP. The “Munich Beer Heart”- Revisited Das Münchner Bierherz, 1976;157(1):1-13. Accessed May 19, 2022.
3. Sanders MG. Alcoholic cardiomyopathy: a critical review. Q J Stud Alcohol; 1970;31(2):324-368.
4. Evans W. Alcoholic myocardiopathy, Progr Cardiovasc Dis;1964 Sep;7:151-171.
5. Xi B, Veeranski SP, Zhao M, Ma C, Yan Y, Mi J. Relationship of alcohol consumption to all-cause, cardiovascular, and cancer-related mortality in US adults. J Am Coll Cardiol;2017;70(8): 913-922.
6. Global Burden of Disease Study (GBD) 2016 Alcohol Collaborators, Griswold MG, Fullman N, Hawley C, et al. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet;2018;392(10152):1015–1035.
7. O’Keefe EL, DiNicolantonio JJ, O’Keefe JH, Lavie CJ. Alcohol and CV health: Jekyll and Hyde J-curves. Prog Cardiovasc Dis;2018;61(1):68–75.
8. Kalinowski A, Humphreys K. Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries. Addiction;2016;111(7):1293–1298.
9. Lieber CS. The Discovery of the Microsomal Ethanol Oxidizing System and Its Physiologic and Pathologic Role. Drug Metabolism Reviews;2004;36(3-4):511-529.
10. Lu D, Ma Y, Zhang W, et al. Knockdown of cytochrome P450 2E1 inhibits oxidative stress and apoptosis in the cTnT(R141W) dilated cardiomyopathy transgenic mice. Hypertension;2012; 60(1):81–89.
11. Fernández-Solà J. Cardiovascular risks and benefits of moderate and heavy alcohol consumption. Nat Rev Cardiol;2015;12(10):576 –587.
12. Goel S, Sharma A, Garg A. Effect of alcohol consumption on cardiovascular health. Curr Cardiol Rep;2018;20(4):19. DOI: 10.1007/s11886-018-0962-2 . Accessed May 19, 2022
13. Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G. Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med;2006;166(22):2437-2445.
14. (accessed 04/28/2022)
15. Maisch B. Alcoholic cardiomyopathy: the result of dosage and individual predisposition. Herz; 2016;41(6):484-493.
16. Roerecke M, Rehm J. Irregular heavy drinking occasions and risk of ischemic heart disease: a systematic review and meta-analysis. Am J Epidemiol; 2010;171(6):633 –644.
17. James TN, Bear ES. Effects of ethanol and acetaldehyde on the heart. Am Heart J;1967;74(2): 243-255.
18. Gould L. Cardiac effect of alcohol. Am Heart J;1970;79(3):422-425.
19. Elliott P, Andersson B, Arbustini E, et al. Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J;2008;29(2):270-276.
20. Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation;2006;113(14):1807-1816.
21. Haissaguerre M, Fleury B, Gueguen A, et al. [Mortality of dilated myocardiopathies as a function of continuation of alcohol drinking. Multivariate analysis concerning 236 patients]. Presse Med; 1989;18(14):711-714.
22. Gavazzi A, De Maria R, Parolini M, Porcu M. Alcohol abuse and dilated cardiomyopathy in men. Am J Cardiol;2000;85(9):1114-1118.
23. Fauchier L, Babuty D, Poret P, et al. Comparison of long-term outcome of alcoholic and idiopathic dilated cardiomyopathy. Eur Heart J;2000;21(4):306-314.
24. Prazak P, Pfisterer M, Osswald S, Buser P, Burkart F. Differences of disease progression in congestive heart failure due to alcoholic as compared to idiopathic dilated cardiomyopathy. Eur Heart J;1996;17(2):251-257.
25. Askanas A, Udoshi M, Sadjadi SA. The heart in chronic alcoholism: a noninvasive study. Am Heart J;1980;99(1):9-16.
26. Lazarević AM, Nakatani S, Nesković AN, et al. Early changes in left ventricular function in chronic asymptomatic alcoholics: relation to the duration of heavy drinking. J Am Coll Cardiol; 2000;35(6):1599-1606.
27. Kino M, Imamitchi H, Morigutchi M, Kawamura K, Takatsu T. Cardiovascular status in asymptomatic alcoholics, with reference to the level of ethanol consumption. Br Heart J;1981; 46(5):545-551.
28. Fernandez-Sola J. The effects of ethanol on the heart: alcoholic cardiomyopathy. Nutrients;2020: 12(2):572. DOI: 10.3390/nu12020572. Accessed May 19, 2022
29. Guzzo-Merello G, Cobo-Marcos M, Gallego-Delgado M, Garcia-Pavia P. Alcoholic cardio-myopathy. World J Cardiol;2014;6(8):771-781.
