Feb. 12, 2002 For alcoholics who suffer from alcohol-related heart failure, cutting back alcohol consumption to a few drinks a day does not cause any further damage. In fact, the heart may actually begin to recover strength.
Researchers at Jefferson Medical College and at the University of Barcelona measured the heart-pumping efficiency of a group of men who were alcoholics and were suffering from heart failure.
They found that those who abstained from alcohol over a year had significant improvement in heart function. But they were surprised to find that those who drank moderately, from one to four drinks a day, also improved to the same degree.
"We're not advocating anyone with heart failure continue to drink," says Emanuel Rubin, M.D., Gonzalo E. Aponte Professor of Pathology and Chair of the Department of Pathology, Anatomy and Cell Biology at Jefferson Medical College of Thomas Jefferson University in Philadelphia, who led the study. "We're saying that for those individuals with heart failure who cannot stop drinking, several drinks a day may not do any more harm and even allow their heart's pumping efficiency to regain strength."
What's more, the researchers say they may have discovered a so-called threshold drinking level for alcohol-related heart damage. The results appear February 5 in the Annals of Internal Medicine.
According to Dr. Rubin, a long-standing - and unresolved - controversy exists among those who treat alcoholics. Many claim that total abstinence from alcohol is the only solution to treat alcohol-related diseases such as cirrhosis, cardiomyopathy and pancreatitis. Others, he says, believe that so-called moderate drinking - two to four drinks a day - may be okay.
In the study, Dr. Rubin and his co-workers looked at 55 alcoholic men living in Barcelona, Spain, who suffered from heart failure. They examined over four years several measures of various heart functions, such as "ejection fraction," which gauges the heart's ability to pump blood.
All of the men were counseled to completely give up alcohol, Dr. Rubin explains. In the study, approximately one-third did become abstinent, while another third continued to drink their usual amounts. But the other third reported that they reduced their drinking to between one and four "standard" drinks a day. A standard drink is defined as equivalent to 1.5 ounces of 86 proof whiskey, 12 ounces of beer or 4 to 5 ounces of wine.
The researchers were surprised by what they found. After one year, those who stopped drinking all showed increased ability to pump blood out of their heart. Dr. Rubin and his colleagues expected that. What they didn't expect was to find that those who had a few drinks a day also showed similarly improved heart-pumping ability.
"The take-home message is that alcohol-related damage to the heart appears to be a 'threshold phenomenon,'" says Dr. Rubin. Below a certain level of alcohol intake, he explains, "there seems to be no damage to the heart.
Yet, once that level is crossed, trouble begins to appear." He believes that this study is the first to demonstrate a threshold phenomenon for alcohol and heart damage. Dr. Rubin speculates that other organs may have similar alcohol damage thresholds, but they would be difficult to measure. "We have an advantage is studying the heart - it can be studied quantitatively. It would be much more difficult to measure such changes in the liver or pancreas."
Dr. Rubin reiterates that the best way to avoid alcohol-related heart damage is to give up drinking completely. "But for some who will only reduce their drinking, we can say now that moderate drinking does not increase the harm to the heart" and allows it to regain some of its former strength.
The treatment implications are clear, he says. "Always try to persuade an alcoholic to become abstinent," he says, "but don't give up on them if they can't. Continue to encourage them to reduce their levels of drinking."
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