PONE-D-25-11641Epidemiological trends in alcoholic cardiomyopathy burden: A 32-year global and Chinese analysis (1990–2021) with projections to 2036PLOS ONE

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Abstract

• The background lacks a strong rationale for why ACM is a critical issue, beyond general disease burden. Clarify why ACM is a growing concern.

• The results section could be more concise—it currently repeats statistics instead of synthesizing the main findings. Summarise key findings concisely.

• The conclusion should explicitly state future research directions—such as potential interventions for ACM burden reduction. Explicitly mention the knowledge gap and future research.

Introduction

• The research gap and justification for a scoping review are unclear. Clearly define the research gap.

• Lacks a clear hypothesis or research question. Explicitly state research questions.

• Overuse of technical jargon—simplify complex epidemiological terms for broader accessibility. Reduce jargon and introduce technical terms only when necessary.

Methods

• Lacks details on data validation and bias mitigation strategies. Specify validation steps for GBD 2021 data.

• The BAPC model parameters should be better explained—readers may not be familiar with integrated nested Laplace approximations (INLA). Simplify Bayesian modelling explanation.

• Needs clarity on ethical considerations for secondary data usage. Clarify ethical considerations for using publicly available datasets.

Results

• Some sections are overly statistical—less emphasis on numerical data, and more focus on interpretation and synthesis. Synthesize key results instead of listing excessive statistics.

• The gender-based analysis could be more detailed—why are males disproportionately affected? Expand on gender disparities.

• Needs a stronger narrative flow between different sections (e.g., prevalence → mortality → DALYs). Improve flow between sections.

5. Discussion

• Lacks in-depth discussion of causal mechanisms behind observed trends. Expand on why ACM is increasing in China.

• The role of healthcare infrastructure and policy interventions in disease burden reduction is underexplored. Discuss healthcare access and intervention disparities.

• The limitations section is missing—important for academic rigor. Add a Limitations Section.

6. Conclusion

• Needs a stronger call to action for policymakers and researchers. Explicitly state implications for policymakers.

• Future research recommendations should be more specific. Clearly outline research priorities.

Reviewer #2: The manuscript provides a data-rich but analytically shallow review of ACM epidemiology. Its primary weaknesses lie in overcomplex language and poor methodological transparency. Substantial revisions are required to sharpen focus, reduce redundancy, and critically interpret findings.

Please use full name for DALY the first time you use it in manuscript, regardless of your mentioning within the abstract. Please include the limitations facing reliance on GBD data, underreporting in low-SDI countries, modeling assumptions. Many citations are from general cardiovascular or alcohol epidemiology studies, not from ACM-specific or recent high-impact sources.

Introduction: Please include the importance of genetic factors in alcoholic myopathy. While traditionally it was thought that alcohol-related disorders such as AFLD are only diet-related, it has now been comprehensively shown that several prevalent variation of several genes such as PNPLA3 and HSD17B13 are highly correlated with metabolic disorders and cardiovascular problems. Most importantly, PNPLA3 gene is a very important gene since it has a prevalence of ~30% worldwide, which is close to the prevalence of diabetes, insulin resistance, metabolic syndrome, and cardiovascular events associated to the named diseases. I highly recommend the authors to integrate genetic part of this disorder by including recent publishings such as PMID: 40231787, so that the revised manuscript would have a more comprehensive view toward the disease.

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Reviewer #1: Yes: Faizul Akmal Abdul Rahim

Reviewer #2: Yes: Alireza Ramandi

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Epidemiological trends in alcoholic cardiomyopathy burden: A 32-year global and Chinese analysis (1990–2021) with projections to 2036

PONE-D-25-11641R1

Dear Dr. Chen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Amir Hossein Behnoush

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: The manuscript has been revised significantly and the authors have improved the manuscript with the revision.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Faizul Akmal Abdul Rahim

Reviewer #2: Yes: Alireza Ramandi

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