30. Fernández-Solà J, Nicolás JM, Oriola J, et al. Angiotensin-converting enzyme gene polymorphism is associated with vulnerability to alcoholic cardiomyopathy. Ann Intern Med; 2002;137(5 Part 1):321-326.
31. Kupari M, Koskinen P, Suokas A. Left ventricular size, mass and function in relation to the duration and quantity of heavy drinking in alcoholics. Am J Cardiol;1991;67(4):274–279.
32. Steinberg JD, Hayden MT. Prevalence of clinically occult cardiomyopathy in chronic alcoholism. Am Heart J;1981;101(4):461–464.
33. Abe H, Kawano Y, Kojima S, et al. Biphasic effects of repeated alcohol intake on 24-hour blood pressure in hypertensive patients. Circulation;1994;89(6):2626–2633.
34. Wigle DA, Pang SC, Sarda IR. Acute ethanol ingestion modifies the circulating plasma levels of atrial natriuretic peptide. Alcohol;1993;10(4):275–280.
35. Guillaume P, Jankowski M, Gianoulakis C, Gutkowska J. Effect of chronic ethanol consumption on the atrial natriuretic system of spontaneously hypertensive rats. Alcohol Clin Exp Res;1996; 20(9):1653–1661.
36. Rupp H, Brilla CG, Maisch B. Hypertension and alcohol: Central and peripheral mechanisms. Herz;1996;21(4):258–264.
37. MacKenzie J. The Study of the Pulse. Pentland YJ ed., Edinburgh;1902
38. Wilke A, Kaiser A, Ferency I, Maisch B. Alcohol and myocarditis. Herz;1996;21(4):248–257.
39. Vasiljevic JD, Kanjuh V, Seferovic P, Sesto M, Stojsic D, Olse EG. The incidence of myocarditis in endomyocardial biopsy samples from patients with congestive heart failure. Am Heart J;1990; 120(6 Pt 1):1370–1377.
40. Bernstein IM, Webster KH, Williams RC, Strickland RG. Reduction in circulating T lymphocytes in alcoholic liver disease. Lancet;1974;2(27879):488–490.
41. Arbabi S, Garcia I, Bauer GJ, Maier RV. Alcohol (ethanol) inhibits IL-8 and TNF: role of the p38 pathway. J Immunol;1999;162(12):7441–7445.
42. Cook RT. Alcohol abuse, alcoholism, and damage to the immune system–a review. Alcohol Clin Exp Res;1998;22(9):1927–1942.
43. Klatsky AL, Friedman GD, Siegelaub AB. Alcohol consumption before myocardial infarction. Results from the Kaiser-Permanente epidemiologic study of myocardial infarction. Ann Intern Med;1974;81(3):294–301.
44. Gaziano JM, Buring JE, Breslow JL, et al. Moderate alcohol intake, increased levels of high-density lipoprotein and its subfractions, and decreased risk of myocardial infarction. N Engl J Med;1993;329(25):1829–1834.
45. Ridker PM, Vaughan DE, Stampfer MJ, Ridker PM, Vaughan DE, Stampfer MJ. Association of moderate alcohol consumption and plasma concentration of endogenous tissue-type plasminogen activator. JAMA;1994;272(12):929–933.
46. Mennen LI, Balkau B, Vol S, Cacès E, Eschwège E. Fibrinogen: A possible link between alcohol consumption and cardiovascular disease? Arterioscler Thromb Vasc Biol;1999;19(4):887–892.
47. Renaud SC, Beswick AD, Fehily AM, Sharp DS, Elwood PC. Alcohol and platelet aggregation: The Caerphilly Prospective Heart Disease study. Am J Clin Nutr;1992:55(5):1012–1017.
48. Klatsky AL. Alcohol and cardiovascular diseases: A historical review and 2005 update, 2005 Accessed May 2, 2002.
49. Patterson E, Dormer KJ, Scherlag BJ, Kosanke SD, Schaper J, Lazzara R. Long-term intra coronary ethanol administration electrophysiologic and morphologic effects. Alcohol;1987;4(5): 375–384.
50. Greenspon AJ, Schaal SF. The ”Holiday Heart“: Electrophysiologic studies of alcohol effects in alcoholics. Ann Intern Med;1983;98(2):135–139.
51. Strasser RH, Nuchter I, Rauch B, Marquetant R, Seitz H. Changes in cardiac sinal transduction systems in chronic ethanol treatment preceding the development of alcoholic cardiomyopathy. Herz;1996;21(4):232–240.
52. Zilkens RR, Burke V, Hodgson JM, Barden A, Beilin LJ, Puddey IB. Red wine and beer elevate blood pressure in normotensive men. Hypertension; 2005;45(5):874-879.
