Alcoholic Cardiomyopathy: Drinking to Excess
Main Article Content
Abstract
Alcohol is a commonly consumed and enjoyed commodity within the global population today. Despite a purported reduction in coronary artery disease with moderate alcohol use, chronic excessive alcohol consumption can lead to deleterious health effects. While mainly associated with liver disease, injury, and mental health, it can also have devastating effects on the cardiovascular system, such as heart failure, sudden cardiac death, and stroke. More than 280 million people worldwide are currently diagnosed with alcohol use disorder. Alcohol and its metabolites exert both direct and indirect toxic effects on myocardial tissues and can lead to myocardial cell damage, apoptosis, fibrosis, and progressive myocardial dysfunction, specifically dilated cardiomyopathy. We present the current epidemiology and incidence, outline the major toxic effects of alcohol and why they occur, discuss the current guideline-directed treatment strategies, and propose targets for possible therapies in the future based on pathophysiology.
Keywords:
Dilated cardiomyopathy, alcohol use disorder, heart failure, ethanol
Article Details
How to Cite
MAY, Patrick; FIGUEREDO, Vincent M..
Alcoholic Cardiomyopathy: Drinking to Excess.
Medical Research Archives, [S.l.], v. 12, n. 9, sep. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5757>. Date accessed: 04 oct. 2024.
doi: https://doi.org/10.18103/mra.v12i9.5757.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Mackenzie W. The study of the pulse, arterial, venous, and hepatic, and of the movements of the heart. Am J Med Sci. 1902;37(7):287
2. Bollinger O. Ueber die haufigkeit und ursachen der idiopathischen herzhypertrophie in munchen. Deutsch Med Wchnschr. 1884:180e1.
3. Walsh CR, Larson MG, Evans JC, et al. Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study. Ann Intern Med. 2002;136(3):181-191. doi:10.7326/0003-4819-136-3-200202050-00005
4. Kannel WB. Incidence and epidemiology of heart failure. Heart Fail Rev. 2000;5(2):167–173. doi: 10.1023/A:1009884820941.
5. McKenna CJ, Codd MB, McCann HA, Sugrue DD. Alcohol consumption and idiopathic dilated cardiomyopathy: A case control study. Am Heart J. 1998;135(5 Pt 1):833–837. doi: 10.1016/s0002-8703(98)70042-0.
6. Bozkurt B, Hershberger RE, Butler J, et al. 2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure). J Am Coll Cardiol. 2021;77(16):2053-2150. doi:10.1016/j.jacc.2020.11.012
7. Glantz MD, Bharat C, Degenhardt L, et al. The epidemiology of alcohol use disorders cross-nationally: Findings from the world mental health surveys. Addict Behav. 2020;102:106128. doi: 10.1016/j.addbeh.2019.106128.
8. Piano MR. Alcoholic cardiomyopathy: Incidence, clinical characteristics, and pathophysiology. Chest. 2002;121(5):1638–1650. doi: 10.1378/chest.121.5.1638.
9. Center for disease control and prevention: Alcohol-related disease impact (ARDI) application. https://nccd.cdc.gov/DPH_ARDI/default/default.aspx. Updated 2024. Accessed 8, 2024.
10. Thun MJ, Peto R, Lopez AD, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997;337(24):1705-1714. doi:10.1056/NEJM199712113372401
11. Lang RM, Borow KM, Neumann A, Feldman T. Adverse cardiac effects of acute alcohol ingestion in young adults. Ann Intern Med. 1985;102(6):742–747. doi: 10.7326/0003-4819-102-6-742.
