Alcohol and the Heart: How to Stay Healthy

Alcohol and the Heart: What You Need to Know to Stay Healthy

Many of us indulge in a drink or a glass of wine to relax or celebrate, but when alcohol consumption becomes excessive and prolonged over time, it can have serious consequences for the heart. One of these is the alcoholic cardiomyopathy, a potentially life-threatening disease in which prolonged consumption of large amounts of alcohol weakens the heart muscle. The heart becomes less effective at pumping blood, leading, if untreated, to arrhythmias, and enlargement of the chambers and subsequent heart failure.

The good news? This condition is preventable and, in many cases, even reversible with the right lifestyle changes. Let's find out what you need to know.

What is alcoholic cardiomyopathy?

Alcoholic cardiomyopathy is a form of dilative cardiomyopathy, in which the heart enlarges and weakens. Excessive alcohol consumption directly damages the heart cells, causing the walls to thin and reducing the heart's ability to pump blood. As the disease progresses, the reduced blood flow affects the entire body, causing fatigue, difficulty breathing, and swelling in the legs or abdomen.

This condition does not develop overnight. It usually appears after years of use. more than 80 grams of alcohol per day (about eight glasses of wine, eight beers, or eight shots of hard liquor), over a period of five years or more. However, the risk threshold varies from person to person, depending on factors such as genetics and general health.

How does alcohol damage the heart?

Alcohol affects the heart in several ways:

1. Direct toxicity: Alcohol and its byproduct, acetaldehyde, are toxic to heart cells. They interfere with their normal function, cause oxidative stress, and damage the structures that allow the heart to contract and pump blood.
2. Inflammation and scarring: Over time, the toxic effects of alcohol lead to cell death and scar tissue, which stiffens the heart and further reduces its ability to pump blood.
3. Role of genetics: Recent studies show that some people have genetic mutations that make them more vulnerable to heart damage caused by alcohol. For example, some genetic variants, such as in the gene that codes for titin, associated with dilated cardiomyopathy may interact with alcohol, accelerating the damage.
4. Nutritional deficiencies: Excessive alcohol consumption often leads to poor nutrition, depriving the heart of essential nutrients like thiamine (vitamin B1) and magnesium, further weakening it.
5. Related conditions: High blood pressure, smoking, liver disease, and diabetes, which are common among heavy drinkers, add further stress to the heart.

Who is most at risk?

• Heavy drinkers: Regular consumption of large amounts of alcohol over years is the main risk factor.
• Men: Alcoholic cardiomyopathy is more common in men, although women can develop it with smaller amounts of alcohol in a shorter period of time.
• People with genetic predisposition: Those who have a family history of heart disease or specific genetic mutations may be more vulnerable (pathogenic mutation on the gene of Titin, eg).

What are the symptoms?

Signs of alcoholic cardiomyopathy often overlap with other heart conditions, making it difficult to identify. Common symptoms include:

• Early signs: Fatigue, weakness, and difficulty breathing during physical activity.
• Progressive symptoms: Swelling in the legs, feet, or abdomen, and difficulty breathing even at rest.
• Advanced symptoms: Dizziness, fainting, chest pain, and irregular heartbeat.

If you experience these symptoms and have a history of excessive alcohol consumption, it is important to consult a doctor.

The Power of Quitting Drinking

The mainstay of treatment for alcoholic cardiomyopathy is stop drinking alcohol completely. Studies show that stopping alcohol consumption can significantly improve heart function, especially in the early stages of the disease. Even for those with advanced symptoms, abstinence can prevent further damage and improve quality of life.

• Heart Recovery: Many people who stop drinking see improvements in their heart’s ability to pump blood, with full recoveries possible within months or a few years.
• Improving Outcomes: Those who stop drinking not only improve their heart health, but also live longer and avoid complications such as heart failure and arrhythmia.

Treatments and lifestyle changes

In addition to abstinence, treatment includes:

1. Medicines: Medicines to support heart function, such as beta-blockers and ACE inhibitors, are often prescribed. Diuretics can help reduce swelling caused by fluid buildup.
2. Heart Healthy Diet: A diet low in salt and rich in fruits, vegetables, whole grains, and lean proteins can be one of many factors that can aid recovery.
3. Regular exercise: Moderate physical activity, guided by a doctor, strengthens the heart and improves circulation.
4. Correction of nutritional deficiencies: Replenishing nutrients like thiamine and magnesium is essential for recovery.
5. Detox Support: For those who have trouble quitting, medications such as naltrexone or acamprosate can help reduce alcohol cravings.

Is it possible to prevent it?

Absolutely yes! Preventing this condition is simple: just moderate your alcohol intake:

• For men, no more than two glasses of wine a day.
• For women, no more than one glass a day.

If you already have a high alcohol consumption, consider seeking help to cut back or quit. Early intervention is essential to avoid permanent heart damage.

Why is it important to talk about this problem?

Alcoholic cardiomyopathy is more common than you think, often responsible for up to 40% of cases of unexplained heart failure in people with a history of heavy drinking. However, because symptoms develop gradually, many people don't connect heart problems to alcohol until it's too late. Knowing the risks can help people make informed choices.

References used:

Domínguez F, Adler E, García-Pavía P. Alcoholic cardiomyopathy: an update. Eur Heart J. 2024 Jul 9;45(26):2294-2305.