O1-4.6 Alcohol-induced damage to heart muscle rather than atherosclerosis may drive the association of circulatory disease with hazardous drinking in Russia

Background Circulatory disease mortality in Russia is associated with hazardous drinking. Over the past 40 years there have been major fluctuations in mortality from circulatory disease that are closely correlated with deaths from acute alcohol poisoning (r=0.8 among working-age men). In a case-control study (2003–2005) hazardous drinking was associated with deaths attributed to ischaemic heart disease. However, rather than hazardous alcohol consumption increasing risk of atherosclerotic disease and subsequent myocardial infarction, these effects could be due to misclassified non-atherosclerotic damage to the heart induced by heavy drinking as occurs in extreme form in alcoholic cardiomyopathy. Methods A population-based sample of 1052 men aged 30–60 years living in Izhevsk (a medium-sized Russian city) were examined (2008–2009). Information about drinking was obtained by interview of proxy informants (mainly spouses or partners). Levels of B-type natriuretic peptide (BNP—a sensitive and highly specific marker of heart muscle stress) and an atherogenic index (ApoB to ApoA1 ratio) were measured in blood. Results Compared to abstainers, men who drank hazardously had an increased risk of being in the top 20% of BNP (OR 4.80, 95% CI 2.29 to 10.1) adjusted for age and BMI, with non-hazardous drinkers being intermediate in risk. The equivalent association for the ApoB/ApoA1 ratio was in the opposite direction (OR 0.31, 0.16 to 0.61). Conclusion Hazardous drinkers show a lipoprotein profile associated with a reduced risk of atherosclerotic disease. However, they have raised levels of BNP. Taken together these results support the hypothesis that hazardous drinking among Russian men may induce non-atherosclerotic heart muscle damage.