A small alcoholic drink a day is associated with an increased risk of atrial fibrillation

A study of about 108,000 people found that people who regularly drink a modest amount of alcohol are at increased risk for atrial fibrillation, a condition in which the heart beats at an abnormal rate.

The study, published today (Wednesday) in European Heart Journal [1], found that, compared to not drinking any alcohol, only one alcoholic drink per day was associated with a 16% increased risk of atrial fibrillation over an average (median) follow-up time of almost 14 years. This means that while four abstainers out of 100 may develop atrial fibrillation during the study period, five out of 100 may develop the condition if they consume alcohol beginning with slightly more than one alcoholic drink per week and more than 75% of them consumed up to one week. drink a day [2]. The researchers classified an alcoholic beverage as containing 12 g of ethanol, which is equivalent to a small glass (120 ml) of wine, a small beer (330 ml) or 40 ml of distillates.

It is well known that people who drink a lot of alcohol regularly have a higher 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 for people who never drink alcohol; they often show that this risk decreases for people who drink a modest amount and then increases dramatically the more alcohol is consumed, creating a ‘J’ shape on the charts. Until now, it was not clear whether this was also the case for atrial fibrillation.

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

Prof. Schnabel said: “As far as we know, this is the largest study on alcohol consumption and the long-term incidence of atrial fibrillation in the community. Previous studies have not been powerful enough to examine this issue, although they have been able to show a relationship between alcohol intake and other heart and blood vessel problems, such as heart attack and heart failure.In our study, we can now demonstrate that even a very low regular consumption of alcohol can increase the risk of atrial fibrillation.

“These findings are important because regular consumption of alcohol, ‘a glass of wine a day’ to protect the heart, as is often recommended, for example, in the lay press, probably should no longer be suggested without balancing risks and possible benefits for all heart and blood vessel disease, including atrial fibrillation. “

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

During the average follow-up period of almost 14 years, 5,854 people developed atrial fibrillation. The associations between alcohol consumption and the risk of atrial fibrillation were similar for all types of alcoholic beverages and for men and women.

In addition to the 16% higher risk of atrial fibrillation compared to abstainers seen in people who consumed only one alcoholic drink a day, the researchers found that the risk increased with increasing alcohol intake; up to two drinks a day was associated with an increased risk of 28% and this rose to 47% for those who consumed more than four.

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

Study limitations include the fact that study participants reported the type and amount of alcohol they ingested and this can lead to underreporting; the information available did not allow researchers to examine the effects of excessive alcohol consumption; 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, therefore, it may not be possible for the results to be generalized to other populations; as the study was observational, it may show only an association between alcohol intake and atrial fibrillation and not that alcohol causes atrial fibrillation.

In a follow-up 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 the AF incident, particularly in the lower spectrum A significant relationship between alcohol and AF has been identified, and even small amounts of alcohol have been associated with an increased, albeit small, risk of incident AF.

“Along with a recent randomized study showing that a reduction in alcohol intake led to a reduction in the recurrence of AF, these data suggest that reducing alcohol consumption may be important for the prevention and control of AF. It is important to note that any low to moderate reduction in alcohol consumption to potentially prevent AF should be balanced with the potentially beneficial association that small amounts of alcohol can have with other cardiovascular outcomes. Until then, each individual has to make their own decision better informed if it is worthwhile and safe to consume even one alcoholic drink a day ”.

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

[2] Data on absolute risk are not provided in the research article. The absolute risk was calculated using more information from researchers and the Winton Center’s RealRisk web tool for Cambridge University Evidence and Risk Communication: https: //url.Wintoncentre.UK/p6lcb

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