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.