Alcohol Abuse and Cardiac Disease
What is the relationship between alcohol abuse and adverse cardiovascular events?
The authors used the California Healthcare Cost and Utilization Project Databases to evaluate the association between alcohol abuse and incident atrial fibrillation (AF), myocardial infarction (MI), and heart failure (HF). California residents >21 years old who received care in a California ambulatory surgical unit, emergency department, or inpatient hospital unit between January 1, 2005 and December 31, 2009 were included. Patients without race or gender information, those who resided outside of California, or those with a first encounter on the final day of the study period were excluded. International Classification of Diseases-9th Edition (ICD-9) and Current Procedural Terminology (CPT) codes were used for disease identification for alcohol abuse, MI, HF, AF, and covariates. The primary outcome was incidence of AF, MI, or HF. Multivariable models adjusting for age, sex, race, hypertension, diabetes, coronary artery disease (for the AF and HF outcomes), HF (for the AF and MI outcomes), chronic kidney disease, valvular heart disease (for the AF and HF outcomes), dyslipidemia, obesity, obstructive sleep apnea, cigarette smoking, and income were used. Cohort participants were censored upon incident diagnosis of the outcome.
Among 14,727,591 patients in the cohort, 1.8% of patients were coded as having alcohol abuse. After multivariable adjustment, persons with alcohol abuse had a greater than two-fold risk of AF (adjusted hazard ratio [HR], 2.14; 95% confidence interval [CI], 2.08-2.19; p < 0.0001). The presence of alcohol abuse increased the risk of MI (adjusted HR, 1.45; 95% CI, 1.4-1.51; p < 0.0001). Alcohol abuse, when adjusted for confounders, imparted a greater than two-fold risk on incident HF (HR, 2.34; 95% CI, 2.29-3.29; p < 0.0001). In interaction analyses, those people without established risk factors for AF, MI, and HF had a higher relative risk for the outcome compared to patients with established risk factors.
In this retrospective population-based study, alcohol abuse increased the risk of AF, MI, and HF in a magnitude similar to other cardiovascular risk factors. Persons with alcohol abuse lacking traditional cardiovascular risk factors were disproportionately prone to adverse cardiac events.
Alcohol is the most commonly consumed drug in the United States. Observational literature favors a protective effect of alcohol on MI risk and also shows an association of alcohol consumption and AF. This study presents data showing that alcohol abuse is associated with increased incidence of MI, AF, and HF. Alcohol in excess is cardiotoxic, and contributes to an increase in major cardiovascular morbidity. More investigation is required to understand how excess alcohol consumption influences the risk of cardiac disease, both in persons with and without established cardiovascular risk factors.
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