LETTER TO THE EDITOR
Acute ethanol exposure fails to elicit preconditioning-like protection in in situ rabbit hearts because of its continued presence during ischemia
Kenneth J. Mukamal, MDa and
Murray A. Mittleman, MD, DrPHa
a Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Libby-303, Boston, Massachusetts 02215, USA
We read the findings of Krenz et al. (1) with great interest. Ischemic preconditioning remains one intriguing explanation for the association of moderate alcohol consumption with lower coronary mortality (2) and lower case-fatality rate of acute myocardial infarction (MI) (3). Their finding that the continued presence of ethanol during ischemia eliminates its preconditioning effect may have important clinical implications. We previously reported that alcohol use less than 6 h before acute MI was not associated with a change in peak creatine kinase level or risk of Q-wave infarction among patients enrolled in the Determinants of Myocardial Infarction Onset Study (4), consistent with their findings. Interestingly, we found 21% lower peak creatine kinase levels and 23% lower odds of Q-wave infarction among patients whose last alcohol consumption occurred 6 to 12 h prior to infarction, although neither finding reached statistical significance. Thus, our findings in a clinical population lend support to their hypothesis that ethanol exposure that ends with sufficient time to be completely metabolized may have a preconditioning effect on infarct size, whereas ethanol exposure that persists close to the time of infarction does not.
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References
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1. Krenz M, Baines CP, Yang XM, Heusch G, Cohen MV, Downey JM. Acute ethanol exposure fails to elicit preconditioning-like protection in in situ rabbit hearts because of its continued presence during ischemia. J Am Coll Cardiol. 2001;37:601–607[Abstract/Free Full Text]
2. Thun MJ, Peto R, Lopez AD, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med. 1997;337:1705–1714[CrossRef][Medline]
3. Wannamethee G, Whincup PH, Shaper AG, Walker M, MacFarlane PW. Factors determining case fatality in myocardial infarction: "Who dies in a heart attack?". Br Heart J. 1995;74:324–331[Abstract/Free Full Text]
4. Mukamal KJ, Muller JE, Maclure M, Sherwood JB, Mittleman MA. Lack of effect of recent alcohol consumption on the course of acute myocardial infarction. Am Heart J. 1999;138:926–933[CrossRef][Medline]
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