12. Regan TJ. Alcohol and the cardiovascular system. JAMA. 1990;264(3):377-381. doi:10.1001/jama.1990.03450030101041
13. Park SK, Moon K, Ryoo JH, et al. The association between alcohol consumption and left ventricular diastolic function and geometry change in general Korean population. Eur Heart J Cardiovasc Imaging. 2018;19(3):271-278. doi:10.1093/ehjci/jex091
14. Wood AM, Kaptoge S, Butterworth AS, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies [published correction appears in Lancet. 2018 Jun 2;391(10136):2212. doi: 10.1016/S0140-6736(18)31168-1]. Lancet. 2018;391(10129):1513-1523. doi:10.1016/S0140-6736(18)30134-X
15. Mathews EC Jr, Gardin JM, Henry WL, et al. Echocardiographic abnormalities in chronic alcoholics with and without overt congestive heart failure. Am J Cardiol. 1981;47(3):570-578. doi:10.1016/0002-9149(81)90540-3
16. Urbano-Marquez A, Estruch R, Navarro-Lopez F, Grau JM, Mont L, Rubin E. The effects of alcoholism on skeletal and cardiac muscle. N Engl J Med. 1989;320(7):409-415. doi:10.1056/NEJM198902163200701
17. Steiner JL, Lang CH. Etiology of alcoholic cardiomyopathy: Mitochondria, oxidative stress and apoptosis. The International Journal of Biochemistry & Cell Biology. 2018;89:125. doi: 10.1016/j.biocel.2017.06.009.
18. Domínguez F, Adler E, García-Pavía P. Alcoholic cardiomyopathy: An update. European Heart Journal. 2024;45(26):2294. doi: 10.1093/eurheartj/ehae362.
19. Laurent D, Mathew JE, Mitry M, Taft M, Force A, Edwards JG. Chronic ethanol consumption increases myocardial mitochondrial DNA mutations: a potential contribution by mitochondrial topoisomerases. Alcohol Alcohol. 2014;49(4):381-389. doi:10.1093/alcalc/agu029
20. Piano MR, Phillips SA. Alcoholic cardiomyopathy: pathophysiologic insights. Cardiovasc Toxicol. 2014; 14(4):291–308. doi: 10.1007/s12012-014-9252-4
21. Rajbanshi SL, Pandanaboina CS. Alcohol stress on cardiac tissue - ameliorative effects of Thespesia populnea leaf extract. J Cardiol. 2014; 63(6):449–59. doi: 10.1016/j.jjcc.2013.10.015
22. Yao Z, Zhang Y, Li H, Deng Z, Zhang X. Synergistic effect of Se-methylselenocysteine and vitamin E in ameliorating the acute ethanol-induced oxidative damage in rat. J Trace Elem Med Biol. 2015; 29:182–7. doi: 10.1016/j.jtemb.2014.08.004
23. Zhou X, Lu X, Xu W, Chen J. Protective effects of hydrogen sulfide against chronic alcohol intake-induced left ventricular remodeling in rats. Cardiovasc Drugs Ther. 2013;27(3):221-227. doi:10.1007/s10557-013-6441-5
24. Chen DB, Wang L, Wang PH. Insulin-like growth factor I retards apoptotic signaling induced by ethanol in cardiomyocytes. Life Sci. 2000;67(14):1683-1693. doi:10.1016/s0024-3205(00)00759-1
25. Zhang RH, Gao JY, Guo HT, et al. Inhibition of CYP2E1 attenuates chronic alcohol intake-induced myocardial contractile dysfunction and apoptosis [published correction appears in Biochim Biophys Acta. 2014 Dec;1842(12):2528]. Biochim Biophys Acta. 2013;1832(1):128-141. doi:10.1016/j.bbadis.2012.08.014
26. Fernández-Solà J, Lluis M, Sacanella E, Estruch R, Antúnez E, Urbano-Márquez A. Increased myostatin activity and decreased myocyte proliferation in chronic alcoholic cardiomyopathy. Alcohol Clin Exp Res. 2011;35(7):1220-1229. doi:10.1111/j.1530-0277.2011.01456.x
