One small alcoholic beverage per day is associated with an increased risk of atrial fibrillation

A study of nearly 108,000 people found that people who regularly drank a moderate amount of alcohol were at increased risk for atrial fibrillation, a condition in which the heart beats in an abnormal rhythm.

The study, conducted today (Wednesday) in the European Heart Journal [1], found that, compared to drinking no alcohol, only one alcoholic beverage per day was associated with an increased risk of atrial fibrillation by 16% during a mean (median) follow-up period of almost 14 years. This means that although four tea totals in 100 atrial fibrillation may develop during the study period, five per 100 may develop the condition if they use alcohol, starting with a little more than one alcoholic beverage per week and more than 75% of them consumption up to one drink per day [2]. According to the researchers, one alcoholic beverage contains 12 g of ethanol, which is equivalent to a small (120 ml) glass of wine, a small beer (330 ml) or 40 ml of spirits.

It is known that people who drink a lot of alcohol regularly are at greater risk of developing heart failure, and heart failure can increase the incidence of atrial fibrillation. Several studies have shown a slightly higher risk of heart problems in people who never drink alcohol; they often show that this risk decreases for people who drink a moderate amount, and then rises sharply the more alcohol is consumed, creating a ‘J’ shape on graphs. Until now, it was not clear whether this was also the case for atrial fibrillation.

In the current study led by Professor Renate Schnabel, a consultant cardiologist at the University Heart and Vascular Center, Hamburg-Eppendorf (Germany), researchers found that although low doses of alcohol are associated with a reduced risk of heart failure compared to with tea totals. , a similar reduction in risk ‘J’ has not been seen for atrial fibrillation. This suggests that the increased risk of atrial fibrillation among people who drink small amounts of alcohol was not caused by heart failure.

Prof. Schnabel said: “To our knowledge, this is the largest study on alcohol use and long-term prevalence of atrial fibrillation in the community. Previous studies have not had enough power to investigate this question, although they have a link between alcohol intake and other cardiovascular vascular problems, such as heart attack and heart failure.In our study, we can now show that even a very low regular alcohol consumption can increase the risk of atrial fibrillation.

“These findings are important as the regular consumption of alcohol, the ‘one glass of wine a day’ to protect the heart, as recommended in the licking press, for example, should probably no longer be suggested without balancing risks and potential benefits. all cardiovascular diseases, including atrial fibrillation. “

The researchers analyzed information on 107,845 people who participated in five community-based studies in Sweden, Norway, Finland, Denmark and Italy. The participants underwent medical examinations when they joined the studies between 1982 and 2010 and provided information about their medical history, lifestyles (including alcohol and tobacco consumption), employment and education levels. A total of 100 092 participants did not have atrial fibrillation when they entered and their median age was almost 48 years (range 24-97 years).

During the median follow-up period of almost 14 years, 5854 people developed atrial fibrillation. The relationship between alcohol use and the risk of atrial fibrillation was similar for all types of alcoholic beverages and for men and women.

In addition to the 16% increased risk of atrial fibrillation compared to tea totals seen in people who consume only one alcoholic beverage per day, the researchers found that the risk increased with increasing alcohol intake; up to two drinks per day associated an increased risk of 28% and it increased to 47% for those who consumed more than four.

The exact mechanisms by which moderate amounts of alcohol can cause atrial fibrillation are not known. Studies have shown that heavy drinking over a short period of time can cause ‘holiday heart syndrome’ in some people, and in some patients with atrial fibrillation, small amounts of alcohol can cause arrhythmia episodes.

Limitations of the study include the fact that study participants reported on the type and amount of alcohol they drank, and this may lead to underreporting; the available information did not enable the researchers to look at the effects of liquor; some episodes of atrial fibrillation may be asymptomatic and therefore may not have been reported; only adults across Europe were included in the analyzes and it is therefore possible that the results to other populations cannot be generalized; since the study was observational, it can only show a link between alcohol intake and atrial fibrillation and not that alcohol causes atrial fibrillation.

In an accompanying editorial [3], Jorge A. Wong and David Conen of the Population Health Research Institute at McMaster University, Hamilton, Canada, write that the research makes an important contribution to our understanding of the relationship between alcohol intake and AF, especially in the lower spectrum. A significant association between alcohol and AF has been identified, and even small amounts of alcohol are associated with an increased, albeit small, risk of AF incident.

“Together with a recent randomized trial showing that a reduction in alcohol intake led to a decrease in AF recurrence, these data suggest that reducing alcohol consumption may be important for the prevention and management of AF. To prevent AF, should be balanced with the potentially beneficial relationship that low levels of alcohol can have over other cardiovascular outcomes … The net clinical benefit of low alcohol intake requires further study, ideally in adequately driven randomized studies Until then each individual must make his or her own best-educated decision as to whether it is worthwhile and safe to drink up to one alcoholic beverage per day.

###

[1] “Alcohol use, cardiac biomarkers and risk of atrial fibrillation and adverse outcomes”, by Dora Csengeri et al. European Heart Journal. doi: 10.1093 / eurheartj / ehaa953

[2] Data on absolute risk are not given in the research article. The absolute risk was calculated using further information from the researchers and the University of Cambridge Winton Center for Risk and Evidence Communication RealRisk web tool: https: ///url.wintonsentrum.uk /p6lcb

[3] “Alcohol consumption, atrial fibrillation and cardiovascular disease: finding the right balance”, by Jorge A. Wong and David Conen. European Heart Journal. doi: 10.1093 / eurheartj / ehaa955