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

A study of nearly 108,000 people found that people who regularly drink a modest amount of alcohol are at increased risk for atrial fibrillation, a condition where the heart beats at an abnormal rate.

The study, published today (Wednesday) in the European Heart Journal [1], found that, compared with not drinking alcohol at all, just one alcoholic drink per day was associated with a 16% increased risk of atrial fibrillation over a mean (median) follow-up period of almost 14 years. This means that while four in 100 tetotallers might develop atrial fibrillation during the study period, five out of 100 might develop the disease if they consumed alcohol starting with little more than one alcoholic beverage with. week and over 75% of them consumed up to one drink per day [2]. Researchers classified an alcoholic drink as containing 12g of ethanol, which is equivalent to a small glass (120ml) of wine, a small beer (330ml), or 40ml of spirits.

It is well known that people who drink a lot of alcohol on a regular basis have 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 for people who never drink alcohol; they often show that this risk decreases for people who drink a modest amount, then increases sharply with alcohol consumption, creating a “J” shape on the graphs. So far, it has not been clear whether this is also the case for atrial fibrillation.

However, in the current study led by Professor Renate Schnabel, consultant cardiologist at the University Heart and Vascular Center Hamburg-Eppendorf (Germany), the researchers found that although low doses of alcohol were associated with a risk reduced heart failure compared to tetotallers. , a similar “J” shaped risk reduction was not observed for atrial fibrillation. This suggests that the increased risk of atrial fibrillation in people who drink small amounts of alcohol was not triggered by heart failure.

Professor Schnabel said: “To our knowledge, this is the largest study on alcohol consumption and the long-term incidence of atrial fibrillation in the community. Previous studies have not had enough power to examine this question, although they may have shown a relationship between alcohol consumption and other heart and vascular problems, such as heart attacks and heart failure.In our study, we can now demonstrate that even very low alcohol consumption on a regular basis 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 for example in the secular press, probably should no longer be suggested without balancing the risks and the possible benefits for all heart and vascular diseases, including atrial fibrillation. “

The researchers analyzed information on 107,845 people participating in five community studies in Sweden, Norway, Finland, Denmark and Italy. Participants underwent medical examinations when they joined the studies between 1982 and 2010 and provided information about their medical history, lifestyle (including alcohol and tobacco use), employment and occupation. level of education. A total of 100,092 participants did not have atrial fibrillation at the time of enrollment and their median age was almost 48 years (range 24 to 97 years).

During the median follow-up period of almost 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 tetotallers seen in people who consumed only one alcoholic beverage per day, the researchers found that the risk increased with increasing alcohol consumption; up to two drinks a day were associated with a 28% increased risk and that figure rose to 47% for those who consumed more than four.

The exact mechanisms by which small amounts of alcohol could trigger atrial fibrillation are not known. Studies have shown that excessive alcohol consumption over a short period of time can trigger “ holiday heart syndrome ” in some people, and in some patients with atrial fibrillation, small amounts of alcohol can trigger arrhythmia episodes.

Limitations of the study include the fact that study participants reported the type and amount of alcohol they drank, which could lead to underreporting; the information available did not allow researchers to examine the effects of excessive alcohol consumption; some episodes of atrial fibrillation may be asymptomatic and therefore may not have been reported; only adults in Europe were included in the analyzes and therefore the results may not be generalized 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 use and the AF incident. , especially in the lower spectrum A significant relationship between alcohol and AF has been identified, and even small amounts of alcohol were associated with an increased, albeit low, risk of an AF incident.

“Coupled with a recent randomized trial showing that a reduction in alcohol consumption led to a reduction in AF recurrence, these data suggest that reducing alcohol consumption may be important for both prevention and management of AF. It is important to note that any reduction in AF alcohol consumption to potentially prevent AF must be balanced with the potentially beneficial association that low amounts of alcohol may have compared to other cardiovascular outcomes. The net clinical benefit of consuming small amounts of alcohol requires further study, ideally in randomized trials of adequate potency Until then, each individual should make their own informed decision as to whether to consume up to one alcoholic beverage. per day is valid and safe “.

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[1] “Alcohol Consumption, Cardiac Biomarkers and Risk of Atrial Fibrillation 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 document. Absolute risk was calculated using additional information provided by researchers and the RealRisk web tool from the Winton Center for Risk Communication and Evidence at the University of Cambridge: https: //url.wintoncentre.United Kingdom/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