Alcohol Consumption, Cardiac Biomarkers, and Risk of Atrial Fibrillation and Adverse Outcomes
Abstract
Aims
There is inconsistent evidence on the relation of alcohol intake with incident atrial fibrillation (AF), in particular at lower doses. This study assessed the association between alcohol consumption, biomarkers, and incident AF across the spectrum of alcohol intake in European cohorts.
Methods and results
In a community-based pooled cohort, the analysis followed 107,845 individuals for the association between alcohol consumption, including types of alcohol and alcohol use patterns, and incident AF. The researchers collected information on classical cardiovascular risk factors and incident heart failure (HF) and measured the biomarkers N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin I. The median age of individuals was 47.8 years, 48.3% were men. The median alcohol consumption was 3 g/day.
N = 5854 individuals developed AF (median follow-up time: 13.9 years). In a sex- and cohort-stratified Cox regression analysis alcohol consumption was non-linearly and positively associated with incident AF. The hazard ratio for one unit of alcohol (12 g) per day was 1.16. Associations were similar across types of alcohol.
In contrast, alcohol consumption at lower doses was associated with reduced risk of incident HF. The association between alcohol consumption and incident AF was neither fully explained by cardiac biomarker concentrations nor by the occurrence of HF.
Conclusions
In contrast to other cardiovascular diseases such as HF, even modest habitual alcohol intake of 1.2 alcoholic beverages/day was associated with an increased risk of AF, which needs to be considered in AF prevention.
Research in Context
Atrial fibrillation is a condition where the heart beats in an abnormal rhythm. One alcoholic beverage according to this study was 12 g of ethanol, which is the equivalent of a small (120 ml) glass of wine, a small beer (330 ml) or 40 ml of spirits.
According to this study, compared to not consuming alcohol at all, even one alcoholic beverage a day can increase the risk of atrial fibrillation by 16% over 14 years.
A common misconception and myth related to alcohol use is that low dose use protects the heart. Despite mounting evidence against the myth it persists at present day. The alcohol industry also promotes low dose alcohol consumption in their “moderate” and “responsible” alcohol use campaigns. This research adds to the evidence base that even low dose alcohol increases health risks such as for the heart compared to not having alcohol at all.