27. Guo R, Ren J. Alcohol dehydrogenase accentuates ethanol-induced myocardial dysfunction and mitochondrial damage in mice: role of mitochondrial death pathway. PLoS One. 2010;5(1):e8757. Published 2010 Jan 18. doi:10.1371/journal.pone.0008757
28. Zhang B, Turdi S, Li Q, Lopez FL, Eason AR, Anversa P, et al. Cardiac overexpression of insulin-like growth factor 1 attenuates chronic alcohol intake-induced myocardial contractile dysfunctionbut not hypertrophy: Roles of Akt, mTOR, GSK3beta, and PTEN. Free Radic Biol Med. 2010; 49(7):1238–53. doi: 10.1016/j.freeradbiomed.2010.07.020
29. Jänkälä H, Eklund KK, Kokkonen JO, et al. Ethanol infusion increases ANP and p21 gene expression in isolated perfused rat heart. Biochem Biophys Res Commun. 2001;281(2):328-333. doi:10.1006/bbrc.2001.4343
30. Liu W, Li J, Tian W, Xu T, Zhang Z. Chronic alcohol consumption induces cardiac remodeling in mice from Th1 or Th2 background. Exp Mol Pathol. 2011;91(3):761-767. doi:10.1016/j.yexmp.2011.08.003
31. Mustroph J, Wagemann O, Lebek S, et al. SR Ca2+-leak and disordered excitation-contraction coupling as the basis for arrhythmogenic and negative inotropic effects of acute ethanol exposure. J Mol Cell Cardiol. 2018;116:81-90. doi:10.1016/j.yjmcc.2018.02.002
32. Wang S, Ren J. Role of autophagy and regulatory mechanisms in alcoholic cardiomyopathy. Biochim Biophys Acta Mol Basis Dis. 2018;1864(6 Pt A):2003-2009. doi:10.1016/j.bbadis.2018.03.016
33. Cheng CP, Cheng HJ, Cunningham C, et al. Angiotensin II type 1 receptor blockade prevents alcoholic cardiomyopathy. Circulation. 2006;114(3):226-236. doi:10.1161/CIRCULATIONAHA.105.596494
34. Brandt, M., Garlapati, V., Oelze, M. et al. NOX2 amplifies acetaldehyde-mediated cardiomyocyte mitochondrial dysfunction in alcoholic cardiomyopathy. Sci Rep 6, 32554 (2016). doi: 10.1038/srep32554.
35. Guzzo-Merello G, Cobo-Marcos M, Gallego-Delgado M, Garcia-Pavia P. Alcoholic cardiomyopathy. World J Cardiol. 2014;6(8):771-781. doi:10.4330/wjc.v6.i8.771
36. George A, Figueredo VM. Alcoholic cardiomyopathy: A review. Journal of Cardiac Failure. 2011;17(10):844. doi: 10.1016/j.cardfail.2011.05.008.
37. Guzzo-Merello G, Segovia J, Dominguez F, et al. Natural history and prognostic factors in alcoholic cardiomyopathy. JACC Heart Fail. 2015;3(1):78-86. doi:10.1016/j.jchf.2014.07.014
38. George A, Figueredo VM. Alcohol and arrhythmias: a comprehensive review. J Cardiovasc Med (Hagerstown). 2010;11(4):221-228. doi:10.2459/JCM.0b013e328334b42d
39. Fauchier L. Alcoholic cardiomyopathy and ventricular arrhythmias. CHEST. 2003(123):1320. doi: 10.1378/chest.123.4.1320.
40. Csengeri D, Sprünker N, Di Castelnuovo A, et al. Alcohol consumption, cardiac biomarkers, and risk of atrial fibrillation and adverse outcomes. Eur Heart J. 2021;42(12):1170–1177. Accessed 8/22/2024. doi: 10.1093/eurheartj/ehaa953.
41. Bozkurt B, Colvin M, Cook J, et al. Current diagnostic and treatment strategies for specific dilated cardiomyopathies: A scientific statement from the american heart association. Circulation. 2024;134(23). doi: 10.1161/cir.0000000000000455.
42. 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.
