The exact mechanism of apoptosis is still not clear, and many factors may be involved in this process, including the end products of alcohol metabolism, such as acetaldehyde; the release of angiotensin II that contribute to myocyte damage, cell death, remodeling, and cardiomyopathy in a protein kinase C/nicotinamide adenine dinucleotide phosphate oxidase-dependent manner; and released growth factors, such as insulin-like growth factor I (IGF-I) and myostatin. Here, IGF1 is linked to cardiomyopathy.