Angiotensin-Converting Enzyme Gene Polymorphism Is Associated with Vulnerability to Alcoholic Cardiomyopathy

  1. Joaquim Fernández-Solà, MD;
  2. Josep María Nicolás, MD;
  3. Josep Oriola, PhD;
  4. Emilio Sacanella, MD;
  5. Ramón Estruch, MD;
  6. Emanuel Rubin, MD; and
  7. Alvaro Urbano-Márquez, MD

    Abstract

    Background: Chronic alcohol abuse has a dose-dependent toxic effect on the myocardium, leading to alcoholic cardiomyopathy. The fact that only a minority of persons with chronic alcoholism have this condition suggests the possibility of a genetic vulnerability. In this context, polymorphism of the angiotensin-converting enzyme (ACE) gene has been implicated in cardiac dysfunction.

    Objective: To compare the ACE genotypes of alcoholic persons who have cardiomyopathy with those of comparable alcohol abusers who have normal cardiac function.

    Design: Case–control study over a 2-year period.

    Setting: An academic tertiary referral hospital in Barcelona, Spain.

    Patients: 30 alcoholic men with symptomatic cardiomyopathy and 27 alcoholic men with normal cardiac function.

    Measurements: Ethanol intake, cardiac status, left ventricular ejection fraction (LVEF), and ACE gene polymorphism.

    Results: The DD ACE genotype was present in 57% of alcoholic persons with an LVEF less than 0.50 and in 7% of those with normal cardiac function. Compared with persons who had an I allele, the odds ratio for development of left ventricular dysfunction in alcoholic persons with the DD genotype was 16.4.

    Conclusions: Vulnerability to cardiomyopathy among chronic alcohol abusers is partially genetic and is related to presence of the ACE DD genotype. This finding demonstrates genetic susceptibility to alcohol-induced myocardial damage.

    Article and Author Information

    • Grant Support: By Fondo de Investigación Sanitaria (grants 98/0330, 99/0115, and 99/0318) and Generalitat de Catalunya (grant CUR 2001/SGR/00379).

    • Requests for Single Reprints: Emanuel Rubin, MD, Department of Pathology, Anatomy, and Cell Biology, Jefferson Medical College, 1020 Locust Street, Suite 279, Philadelphia, PA 19107; e-mail, emanuel.rubin{at}mail.tju.edu.

    • Potential Financial Conflicts of Interest:Grants Received: J. Fernández-Solà, J.M. Nicolás, E. Sacanella, R. Estruch, A. Urbano-Márquez.

    • Current Author Addresses: Drs. Fernández-Solà, Nicolás, Oriola, Sacanella, Estruch, and Urbano-Márquez: Alcohol Research and Cardiac Units, Department of Medicine, Hospital Clínic i Provincial, University of Barcelona, Villaroel, 170 08036, Barcelona, Spain.

    • Dr. Rubin: Department of Pathology and Cell Biology, Jefferson Medical College, Thomas Jefferson University, 1020 Locust Street, Suite 279, Philadelphia, PA 19107-6799

    • Author Contributions: Conception and design: J. Fernández-Solà, J. María Nicolás, E. Rubin, A. Urbano-Márquez.

    • Analysis and interpretation of the data: J. Fernández-Solà, J. María Nicolás, E. Rubin.

    • Drafting of the article: J. Fernández-Solà, J. María Nicolás, E. Rubin, A. Urbano-Márquez.

    • Critical revision of the article for important intellectual content: E. Rubin

    • Final approval of the article: A. Urbano-Márquez.

    • Provision of study materials or patients: E. Sacanella, R. Estruch.

    • Statistical expertise: J. María Nicolás.

    • Obtaining of funding: J. Fernández-Solà, J. María Nicolás, R. Estruch, E. Rubin.

    • Administrative, technical, or logistic support: J. Oriola.

    • Collection and assembly of data: E. Sacanella.

    Summary for Patients

    • Summaries for Patients:Genetic Variations and the Risk for Alcohol-Induced Weakness of the Heart Ann Intern Med September 3, 2002 137:I-44
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    1. Ann Intern Med September 3, 2002 vol. 137 no. 5 Part 1 321-326
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