43. 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. doi:10.1053/euhj.1999.1761
44. Carroll KM, Kiluk BD. Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again. Psychol Addict Behav. 2017;31(8):847-861. doi:10.1037/adb0000311
45. Day E, Rudd JHF. Alcohol use disorders and the heart. Addiction. 2019;114(9):1670-1678. doi:10.1111/add.14703
46. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the american college of cardiology/american heart association joint committee on clinical practice guidelines. Circulation. 2022;145(18):e895–e1032. doi: 10.1161/CIR.0000000000001063.
47. Wang Z, Song J, Zhang L, Huang S, Bao L, Chen F, et al. Increased expression of microRNA-378a-5p in acute ethanol exposure of rat cardiomyocytes. Cell Stress Chaperones. 2017; 22(2):245–52. Epub 2017/02/03. doi: 10.1007/s12192-016-0760-y.
2. Bollinger O. Ueber die haufigkeit und ursachen der idiopathischen herzhypertrophie in munchen. Deutsch Med Wchnschr. 1884:180e1.
3. Walsh CR, Larson MG, Evans JC, et al. Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study. Ann Intern Med. 2002;136(3):181-191. doi:10.7326/0003-4819-136-3-200202050-00005
4. Kannel WB. Incidence and epidemiology of heart failure. Heart Fail Rev. 2000;5(2):167–173. doi: 10.1023/A:1009884820941.
5. McKenna CJ, Codd MB, McCann HA, Sugrue DD. Alcohol consumption and idiopathic dilated cardiomyopathy: A case control study. Am Heart J. 1998;135(5 Pt 1):833–837. doi: 10.1016/s0002-8703(98)70042-0.
6. Bozkurt B, Hershberger RE, Butler J, et al. 2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure). J Am Coll Cardiol. 2021;77(16):2053-2150. doi:10.1016/j.jacc.2020.11.012
7. Glantz MD, Bharat C, Degenhardt L, et al. The epidemiology of alcohol use disorders cross-nationally: Findings from the world mental health surveys. Addict Behav. 2020;102:106128. doi: 10.1016/j.addbeh.2019.106128.
8. Piano MR. Alcoholic cardiomyopathy: Incidence, clinical characteristics, and pathophysiology. Chest. 2002;121(5):1638–1650. doi: 10.1378/chest.121.5.1638.
9. Center for disease control and prevention: Alcohol-related disease impact (ARDI) application. https://nccd.cdc.gov/DPH_ARDI/default/default.aspx. Updated 2024. Accessed 8, 2024.
10. Thun MJ, Peto R, Lopez AD, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997;337(24):1705-1714. doi:10.1056/NEJM199712113372401
11. Lang RM, Borow KM, Neumann A, Feldman T. Adverse cardiac effects of acute alcohol ingestion in young adults. Ann Intern Med. 1985;102(6):742–747. doi: 10.7326/0003-4819-102-6-742.
12. Regan TJ. Alcohol and the cardiovascular system. JAMA. 1990;264(3):377-381. doi:10.1001/jama.1990.03450030101041
13. Park SK, Moon K, Ryoo JH, et al. The association between alcohol consumption and left ventricular diastolic function and geometry change in general Korean population. Eur Heart J Cardiovasc Imaging. 2018;19(3):271-278. doi:10.1093/ehjci/jex091
14. Wood AM, Kaptoge S, Butterworth AS, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies [published correction appears in Lancet. 2018 Jun 2;391(10136):2212. doi: 10.1016/S0140-6736(18)31168-1]. Lancet. 2018;391(10129):1513-1523. doi:10.1016/S0140-6736(18)30134-X
15. Mathews EC Jr, Gardin JM, Henry WL, et al. Echocardiographic abnormalities in chronic alcoholics with and without overt congestive heart failure. Am J Cardiol. 1981;47(3):570-578. doi:10.1016/0002-9149(81)90540-3
16. Urbano-Marquez A, Estruch R, Navarro-Lopez F, Grau JM, Mont L, Rubin E. The effects of alcoholism on skeletal and cardiac muscle. N Engl J Med. 1989;320(7):409-415. doi:10.1056/NEJM198902163200701
17. Steiner JL, Lang CH. Etiology of alcoholic cardiomyopathy: Mitochondria, oxidative stress and apoptosis. The International Journal of Biochemistry & Cell Biology. 2018;89:125. doi: 10.1016/j.biocel.2017.06.009.
