One small alcoholic drink per day has been linked to an increased risk of atrial fibrillation

A study of nearly 108,000 people found that people who regularly drink modest amounts of alcohol have an increased risk of atrial fibrillation, a condition in which the heart beats in an abnormal rhythm.

The study, published today (Wednesday) in the European Heart Journal [1], found that, compared to drinking no alcohol at all, just one alcoholic drink per day was associated with a 16% increased risk of atrial fibrillation over an average (median) follow-up time of nearly 14 years. This means that while four total abstainers in 100 could develop atrial fibrillation during the study period, five in 100 could develop the condition if they drank alcohol, starting with just over one alcoholic drink per week and over 75% of them to one drink a day [2]. The researchers categorized an alcoholic drink with 12 g of ethanol, which corresponds to a small (120 ml) glass of wine, a small beer (330 ml) or 40 ml of spirits.

People who regularly drink a lot of alcohol are known to be at 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 in people who never drink alcohol; they often show that this risk decreases for people who drink a modest amount, then rises sharply with more alcohol consumed, creating a ‘J’ shape in graphs. Until now it was not clear whether this was also the case with atrial fibrillation.

However, in the current study led by Professor Renate Schnabel, a cardiologist consultant at the University Heart and Vascular Center, Hamburg-Eppendorf (Germany), researchers found that although low doses of alcohol were associated with a reduced risk of heart failure in comparison with total abstainers. , a comparable ‘J’ shape reduction in risk was not seen for atrial fibrillation. This suggests that the increased risk of atrial fibrillation in people who drank small amounts of alcohol was not caused by heart failure.

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

“ These findings are important because the regular consumption of alcohol, the ‘one glass of wine a day’ to protect the heart, as is often recommended in the lay press, for example, should probably no longer be suggested without the risks and potential benefits for all cardiovascular disease, 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 at the time of their participation in the studies between 1982 and 2010 and provided information on their medical history, lifestyle (including alcohol and tobacco use), employment and education level. A total of 100,092 participants had no atrial fibrillation when they enrolled and their median age was nearly 48 years (range 24-97 years).

During the median follow-up period of nearly 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% increased risk of atrial fibrillation compared to abstainers seen in people who only consume one alcoholic drink per day, the researchers found that the risk increased with increasing alcohol consumption; Up to two drinks per day was associated with a 28% increased risk, up to 47% for those who consumed more than four.

The exact mechanisms by which modest amounts of alcohol can cause atrial fibrillation are unknown. Studies have shown that heavy drinking for a short period of time can cause “holiday heart syndrome” in some people, and in some atrial fibrillation patients, small amounts of alcohol can cause arrhythmia episodes.

Limitations of the study include the fact that study participants reported the type and amount of alcohol they drank and this could lead to underreporting; the available information did not allow the researchers to look at the effects of binge drinking; 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 to generalize the results to other populations; since the study was observational, it can only show an association between alcohol consumption 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 incident AF, particularly in the lower spectrum A significant association between alcohol and AF was established, and even small amounts of alcohol were associated with an increased, albeit small, risk of AF for incidents.

“Together with a recent randomized trial showing that a reduction in alcohol consumption led to a reduction in the recurrence of AF, these data suggest that lowering alcohol consumption may be important for both prevention and treatment of AF. should be weighed against the potentially beneficial association that low amounts of alcohol may have with other cardiovascular outcomes … The net clinical benefit of consuming low amounts of alcohol requires further investigation, ideally in sufficiently substantiated randomized trials. time each individual must make their own informed decision as to whether it is worthwhile and safe to consume a maximum of one alcoholic drink per day ”.

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

[2] Absolute risk data is not provided in the research paper. Absolute risk was calculated using further information from the researchers and the University of Cambridge’s Winton Center for Risk and Evidence Communication RealRisk web tool: https: //url.wintoncentre.NL /p6lcb

[3] “Alcohol Use, Atrial Fibrillation, and Cardiovascular Disease: Finding the Right Balance”, by Jorge A. Wong and David Conen. European Heart Journal. doi: 10.1093 / eurheartj / ehaa955