Evidence for a Direct Harmful Effect of Alcohol on Myocardial Health: A Large Cross-Sectional Study of Consumption Patterns and Cardiovascular Disease Risk Biomarkers From Northwest Russia, 2015 to 2017

Abstract

Background Alcohol drinking is an increasingly recognized risk factor for cardiovascular disease. However, there are few studies of the impact of harmful and hazardous drinking on biomarkers of myocardial health. We conducted a study in Russia to investigate the impact of heavy drinking on biomarkers of cardiac damage and inflammation. Methods and Results The Know Your Heart study recruited a random sample of 2479 participants from the population of northwest Russia (general population) plus 278 patients (narcology clinic subsample) with alcohol problems. The general population sample was categorized into harmful drinkers, hazardous drinkers, nonproblem drinkers, and nondrinkers, according to self-reported level of alcohol consumption, whereas the narcology clinic sample was treated as the separate group in the analysis. Measurements were made of the following: (1) high-sensitivity cardiac troponin T, (2) NT-proBNP (N-terminal pro-B-type natriuretic peptide), and (3) hsCRP (high-sensitivity C-reactive protein). The narcology clinic subsample had the most extreme drinking pattern and the highest levels of all 3 biomarkers relative to nonproblem drinkers in the general population: high-sensitivity cardiac troponin T was elevated by 10.3% (95% CI, 3.7%-17.4%), NT-proBNP by 46.7% (95% CI, 26.8%-69.8%), and hsCRP by 69.2% (95% CI, 43%-100%). In the general population sample, NT-proBNP was 31.5% (95% CI, 3.4%-67.2%) higher among harmful drinkers compared with nonproblem drinkers. Overall, NT-proBNP and hsCRP increased with increasing intensity of alcohol exposure (test of trend P<0.001). Conclusions These results support the hypothesis that heavy alcohol drinking has an adverse effect on cardiac structure and function that may not be driven by atherosclerosis.

Keywords: CRP (C‐reactive protein); NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide); alcohol use; troponin T.

Figure 1

The assignment scheme of the general population sample into categories by drinking status: (1) harmful drinkers, (2) hazardous drinkers, (3) nonproblem drinkers, and (4) nondrinkers. *Twice weekly or more frequency of hangover and/or excessive drunkenness and/or sleeping in clothes at night because of drunkenness and/or failing their family or personal obligations because of drinking and/or drinking nonbeverage alcohols (sources of ethanol not intended for drinking, such as medicinal tinctures) and/or ≥1 episodes of zapoi (a period of ≥2 days of being drunk, during which a participant is withdrawn from normal social life).32 AUDIT indicates Alcohol Use Disorders Identification Test; GAGE, Cut down, Annoyed, Guilty, Eye Opener.