THE GREATER RISK OF ALCOHOLIC CARDIOMYOPATHY AND MYOPATHY IN WOMEN COMPARED WITH MEN

Objective.-To compare the cardiac and muscular status of male and female alcoholics to determine if the response of women to alcohol is different from that of men. Design.-Cross-sectional study. Setting.-An ambulatory alcoholism treatment unit in the Hospital Clinic of Barcelona. Patients.-Fifty asymptomatic alcoholic women, 100 asymptomatic alcoholic men, and 50 female nonalcoholic controls. Main Outcome Measures.-Studies included clinical assessment of muscle strength, muscle biopsy, echocardiography, radionuclide cardiac angiography, and treadmill exercise electrocardiographic recording test. Results.-The mean strength of the deltoid muscle in alcoholic women was significantly lower than that in controls (P<.001) and half suffered clinical weakness (muscle strength greater than or equal to SD below controls). Muscle biopsy specimens from half of all asymptomatic women showed histologic evidence of myopathy. Left ventricular ejection fractions tended to be depressed, and a third of the alcoholic women had evidence of cardiomyopathy. Muscular strength and ejection fractions in women were inversely correlated with the total lifetime dose of ethanol, whereas the left ventricular mass showed a direct correlation. Of the alcoholic men, 39% suffered clinical weakness, and 45% had histologic evidence of myopathy. Evidence of cardiomyopathy was found in almost a third of the men, and their ejection fractions also correlated inversely with the total lifetime dose of ethanol. However, the threshold dose for the development of cardiomyopathy was considerably less in women than in men, and the decline in the ejection fraction with increasing alcohol dose was significantly steeper (P<.001). Conclusions.-Despite the fact that the mean lifetime dose of alcohol in female alcoholics was only 60% that in male alcoholics, cardiomyopathy and myopathy were as common in female alcoholics as in male alcoholics. This finding, together with a more pronounced response of the ejection fraction to the dose of ethanol, indicates that women are more sensitive than men to the toxic effects of alcohol on striated muscle.