Angiotensin-converting enzyme gene polymorphism is associated with vulnerability to alcoholic cardiomyopathy

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.