Alcohol flushing syndrome and coronary vasospastic angina

Alcohol flushing syndrome and coronary vasospastic angina

Alcohol flushing syndrome is due to due deficient activity of the enzyme aldehyde dehydrogenase 2 (ALDH2) which metabolizes acetaldehyde derived from alcohol. The syndrome is characterized by facial flushing, headache, nausea, and palpitation occurring even with intake of small amount of alcohol.

It is more common in the East Asian population and is due to variant of ALDH2 known as ALDH2*2. ALDH2 is also involved in deactivation of other toxic aldehydes generated by lipid peroxidation and even smoking. It is also involved in the bioactivation of nitroglycerin. A study published in Circulation [1] has linked ALDH2*2 genotype with coronary vasospastic angina, which has a higher prevalence in the East Asian population.

Ethanol patch test has been used in this subset of persons with coronary spastic angina. Positive ethanol patch test was a significant predictor of coronary spastic angina with p=0.011 [2]. From the study, the authors concluded that alcohol ingestion and smoking were significant risk factors for coronary spastic angina in the Japanese population.

Deficient variant ALDH2*2 genotype is prevalent in up to 40% of East Asians and has been associated with myocardial infarction also. Another study found that ALDH2*2 had a prevalence of 51% among Japanese patients with ST segment elevation myocardial infarction. Those with ALDH2*2 had higher frequencies of coronary spasm, alcohol flushing syndrome and more-severe myocardial injury compared to those with ALDH2*1/*1 [3].

References

1. Mizuno Y, Harada E, Morita S, Kinoshita K, Hayashida M, Shono M, Morikawa Y, Murohara T, Nakayama M, Yoshimura M, Yasue H. East asian variant of aldehyde dehydrogenase 2 is associated with coronary spastic angina: possible roles of reactive aldehydes and implications of alcohol flushing syndrome. Circulation. 2015 May 12;131(19):1665-73.
2. Mizuno Y, Morita S, Harada E, Shono M, Morikawa Y, Murohara T, Yasue H. Alcohol flushing and positive ethanol patch test in patients with coronary spastic angina: possible role of aldehyde dehydrogenase 2 polymorphisms. Intern Med. 2013;52(23):2593-8.
3. Mizuno Y, Hokimoto S, Harada E, Kinoshita K, Nakagawa K, Yoshimura M, Ogawa H, Yasue H. Variant Aldehyde Dehydrogenase 2 (ALDH2*2) Is a Risk Factor for Coronary Spasm and ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc. 2016 May 6;5(5)