18. Domínguez F, Adler E, García-Pavía P. Alcoholic cardiomyopathy: An update. European Heart Journal. 2024;45(26):2294. doi: 10.1093/eurheartj/ehae362.
19. Laurent D, Mathew JE, Mitry M, Taft M, Force A, Edwards JG. Chronic ethanol consumption increases myocardial mitochondrial DNA mutations: a potential contribution by mitochondrial topoisomerases. Alcohol Alcohol. 2014;49(4):381-389. doi:10.1093/alcalc/agu029
20. Piano MR, Phillips SA. Alcoholic cardiomyopathy: pathophysiologic insights. Cardiovasc Toxicol. 2014; 14(4):291–308. doi: 10.1007/s12012-014-9252-4
21. Rajbanshi SL, Pandanaboina CS. Alcohol stress on cardiac tissue - ameliorative effects of Thespesia populnea leaf extract. J Cardiol. 2014; 63(6):449–59. doi: 10.1016/j.jjcc.2013.10.015
22. Yao Z, Zhang Y, Li H, Deng Z, Zhang X. Synergistic effect of Se-methylselenocysteine and vitamin E in ameliorating the acute ethanol-induced oxidative damage in rat. J Trace Elem Med Biol. 2015; 29:182–7. doi: 10.1016/j.jtemb.2014.08.004
23. Zhou X, Lu X, Xu W, Chen J. Protective effects of hydrogen sulfide against chronic alcohol intake-induced left ventricular remodeling in rats. Cardiovasc Drugs Ther. 2013;27(3):221-227. doi:10.1007/s10557-013-6441-5
24. Chen DB, Wang L, Wang PH. Insulin-like growth factor I retards apoptotic signaling induced by ethanol in cardiomyocytes. Life Sci. 2000;67(14):1683-1693. doi:10.1016/s0024-3205(00)00759-1
25. Zhang RH, Gao JY, Guo HT, et al. Inhibition of CYP2E1 attenuates chronic alcohol intake-induced myocardial contractile dysfunction and apoptosis [published correction appears in Biochim Biophys Acta. 2014 Dec;1842(12):2528]. Biochim Biophys Acta. 2013;1832(1):128-141. doi:10.1016/j.bbadis.2012.08.014
26. Fernández-Solà J, Lluis M, Sacanella E, Estruch R, Antúnez E, Urbano-Márquez A. Increased myostatin activity and decreased myocyte proliferation in chronic alcoholic cardiomyopathy. Alcohol Clin Exp Res. 2011;35(7):1220-1229. doi:10.1111/j.1530-0277.2011.01456.x
27. Guo R, Ren J. Alcohol dehydrogenase accentuates ethanol-induced myocardial dysfunction and mitochondrial damage in mice: role of mitochondrial death pathway. PLoS One. 2010;5(1):e8757. Published 2010 Jan 18. doi:10.1371/journal.pone.0008757
28. Zhang B, Turdi S, Li Q, Lopez FL, Eason AR, Anversa P, et al. Cardiac overexpression of insulin-like growth factor 1 attenuates chronic alcohol intake-induced myocardial contractile dysfunctionbut not hypertrophy: Roles of Akt, mTOR, GSK3beta, and PTEN. Free Radic Biol Med. 2010; 49(7):1238–53. doi: 10.1016/j.freeradbiomed.2010.07.020
29. Jänkälä H, Eklund KK, Kokkonen JO, et al. Ethanol infusion increases ANP and p21 gene expression in isolated perfused rat heart. Biochem Biophys Res Commun. 2001;281(2):328-333. doi:10.1006/bbrc.2001.4343
30. Liu W, Li J, Tian W, Xu T, Zhang Z. Chronic alcohol consumption induces cardiac remodeling in mice from Th1 or Th2 background. Exp Mol Pathol. 2011;91(3):761-767. doi:10.1016/j.yexmp.2011.08.003
