Risk of incident atrial fibrillation with low-to-moderate alcohol consumption is associated with gender, region, alcohol category: a systematic review and meta-analysis

Abstract

Aims The association between low-to-moderate alcohol consumption and atrial fibrillation (AF) has yet to be fully elucidated. The main purpose of this meta-analysis was to estimate the risk of incident AF related to low-to-moderate alcohol consumption. Methods and results A meta-analysis was performed on 13 publications discussing the estimated risk for AF with habitual low-to-moderate alcohol intake in 10 266 315 participants. Graphical augmentations to the funnel plots were used to illustrate the potential impact of additional evidence on the current meta-analysis. Thirteen eligible studies were included in this meta-analysis. We found that moderate alcohol consumption was associated with an increased risk of incident AF in males [hazard ratio (HR) 1.09, 95% confidence interval (CI): 1.07–1.11, P < 0.00001], Europeans (HR 1.32, 95% CI: 1.23–1.42, P < 0.00001), and Asians (HR 1.09, 95% CI: 1.07–1.11, P < 0.00001). Moderate beer consumption was associated with an increased risk of developing AF (HR 1.11, 95% CI: 1.02–1.21, P = 0.01). Low alcohol consumption conferred an increased risk of AF in males (HR 1.14, 95% CI: 1.01–1.28, P = 0.04) and Europeans (HR 1.12, 95% CI: 1.07–1.17, P < 0.00001). Conclusions This analysis represents the increased risk of incident AF in males, Europeans, and Asians at moderate alcohol consumption levels and in males and Europeans at low alcohol consumption levels. Those who drink any preferred alcohol beverage at moderate levels should be cautious for incident AF. More studies are warranted to find those factors that influence alcohol’s effect on predisposing AF.

Alcohol and Atrial Fibrillation

“…In a study by Cha et al [41], men were also more predisposed to a higher risk of AF related to alcohol consumption compared to women. A greater susceptibility of men to develop AF in relation to alcohol was also found in the meta-analysis by Yang et al [36] who found that although low alcohol consumption did not affect the risk of AF, moderate alcohol consumption increased it among men (HR = 1.09; 95% CI: 1.07-1.11) but not among women. A meta-analysis by Zhang et al [37] found that moderate and heavy alcohol consumption was significantly associated with the risk of AF among men (HR = 1.21; 95% CI: 1.10-1.33 and HR = 1, respectively, 54; 95% CI: 1.26-1.89), while among women this was only evident with high alcohol consumption (HR = 1.32; 95% CI: 1.10-1.60).…”

“…No significant differences in the effects of spirits or beer on AF risk were found in a prospective study by Csengeri et al [42], where the risk of AF associated with wine consumption was the least pronounced or insignificant. In the meta-analysis by Yang et al [36], analyzing the same types of alcohol, no significant differences in their impact on the risk of AF were found. In a prospective study by Tu et al [17], beverage-specific analyzes have shown detrimental associations between any beer/cider consumption and the risk of AF, while for consumption of red and white wine and spirits up to 10, 8 and 3 drinks/week, respectively, no harmful effects were observed (Fig.…”

“…In an observational study by Frederiksen et al [47] of 43,758 participants without AF at baseline was found that increasing alcohol consumption in a 5-year follow-up significantly increased the risk of AF only among women. Some [29,31,32,34,36], but not all [15,27,28,47], studies have found a higher risk of AF in men who consume alcohol. Several studies have failed to show an increase in the risk of AF at all levels of alcohol consumption in women.…”

“…The most important results relating alcohol consumption and AF are summarized in Table 1 (Ref. [17,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]).…”

“…In a meta-analysis of 7 prospective studies (205,073 participants), it was found that each one drink/day increase in alcohol consumption was significantly associated with an 8% increase in the risk of AF (RR = 1.08; 95% CI: 1.06-1.10) [35]. One meta-analysis of 13 studies (10,266,315 subjects) found that regular moderate (about 2 units of alcohol/day) alcohol consumption increased the risk of AF (HR = 1.14; 95% CI: 1.07-1.21), while low alcohol consumption (about 1 unit of alcohol/day) had no effect on this risk [36]. Another meta-analysis of 13 studies (668,905 subjects) found that heavy alcohol consumption increased the risk of AF by 30% (HR = 1.30; 95% CI: 1.20-1.41), moderate by 12% (HR = 1.12; 95% CI: 1.06-1.18), while low did not affect the risk (HR = 1.00; 95% CI: 0.96-1.05) [37].…”