Endothelial dysfunction and high cardiovascular risk profile in severe alcoholics improve only partially following a medium-term alcohol withdrawal.
BACKGROUND
Little is known about brachial artery flow-mediated vasodilatation (FMD) in active and medium-term withdrawing heavy alcoholics (HA).


METHODS
FMD and some parameters of cardiovascular (CV) risk were measured in 29 HA (average alcohol intake 135, range 86 to 215 g per day) at baseline and after a 9 ± 7 months withdrawal and in 35 teetotalers.


RESULTS
HA showed baseline impaired maximal % FMD (8.5 ± 5.4 SD vs. 14.9 ± 7.4, <0.001 vs. teetotalers), higher systolic (SBP) and diastolic (DBP) blood pressure (+24 mm Hg, <0.001; +15 mm Hg, <0.01), uric acid (5.3 ± 1.1 vs. 4.4 ± 0.8 mg/dl, <0.05), high-sensitivity C-reactive protein (hs-CRP; 2.7 ± 2.0 vs. 1.0 ± 0.9 mg/l, <0.02), endothelin-1 (ET-1, 0.88 ± 0.36 vs. 0.37 ± 0.10 pg/ml,<0.001), asymmetric dimethylarginine (ADMA, 0.50 ± 0.21 vs. 0.41 ± 0.12 μmol/l, p < 0.001), homeostasis model assessment of insulin resistance (HOMA-IR) (2.3 ± 1.1 vs. 1.2 ± 0.4, <0.001), and urinary 8-isoprostane (U8-iso-PGF2α) (237.2 ± 172.4 vs. 168.5 ± 96.6 pg/mg creatinine, <0.05). After withdrawal, SBP fell by 15 mm Hg, DBP by 11 mm Hg (p < 0.001), and hs-CRP by 0.94 mg/l (p < 0.02), all remaining still higher than teetotalers (<0.05, 0.01, 0.05 respectively). ET-1, HOMA-IR, and U8-iso-PGF2α were unchanged (p = NS vs. baseline, <0.05 to 0.001 vs. teetotalers). Maximal % FMD rose (to 10.6 ± 6.2, p < 0.04), but it still remained impaired (<0.04 vs. teetotalers). ADMA increased further to 0.64 ± 0.15 μmol/l (<0.05 vs. baseline, <0.02 vs. teetotalers).


CONCLUSIONS
HA show marked endothelial dysfunction (ED) and high BP, impaired insulin sensitivity, inflammation, increased oxidative stress, and elevated ET-1 and ADMA, which are unaffected or only partially reversed by a medium-term alcohol withdrawal. ED and related abnormalities persist in detoxified alcoholics, thus contributing to a greater CV morbidity and mortality.
Centro di Alcologia at the Dipartimento di Medicina Interna e Scienze Biomediche, University of Parma Medical School, Parma, Italy.
Cristiana
C
Di Gennaro
Gloria
G
Saccani-Jotti
Silvana
S
Pinelli
Nicola
N
Venturi
Francesca
F
Palombi
Guido
G
Manfredi
Antonina
A
Pellegrino
Lorenza
L
Bicchieri
Paolo
P
Sansoni
Alberto
A
Montanari
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000437:Alcoholism / Q000150:complications / Q000473:pathology* / Q000534:rehabilitation*; D001120:Arginine / Q000031:analogs & derivatives / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001916:Brachial Artery / Q000502:physiology; D002318:Cardiovascular Diseases / Q000473:pathology*; D016001:Confidence Intervals; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018384:Oxidative Stress / Q000187:drug effects; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D014664:Vasodilation / Q000502:physiology
D015415:Biomarkers; D008055:Lipids; C018524:N,N-dimethylarginine; D001120:Arginine