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

A study of about 108,000 people has found that people who regularly drink a modest amount of alcohol have an increased risk of 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 alcohol, only one alcoholic drink a day was related to a 16% increase in the risk of atrial fibrillation in a mean (mean) follow-up time of almost 14 years. This means that while four out of 100 teetotal patients could develop atrial fibrillation during the study period, five out of 100 could develop the condition if they consumed alcohol from a little more than one drink. alcoholic per week and more than 75% one drink per day [2]. The researchers classified an alcoholic beverage as containing 12 g of ethanol, which equates to a small glass of wine (120 ml), a small beer (330 ml), or 40 ml of alcohol.

It is well known that people who drink a lot of alcohol regularly have an increased 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 is reduced for people who drink a modest amount, and then increases sharply when more alcohol is consumed, creating a “J” shape in the graphs. Until now it was not clear if this was also the case with atrial fibrillation.

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

Professor Schnabel said: “To our knowledge, this is the largest study on alcohol consumption and the long-term incidence of atrial fibrillation in the community. Previous studies have not had enough power. to examine this issue, although they have been able to demonstrate 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 regular consumption of very low alcohol can increase the risk of atrial fibrillation.

“These findings are important, as regular consumption of alcohol, the ‘glass of wine a day’, should probably no longer be suggested to protect the heart, as is often recommended in the secular press, without balancing the risks and the potential benefits for all diseases of the heart and blood vessels, 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. Participants underwent medical examinations at the time they entered the studies between 1982 and 2010 and provided information about their medical history, lifestyles (including alcohol and tobacco use), levels. employment and education. A total of 100,092 participants had no atrial fibrillation at the time of enrollment and their mean age was nearly 48 years (range 24–97 years).

During the mean 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 both men and women.

In addition to the 16% increased risk of atrial fibrillation compared to teetotalists observed in people who only drank alcohol per day, the researchers found that the risk increased with increased intake of atrial fibrillation. ‘alcohol; up to two drinks a day was associated with a 28% increase in risk and increased to 47% in those who consumed more than four.

The exact mechanisms by which modest amounts of alcohol can cause atrial fibrillation are not known. Studies have shown that excessive alcohol consumption for a short period of time can cause “heart syndrome during the holidays” in some people, and in some patients with atrial fibrillation, small amounts of alcohol can cause episodes of alcoholism. arrhythmia.

Limitations in the study include the fact that study participants reported on the type and amount of alcohol they drank and this could lead to misinformation; the available information did not allow researchers to study the effects of excessive alcohol; 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 the results may not be generalized to other populations; since the study was observational, it can only show an association between alcohol intake and atrial fibrillation and not that alcohol causes atrial fibrillation.

In an editorial that accompanies it [3], Jorge A. Wong and David Conen of the Institute for Population Health Research at McMaster University, Hamilton, Canada, write that the research “makes an important contribution to our understanding of the relationship between alcohol and AF, particularly in the lower spectrum A significant relationship between alcohol and AF was identified, and even small amounts of alcohol were associated with a small FA incident.

“Along with a recent randomized trial 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 both prevention and for the treatment of AF.It is important to note that any reduction in the rate of low to moderate alcohol consumption to potentially prevent AF should be balanced with the potentially beneficial association that low amounts of alcohol may have. with respect to other cardiovascular outcomes … The net clinical benefit of consuming low amounts of alcohol requires a more in-depth study, ideally in randomized trials with adequate nutrition.Until then, each individual must make his or her own decision in the best way to know if consuming up to one alcoholic drink a day is worth it and be safe. “

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

[2] Absolute risk data are not given in the research work. Absolute risk was calculated using more information from researchers and the University of Cambridge’s RealRisk web tool for risk and evidence communication Winton: https: //url.wintoncentre.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