Endothelial dysfunction and high cardiovascular profile persist after a medium-term withdrawal in heavy alcoholic patients

Abstract Impaired flow•mediated vasodilatation of brachial artery (FMD) and a high cardiovascular •. (CV) risk profile have -been observed previously in apparently disease-free, long-term detoxified heavy alcoholics (A). In this study, FMD and some parameters of endothelial activation, oxidative stress, vascular inflammation and insulin sensitivity (uric acid [UA], lipids, C-reactive protein [C-RP], adhesion molecules, asymmetric dimethylarginine [ADMA]. homocysteine, endothelin-1, urine 8-isoprostane, microalbuminuria, fasting insulin, HOMA-IR) were measured in 29 A before and after detoxification and subsequent 9±7 months controlled alcohol withdrawal. Results also were compared with those of 39 lifetime alcohol -abstaining control subjects (C). Before Alcohol Detoxification, maximal % FMD was reduced in A (9.7± 5.1 SO vs 14.9±7.4, P <,0.001 vs C). Blood pressure (BP) also was higher (systolic 144±19 vs 118.2 ±10.7mmHg, P<0.001; diastolic 89±8 vs 74.6±6.4mmHg, P<001; mean BP 1Q8±12 vs 89.1±7.3 mmHg, P<0.001). Significant alterations also were found in: UA (5.3±1.1 vs 4.4±0.8mg/dl, P 0.05), C-RP (2.7±2.0 vs 1.0±0.9mg/l, P<0.01), endothelin-1 (0.88±0.36 vs 0.17±0.10 pg/ml. P<0.001), fasting insulin (8.9±5.6 vs 5.6±1.6flUlml, P <0.001), and HOMA-IR (2.3±1.1 vs 1.2;±0.4, P<O.001). After Alcohol Detoxification and withdrawal, BP fell (systolic to 129± 12 mmHg; diastolic to 78 ± 10; mean BP to 95±10, P <0.001 for all vs before detoxification), but it was still higher than in C (P<0.001 for all). Maximal % FMD increased to 11.9± 5.3 (P<0.04 vs before detoxification), but it still remained impaired (P < 0.004 vs C). C-RP fell significantly (down to 1.76±2.2, P <0.02 vs before detoxification), remaining however significantly elevated (P<0.05 vs C). High UA, endothelin~1, insulin and HOMA-IR remained essentially unchanged (P= NS vs before detoxification, P < 0.02 to 0.001 vs C). Endothelial dysfunction and a cluster of haemodynamic, vascular and metabolic alterations in keeping with an unfavourable CV and metabolic risk profile are associated with active heavy alcoholism. Such abnormalities are only marginally corrected following medium-term alcohol withdrawal, thus contributing to a greater CV morbidity/mortality even in detoxified heavy A if compared to both teetotallers and light-la-moderate drinkers. Endothelial dysfunction and abnormal cardiovascular markers even in alcoholics under controlled withdrawal conditions indicate the need of a careful CV risk assessment in former alcoholics