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Alcohol and established heart failure

 

Clinical bottom line

In established heart failure, up to two alcoholic drinks a day is not associated with and deleterious effects. All cause mortality is reduced, particularly death from myocardial infarction.


Patients with heart failure often ask whether they can still enjoy a glass of wine, or beer, or whatever. Because drinking large amounts of alcohol can cause cardiomyopathy, drinking alcohol is sometimes discouraged. A new study suggests that not only is there no harm from moderate alcohol intake, but also that there may be some benefit.

Reference

HA Cooper et al. Light-to-moderate alcohol consumption and prognosis in patients with left ventricular systolic dysfunction. Journal of the American College of Cardiology 2000 35: 1753-1759.

Study

Two major randomised controlled trials (SOLVD) with 6,797 participants had examined enalapril, and ACE inhibitor, in the treatment and prevention of heart failure (more particularly left ventricular dysfunction). At baseline patients were asked about average alcohol consumption over the previous year. Exclusions were those patients with no data on alcohol consumption, and those with established cardiomyopathy. That meant that 6,609 were eligible.

Of these, 55% drank no alcohol. Up to two drinks a day were consumed by 39% and only 6% drank more than this. Because this was a small number, with even fewer events, the analysis done was on the comparison between non drinkers and those drinking up to two alcoholic drinks a day.

Follow up was an average of 33 months, and the main outcome was mortality, and cause of death.

Results

The mean age was 60 years. Non-drinkers were more likely to be women, nonwhite, have more diabetes, less likely to be a smoker and to use more diuretics and digoxin, as well has having other minor differences.

For those (5,331) with ischaemic left ventricular dysfunction, all cause mortality was significantly lower in drinkers of alcohol. For cardiovascular mortality and hospital admission for heart failure, increasing the number of covariates eventually reduced the significance of any differences:

Covariates

Relative risk

All-cause mortality

Cardiovascular mortality

Hospital admission with heart failure

Age, sex, ejection fraction, disease severity, enalapril

0.78 (0.69 to 0.89)

0.82 (0.72 to 0.93)

0.78 (0.68 to 0.91)

Above plus race, smoking, diabetes and hypertension

0.82 (0.72 to 0.93)

0.86 (0.75 to 0.98)

0.84 (0.73 to 0.98)

Above plus digoxin, beta-blockers, diuretics, antiarrhythmics, aspirin and anticoagulants

0.85 (0.75 to 0.97)

0.90 (0.79 to 1.03)

0.88 (0.76 to 1.02

For the 1,278 patients with non-ischaemic left ventricular dysfunction, there was no benefit, nor any harm, from alcohol consumption.

The major benefits to lower all-cause mortality in those with ischaemic left ventricular dysfunction was from a halving of the number with fatal myocardial infarctions, as well as noncardiovascular causes of death.

Comment

Can I still enjoy my pint, doc? For most people with established heart failure, the answer would seem to be yes.