ALCOHOL-RELATED CARDIOMYOPATHY IN THE SEYCHELLES

Objective: To determine the frequency and features of alcohol-related cardiomyopathy in the Seychelles. Design and subjects: The study was multifaceted investigation involving: a randomised cross-sectional survey of drinking habits in the general population; a cross-sectional survey of blood alcohol levels in patients admitted to hospital; a prospective case series of all consecutive patients hospitalised with alcohol-related cardiomyopathy; a retrospective review of medical records of patients with alcohol-related diseases; a retrospective review of autopsy records; and an analysis of volatile oils and trace metals in alcoholic drinks. Setting: Data on drinking habits were obtained from a randomised sample of 1309 adults from the total population of the Seychelles (66 000). All clinical data were obtained from patients in the Victoria Hospital, which is the single reference hospital of the country. Intervention: Hospitalised patients with alcohol-related cardiomyopathy were treated initially with vitamin B1 and/or diuretics. Results: The survey of alcohol habits revealed that 75% of the male population were regular alcohol consumers, with 19% of men consuming more than 100 g of alcohol per day. The estimated annual consumption of alcohol per capita was 26.4 L for men and 3.5 L for women. The survey of blood alcohol levels showed that 28% of male and 13% of female patients had raised alcohol levels at hospital admission. Throughout 1989, 96 patients were diagnosed as having alcohol-related cardiomyopathy and 12 of these had beriberi. The majority of young patients responded with marked diuresis within four hours of a single administration of thiamine. Overall, one-third of all male medical admissions were due to alcohol-related disease. The pathological effects of alcohol consumption were detected in 47% of autopsies and in 20% there was evidence of alcohol-related cardiomyopathy. Conclusions: These findings confirm the high frequency of alcohol-related disease in general and cardiomyopathy in particular.