Alcohol Consumption and Risk of Heart Failure: The Atherosclerosis Risk in Communities Study | Journal Scan

Study Questions:

Alcohol is a known cardiac toxin and heavy consumption can lead to heart failure (HF). Is there a risk of HF in men and women with moderate alcohol consumption?

Methods:

The authors examined 14,629 participants of the Atherosclerosis Risk in Communities (ARIC) study without prevalent HF at baseline (1987–89) who were followed for 24 ± 1 years. Self-reported alcohol consumption was assessed as the number of drinks/week (1 drink = 14 g of alcohol) at baseline, and updated cumulative average alcohol intake was calculated over 8.9 ± 0.3 years. Multivariable Cox proportional hazards models were used to examine the relation of alcohol intake with incident HF and whether associations were modified by sex.

Results:

Mean age was 54 ± 6 years and 55% women. Overall, most participants were abstainers (42%) or former drinkers (19%), with 25% reporting up to 7 drinks per week, 8% reporting ≥7 to 14 drinks per week, and 3% reporting ≥14 to 21 and ≥21 drinks per week, respectively. Incident HF occurred in 1,271 men and 1,237 women. Men consuming up to 7 drinks/week had reduced risk of HF relative to abstainers (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.68-0.94; p = 0.006). This effect was less robust in women (HR, 0.84; 95% CI, 0.71-1.00; p = 0.05) and independent of coronary artery disease, myocardial infarction, and cardiovascular risk factors. In the higher drinking categories, the risk of HF was not significantly different from abstainers, either in men or in women.

Conclusions:

In the community study, alcohol consumption of up to 7 drinks/week at early-middle age was associated with lower risk for future HF, with a similar but less definite association in women than in men. These findings suggest that despite the dangers of heavy drinking, modest alcohol consumption in early-middle age may be associated with a lower risk for HF.

Perspective:

Alcohol presents a ‘two-edged sword’ in cardiovascular disease. Myocardial damage may occur from a direct toxic effect of alcohol or its metabolites by inducing apoptosis, associated hypertension, or coexisting nutritional deficiencies which are now rare. Cardiovascular mechanisms of alcohol benefit in HF may involve the risk reduction for coronary artery disease, neurohormonal changes, and blood pressure lowering. The accumulating evidence is that mild to moderate alcohol consumption has a beneficial effect on cardiovascular and outcome compared to abstainers. But in this and many other studies, heavy alcohol intake increases the risk of all-cause mortality among men and women.

Clinical Topics: Heart Failure and Cardiomyopathies, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure

Keywords: Alcohol Drinking, Alcohols, Coronary Artery Disease, Heart Failure, Risk Factors, Cardiovascular Diseases, Middle Aged, Risk Reduction Behavior


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