"Normally, when you see patients, they have to have high blood pressure for more than 10 years to develop any structural changes in the heart," lead investigator Dr Azra Mahmud (St James Hospital, Dublin, Ireland) told heartwire. "The idea was that if the excessive alcohol consumption wasn't really damaging, they shouldn't have any structural problems, but we were really quite shocked by the data, particularly for women. They don't have higher blood pressure than men or more stiffening of the arteries, but at a very young age they already have much bigger hearts, with an abnormal configuration."

Investigators who presented the data here this week at the American Society of Hypertension 2008 Annual Meeting assessed the deleterious effects of heavy drinking in males and females in Dublin, Ireland. Mahmud told heartwire that previous data have suggested that women are at greater risk of alcoholic cardiomyopathy, as well as skeletal myopathy, than men for any given lifetime amount of alcohol.

"Women, we know, get more liver disease than men if they drink too much," she said. "They can't cope with as much alcohol as men, mainly because they are smaller and have fewer liver enzymes, but there is evidence, including this study, suggesting there might be other mechanisms where they are somehow programmed to have much more direct damage to the heart than men."

In this study, investigators assessed 200 consecutive untreated subjects referred to a hypertension clinic for the assessment of elevated blood pressure. Subjects were classified according to their drinking patterns: nondrinkers, moderate drinkers (males: 1-21 units of alcohol per week; females: 1-14 units per week), and heavy drinkers (males: >21 units per week; females: >14 units per week). All subjects underwent conventional echocardiography, including tissue Doppler imaging. Arterial stiffness was measured by pulse-wave velocity and the augmentation index, another measure of systemic arterial stiffness.

Investigators observed in men a dose-response relationship between alcohol intake and aortic systolic and diastolic blood pressure, the augmentation index, pulse-wave velocity, and indices of diastolic function. Even among those who drank moderately, there were significant increases in aortic blood pressures and the augmentation index. These findings, however, differed from the females in the study. In women, there was a dose-response relationship between alcohol and left ventricular septal and posterior wall thickness and left ventricular mass index. Even among heavy female drinkers, there was no relationship between drinking and arterial stiffness and high blood pressures.

This enlargement of the heart, noted Mahmud, is an early sign of the progression to heart failure, although she noted that these women, with the average age of the heavy female drinker being 42 years, had not yet reached that stage. The average ejection fraction among female nondrinkers was 65%, and 58% in those who drank heavily.

"Still, if these women continue to drink at this pace, it's going to take away many years from their life," said Mahmud. "The heart is going to become weaker and weaker until it is no longer able to contract."

Mahmud said that Irish clinicians are seeing a rise in amount of alcohol females are consuming. Asked about the reasons, she speculated that there might be mixed messages about the benefits of alcohol, with the cardioprotective benefits of red wine often reported in the media, or it might be the result of the "Celtic Tiger," Ireland's booming economy, which possibly leads to the consumption of more alcohol. Opening the wine bottle, she said, often means finishing the bottle, but there is absolutely no clinical benefit to getting drunk or having more than two drinks daily, she added.

Dr Gerald Berenson (Tulane Center for Cardiovascular Health, New Orleans, LA) told heartwire that there is still uncertainty as to why excessive drinking manifests differently in men and women. It could be a dose effect, because women are smaller, or it could be an unknown metabolic effect. He noted that the study showed significant increases in liver enzymes in the female subjects, meaning many had experienced a hepatic inflammatory reaction to the alcohol. In men and women, especially those presenting to clinic with hypertension caused by alcohol, Berenson said the only way to treat them is to "throw the book at them," meaning changes in diet and exercise, weight reduction, quitting smoking, and quitting drinking.