*4.3.5 Alcohol consumption and smoking*

Excessive alcohol consumption is one of the most important causes of dilated cardiomyopathy [defined as alcoholic cardiomyopathy-ACM], and it is estimated that 40% of dilated cardiomyopathy can be associated with excessive alcohol consumption. This supports that there should be lower alcohol consumption limits than are recommended in many guidelines and that patients with cardiac myopathy should stop drinking to prevent cardiac failure [35].

Nicotine and carbon monoxide in cigarettes are the primary harmful substances in respect of the heart and vascular system. Nicotine increases the pulse rate and the oxygen requirement of the heart, temporarily increases blood pressure, increases blood clotting, and causes atherosclerosis by damaging the endothelial layer. By combining with haemoglobin, carbon monoxide converts to carboxyhaemoglobin, thereby reducing the oxygen transport capacity of the blood and the amount of oxygen going to the tissues.