53. Agewall S, Wright S, Doughty RN, Whalley GA, Duxbury M, Sharpe N. Does a glass of red wine improve endothelial function? Eur Heart J; 2000;21(1):74–78.
54. Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature; 2011;473(7347):317–325.
55. Pahor M, Guralnik JM, Havlik RJ, et al. Alcohol consumption and risk of deep venous thrombosis and pulmonary embolism in older persons. J Am Geriatr Soc;1996;44(9):1030–1037.
56. Pomp ER, Rosendaal FR, Doggen CJ. Alcohol consumption is associated with a decreased risk of venous thrombosis. Thromb Haemost;2008;99(1):59–63.
57. Hansen-Krone IJ, Braekkan SK, Enga KF, Wilsgaard T, Hansen JB. Alcohol consumption, types of alcoholic beverages and risk of venous thromboembolism—the Tromso Study. Thromb Haemost; 2011;106(2):272–278.
58. Furchgott RF, Vanhoutte PM. Endothelium-derived relaxing and contracting factors. FASEB J; 198;3(9):2007–2018.
59. Gkaliagkousi E, Ferro A. Nitric oxide signalling in the regulation of cardiovascular and platelet function. Front. Biosci; 2011;16(5):1873–1897.
60. Abou-Agag LH, Khoo NK, Binsack R, et al. Evidence of cardiovascular protection by moderate alcohol: Role of nitric oxide. Free Radic Biol Med;2005;39(4):540–548.
61. Husain K, Vazquez-Ortiz M, Lalla J. Down regulation of aortic nitric oxide and antioxidant systems in chronic alcohol-induced hypertension in rats. Hum Exp Toxicol; 2007;26(5):427–434.
62. Matsuo S, Nakamura Y, Takahashi M, et al. Effect of red wine and ethanol on production of nitric oxide in healthy subjects. Am J Cardiol; 2001;87(8):1029–1031.
63. Xue L, Xu F, Meng L, et al. Acetylation-dependent regulation of mitochondrial ALDH2 activation by SIRT3 mediates acute ethanol-induced eNOS activation. FEBS Lett; 2012;586(2): 137–142.
64. Kuhlmann CR, Li F, Ludders DW, et al. Dose-dependent activation of Ca2+-activated K+ channels by ethanol contributes to improved endothelial cell functions. Alcohol Clin Exp Res; 2004:28(7): 1005–1011.
65. Altura BM, Zou LY, Altura BT, Jelicks L, Wittenberg BA, Gupta RK, Beneficial vs. detrimental actions of ethanol on heart and coronary vascular muscle: Roles of Mg2+ and Ca2+. Alcohol; 1996; 13(5):499–513.
66. Rocha JT, Hipolito UV, Callera GE, et al Ethanol induces vascular relaxation via redox-sensitive and nitric oxide-dependent pathways. Vasc Pharmacol;2012;56(1-2):74–83.
67. Yogi A, Callera GE, Hipolito UV, Silva CR, Touyz RM, Tirapelli, CR. Ethanol-induced vasoconstriction is mediated via redox-sensitive cyclo-oxygenase-dependent mechanisms. Clin Sci;2010;118(11):657–668.
68. Romani A, Scarpa A. Regulation of cell magnesium. Arch Biochem Biophys;1992;298(1):1-12.
69. Romani AM. Magnesium in health and disease. Met Ions Life Sci;2013;13:49-79.
70. Romani A, Scarpa A. Hormonal regulation of Mg2+ in the heart. Nature;1990;346(6287):841-844.
71. Romani AMP. Effect of acute and prolonged alcohol administration on Mg2+ homeostasis in cardiac cells. Alcohol;2015;49(3):265-273.
72. Nguyen H, Romani AMP. Effect of alcohol administration on Mg2+ homeostasis in H9C2 cells. J Cardiovasc Dis Diagn;2014;2(6):179. doi: 10.4172/2329-9517.1000179. Accessed May 21, 2022
73. Tzivoni D, Banai S, Schuger C, et al. Treatment of torsade de point with magnesium sulfate. Circulation;1988;77(2):392-397.
74. Brown RA, Crawford M, Natavio M, Petrowski P, Ren J. Dietary magnesium supplementation attenuates ethanol-induced myocardial dysfunction. Alcohol Clin Exp Res;1998;22(9):2062-2072.
75. Connor JP, Huber PS, Hall WD. Alcohol use disorders. Lancet;2016;387(10022):988–998.
76. Parker R, Armstrong MJ, Corbett C, Day EJ, Neuberger JM. Alcohol and substance abuse in solid-organ transplant recipients. Transplantation;2013:96(12):1015-1024.