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Just one drink a day can raise risk of developing atrial fibrillation

European Heart Journal
Reuters Health - 13/01/2021 - Even light drinking, if it's regular, can raise a person's risk of developing atrial fibrillation, a new study suggests.

An analysis of data from more than 100,000 European adults who were free of atrial fibrillation at baseline, reveals that a drink a day raises the risk of developing the abnormal heart rhythm by 16%, according to the results published in the European Heart Journal.

The researchers defined a drink a day as 12 g of ethanol or the equivalent of one small glass of wine (120 ml), a small beer (330 ml) or 40 ml of spirits.

"The take-home message is that alcohol, even at very low regular consumption, appears to increase arrhythmia risk for atrial fibrillation, no clear threshold was observed," said study coauthor Dr. Renate Schnabel, a professor at the University Heart and Vascular Center, Hamburg-Eppendorf.

"This is in contrast to other cardiovascular diseases, for example, heart attack or heart failure," Dr. Schnabel said in an email. "We could show the latter in our article too. At low doses, regular alcohol consumption was negatively associated with incident heart failure. When counseling patients on prevention of atrial fibrillation these findings could be considered, and the risks and benefits of alcohol consumption should be weighed."

The new research does not answer questions regarding how alcohol might be causing abnormal heart rhythms.

"The mechanisms of alcohol on arrhythmias, in particular atrial fibrillation, are not fully understood," Dr. Schnabel said. "Acute alcohol consumption ('holiday heart syndrome' for example) leads to changes in cardiac ionic currents and metabolic changes such as electrolyte imbalance and acidosis which may trigger the arrhythmia. The effects of chronic alcohol consumption are less well studied. Changes in the electrical cardiac activity and remodeling of the atria, the upper chambers of the heart, have been described and may increase the likelihood to develop atrial fibrillation during the lifespan."

To study the impact of various amounts of alcohol on atrial fibrillation, Dr. Schnabel and her colleagues turned to data on 107,845 adults from five community-based cohorts from Sweden, Norway, Finland, Denmark and Italy. The researchers excluded the 7,753 participants with atrial fibrillation at baseline, leaving 100,092 people included in the analysis.

At baseline, risk factor information was collected, including BMI, blood pressure, diabetes, cholesterol, smoking habits, heart disease, employment status, educational level, and habitual alcohol intake. The study participants' median age at baseline was 47.8, and 51.7% were women. The median alcohol consumption was 3 g/day.

During follow-up, which was a median of 13.9 years, there were 5,854 new cases of atrial fibrillation. Using a Cox regression analysis, the researchers found an increased risk (hazard ratio 1.16) with one drink per day for developing new atrial fibrillation. As alcohol consumption increased, so did the risk of developing atrial fibrillation.

"This is an important study which provides further support for the link between alcohol intake and the development of atrial fibrillation," said Dr. Hugh Calkins, a professor of medicine and director of cardiac arrhythmia services at Johns Hopkins Medicine in Baltimore.

"This study provides strong evidence that even low amounts of alcohol intake can slightly, but significantly, increase the risk of developing atrial fibrillation," Dr. Calkins said in an email.

While there has been evidence in the past that there is an association between alcohol and atrial fibrillation, that's been with binge drinking or moderate to heavy use, said Dr. Sandeep Jain, professor of medicine at the University of Pittsburgh and director of the UPMC Center for Atrial Fibrillation.

"What's unique about this study is they are looking at all comers who have never had a diagnosis of atrial fibrillation," Dr. Jain said. "Even with what many would consider to be a low level of consumption at one drink a day, there was a signal of increased risk of new atrial fibrillation."

And while the study has a limitation of being retrospective and therefore can only show an association, it's a large study and a pretty strong association, Jain said.

SOURCE: https://bit.ly/3bz3sOA and https://bit.ly/39tIcqH European Heart Journal, online January 13, 2021.

By Linda Carroll

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