31. Mustroph J, Wagemann O, Lebek S, et al. SR Ca2+-leak and disordered excitation-contraction coupling as the basis for arrhythmogenic and negative inotropic effects of acute ethanol exposure. J Mol Cell Cardiol. 2018;116:81-90. doi:10.1016/j.yjmcc.2018.02.002
32. Wang S, Ren J. Role of autophagy and regulatory mechanisms in alcoholic cardiomyopathy. Biochim Biophys Acta Mol Basis Dis. 2018;1864(6 Pt A):2003-2009. doi:10.1016/j.bbadis.2018.03.016
33. Cheng CP, Cheng HJ, Cunningham C, et al. Angiotensin II type 1 receptor blockade prevents alcoholic cardiomyopathy. Circulation. 2006;114(3):226-236. doi:10.1161/CIRCULATIONAHA.105.596494
34. Brandt, M., Garlapati, V., Oelze, M. et al. NOX2 amplifies acetaldehyde-mediated cardiomyocyte mitochondrial dysfunction in alcoholic cardiomyopathy. Sci Rep 6, 32554 (2016). doi: 10.1038/srep32554.
35. Guzzo-Merello G, Cobo-Marcos M, Gallego-Delgado M, Garcia-Pavia P. Alcoholic cardiomyopathy. World J Cardiol. 2014;6(8):771-781. doi:10.4330/wjc.v6.i8.771
36. George A, Figueredo VM. Alcoholic cardiomyopathy: A review. Journal of Cardiac Failure. 2011;17(10):844. doi: 10.1016/j.cardfail.2011.05.008.
37. Guzzo-Merello G, Segovia J, Dominguez F, et al. Natural history and prognostic factors in alcoholic cardiomyopathy. JACC Heart Fail. 2015;3(1):78-86. doi:10.1016/j.jchf.2014.07.014
38. George A, Figueredo VM. Alcohol and arrhythmias: a comprehensive review. J Cardiovasc Med (Hagerstown). 2010;11(4):221-228. doi:10.2459/JCM.0b013e328334b42d
39. Fauchier L. Alcoholic cardiomyopathy and ventricular arrhythmias. CHEST. 2003(123):1320. doi: 10.1378/chest.123.4.1320.
40. Csengeri D, Sprünker N, Di Castelnuovo A, et al. Alcohol consumption, cardiac biomarkers, and risk of atrial fibrillation and adverse outcomes. Eur Heart J. 2021;42(12):1170–1177. Accessed 8/22/2024. doi: 10.1093/eurheartj/ehaa953.
41. Bozkurt B, Colvin M, Cook J, et al. Current diagnostic and treatment strategies for specific dilated cardiomyopathies: A scientific statement from the american heart association. Circulation. 2024;134(23). doi: 10.1161/cir.0000000000000455.
42. 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.
43. 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. doi:10.1053/euhj.1999.1761
44. Carroll KM, Kiluk BD. Cognitive behavioral interventions for alcohol and drug use disorders: Through the stage model and back again. Psychol Addict Behav. 2017;31(8):847-861. doi:10.1037/adb0000311
45. Day E, Rudd JHF. Alcohol use disorders and the heart. Addiction. 2019;114(9):1670-1678. doi:10.1111/add.14703
46. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the american college of cardiology/american heart association joint committee on clinical practice guidelines. Circulation. 2022;145(18):e895–e1032. doi: 10.1161/CIR.0000000000001063.
47. Wang Z, Song J, Zhang L, Huang S, Bao L, Chen F, et al. Increased expression of microRNA-378a-5p in acute ethanol exposure of rat cardiomyocytes. Cell Stress Chaperones. 2017; 22(2):245–52. Epub 2017/02/03. doi: 10.1007/s12192-016-0760-y.