The Greater Risk of Alcoholic Cardiomyopathy and Myopathy in Women ComparedWith Men

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The Greater Risk of Alcoholic Cardiomyopathy and Myopathy in Women Compared
With Men

Alvaro Urbano-Marquez, MD; Ramon Estruch, MD; Joaquin Fernandez-Sola, MD;
Jose Ma Nicolas, MD; Juan Carlos Pare, MD; Emanuel Rubin, MD

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 >=2 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.

Copyright 1995 American Medical Association (JAMA. 1995;274:149-154)

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