Alcohol may decrease intimal proliferation, inflammation, and reduce atherosclerotic heart disease. However, coronary anatomy has not been well studied in alcoholic patients. The objective of this study was to compare angiographic results of patients presenting with angina with and without alcoholism.
We studied alcoholic patients (n = 60), diagnosed by alcoholism, alcoholic related pancreatitis or liver cirrhosis who presented with chest pain to the New York Harbor HealthCare System of the Brooklyn Veterans Affairs Medical Center (NYHBVA). Patients were compared to age and coronary risk factor matched controls (n= 200) without alcoholism between 1994 and 2002. All patients were male and underwent diagnostic cardiac catheterization after an abnormal stress test.
Baseline demographics were similar in both groups. The mean Canadian Cardiovascular Society Functional Classification was significantly higher in the alcoholic group compared to controls ( 2.8+0.7 vs. 1.3+0.3, p<0.05). The prevalence of coronary artery disease (CAD) (luminal diameter stenosis > 50%) was lower in alcoholic group than controls, 28% vs. 58%, p<0.05, OR 0.3, 95% CI 0.16-0.54. Alcoholics had less extensive CAD, 1.7+0.2 vs. 2.3+0.3 stenosed vessels as compared to controls, p<0.05. The alcoholic group had lower mean left ventricular ejection fraction (LVEF) as compared to the controls, 31 + 4 % vs. 48 + 5 %, p<0.05. Left ventricular dysfunction (LVD) (LVEF < 40%) was more common in alcoholic group (80% vs. 40%, p< 0.05). In patients with LVD, alcoholism associated with a lower prevalence of CAD (OR 0.015, 95% CI 0.004 - 0.047). In contrast, alcoholism associated with a higher prevalence of CAD in patients with preserved systolic function (OR 18, 95% CI 2.3-148.7).
In this group of patients presenting with chest pain to the NYHBVA, alcoholism associated with a lower prevalence of and less extensive CAD despite worse anginal symptoms. LVD was more common in the alcoholic group and was associated with a lower prevalence of CAD.
There appears to be an inverse relationship between CAD and LVD in alcoholic patients.
S. Kokolis, None.