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Harmful drinking confers elevated biomarker levels for myocardial tissue damage
Hazardous drinking patterns may confer significantly elevated levels of several biomarkers linked to myocardial health and cardiac structure, according to findings published in the Journal of the American Heart Association.
In a cohort of individuals from Arkhangelsk, Russia, researchers found that patients admitted to the Arkhangelsk Regional Psychiatric Hospital with a primary diagnosis of alcohol problems had higher levels of high-sensitivity cardiac troponin T (10.3% higher; 95% CI, 3.7–17.4), N-terminal pro-B-type natriuretic peptide (46.7% higher; 95% CI, 26.8-69.8) and high-sensitivity C-reactive protein (69.2% higher; 95% CI, 43-100) vs. individuals classified as nonproblem drinkers.
“In many countries, there is a strong culture of alcohol drinking, with large quantities of alcohol being consumed within short time period,” Olena Iakunchykova, MS, a PhD candidate in community medicine at the University in Tromsø – The Arctic University in Norway, told Healio. “There is insufficient attention to measures and policies, which could target this problem. Our findings add to the body of evidence that heavy alcohol use should be recognized as a risk factor for heart disease and included into primary prevention programs for cardiovascular disease.”
In addition, when the researchers analyzed a cohort representative of the general population of Arkhangelsk, they found that NT-proBNP was 31.5% (95% CI, 3.4-67.2) higher among harmful drinkers compared with nonproblem drinkers.
“These findings were not very surprising because alcohol use was shown to increase risk of heart disease before,” Iakunchykova said in an interview. “However, it was intriguing to see that mechanisms of heart damage caused by alcohol might be different to those that happen due to smoking or high cholesterol.”
Moreover, researchers determined that the NT-proBNP and high-sensitivity CRP biomarkers for CVD increased with rising intensity of alcohol exposure (test of trend P < .001).
“We are now looking at information collected in the same study that will allow us to identify the precise sorts of heart damage associated with heavy and harmful drinking,” Iakunchykova told Healio. “This is from ultrasound studies where images of the heart as it beats have been captured.”
Classifying drinkers
Researchers assessed a random sampling of 2,479 individuals living in Arkhangelsk (42% men; mean age, 54 years; 26% current smokers) as well as a cohort of patients receiving treatment for drinking problems at the Arkhangelsk Regional Psychiatric Hospital (77% men; mean age, 49 years; 75% current smokers). Individuals were classified as either nondrinker, nonproblem drinker, hazardous drinker or harmful drinker as determined by whether they drank in the past 12 months, the AUDIT test score, the CAGE test score or exhibiting behavior consistent with a harmful Russian drinking pattern. Harmful drinkers met thresholds of all four metrics, hazardous drinkers met thresholds for two or three metrics, nonproblem drinkers only met the metric for drinking in the past 12 months and nondrinkers met thresholds for no metrics.
Alcohol as part of diet
“Currently, alcohol is not recommended as part of the diet because it increases the risks of various diseases at any level of consumption,” Iakunchykova said in an interview. “Then what about the evidence from earlier studies that light alcohol consumption protects from heart disease? Although this effect was found in some studies, many researchers believe that marginal benefit to the vessels is offset by larger damage to other organs of the body including the heart itself.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
Perspective
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The many harmful effects of alcohol abuse are well known. This study adds to knowledge about one of those effects, impact on the heart. It is particularly evident in very heavy users who, in Russia, are hospitalized for their alcoholism.
For the clinician, the message should be to be more aware of CV problems in those who are heavy alcohol users. Their health and social problems are frequently so extensive that heart damage may not be considered.
As the authors note, this is a unique population of alcohol users with particular types of alcohol used in the abuse. This may limit generalizability to other populations, although I doubt it.
The study of extreme populations, in this case, heavy alcohol users in Russia, is a common method to better understand some condition. They have done that. However, in the more general population who are more moderate users, the actual impact seems to be modest.
The study appears to be well executed and while I am not familiar with the Russian group, the Norwegian investigators are a very competent group. I believe that the findings are reasonable and scientifically valid.
This is a cross-sectional study which only looks at one point in time. The question would be whether these levels of biomarkers persist, get worse or get better with multiple measurements over time. One would then compare to later signs of CVD.
I have considerable experience in doing studies in the Soviet Union for NIH. I am well aware of the challenges of obtaining quality data in this setting. I am impressed that they appear to have been successful.