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. We 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, we followed 107 845 individuals for the association between alcohol consumption, including types of alcohol and drinking patterns, and incident AF. We 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 drink (12 g) per day was 1.16, 95% CI 1.11–1.22, P < 0.001. 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 drinks/day was associated with an increased risk of AF, which needs to be considered in AF prevention.

Association between Cardiovascular Health and Incident Atrial Fibrillation in the General Japanese Population Aged ≥40 Years

“…Therefore, further trials of CVH intervention focused on the younger population are needed. Moreover, we also found that alcohol intake was significantly associated with incident AF as previously described [ 16 ]. Accordingly, drinking restrictions should also be considered together with CVH intervention among Japanese as well.…”

Consensus and Controversy in the Debate over the Biphasic Impact of Alcohol Consumption on the Cardiovascular System

“…A recent study including 107,485 subjects followed up for nearly 14 years found that the consumption of only 12 g ethanol per day was linked to a 16% increase in the risk of developing atrial fibrillation, regardless of the beverage type. This finding adds to the growing body of evidence that even small amounts of alcohol intake favor CVD development, including atrial fibrillation [25].…”

Prevention and Treatment of Atrial Fibrillation via Risk Factor Modification

“…42 Excess alcohol intake produces direct cardiotoxic effects, including inflammation in myocardial cells, and upregulated sympathetic tone. 43,44 Furthermore, alcohol has causal links with other AF risk factors, including OSA, hypertension, abdominal obesity, and left ventricular dysfunction. Studies show that daily alcohol consumption of even 1 drink-defined as 14 g of ethanol-may significantly increase the risk of AF.…”

“…44 A large and consistent body of observational data indicates that the incremental risk of AF increases about 10% for each additional drink of beer, wine, or spirits per day. 43,44 During the past century, AF caused by binge drinking was referred to as Holiday Heart Syndrome. 45 Indeed, binge drinking-defined as ≥5 drinks on a single occasion-is a potent risk factor, causing a threefold increased risk of AF compared with infrequent drinking.…”