Log in to MyACC
Lower Risk of Stroke After Alcohol Abstinence in Atrial Fibrillation
Quick Takes
- Current alcohol consumption was associated with an increased risk of ischemic stroke in patients with newly diagnosed AF, and alcohol abstinence after AF diagnosis could reduce the risk of ischemic stroke.
- The reduced rate of ischemic stroke in those who claimed to have refrained from alcohol was highly influenced by age, but attenuated in persons ≥75 years, possibly because of the strong association of age and stroke risk.
- After adjustment for age and other variables, weighted incident rate of ischemic stroke were highest in current drinkers (11.7 per 1,000 person-years) compared to abstainers and nondrinkers (10.1 per 1,000 person-years and 8.8 per 1,000 person-years, respectively or about 2-3 per 1,000 person-years).
Study Questions:
Is there an association between alcohol consumption status (and its changes) after newly diagnosed atrial fibrillation (AF) and the risk of ischemic stroke?
Methods:
The authors used the Korean nationwide database to identify subjects who were newly diagnosed with AF between 2010 and 2016. Patients were categorized into three groups according to the status of alcohol consumption before and after AF diagnosis: nondrinkers; abstainers from alcohol after AF diagnosis; and current drinkers. The primary outcome was incident ischemic stroke during follow-up, which began from the index date until the occurrence of ischemic stroke, death, or end of the study period. Nondrinkers, abstainers, and current drinkers were compared using incidence rate differences after the inverse probability of treatment weighting (IPTW) analysis, which used stabilized weights calculated from propensity score. Based on the frequency per week and amount per session, the amount of alcohol consumption per week was classified as mild (0 to <105 g), moderate (105 to <210 g), and heavy (≥210 g); 14 g per drink equivalent.
Results:
There was a total of 97,869 newly diagnosed AF with mean age 61.3 ± 12.3 years, 62.4% men, and mean CHA2DS2-VASc score of 2.3 ± 1.5. Fifty-one percent were nondrinkers, 13% were abstainers, and 36% were current drinkers. Current drinkers had the lowest mean CHA2DS2-VASc score among the three groups, a lower prevalence of most comorbidities, and lower prevalence of anticoagulant use than nondrinkers and abstainers. During 310,926 person-years of follow-up, 3,120 patients were diagnosed with incident ischemic stroke (10.0 per 1,000 person-years). At 5-year follow-up, abstainers and nondrinkers were associated with a lower risk for stroke than current drinkers (incidence rate differences after IPTW, -2.03 [-3.25, -0.82] for abstainers and -2.98 [-3.81, -2.15] for nondrinkers, per 1,000 person-years, respectively and incidence rate ratios after IPTW, 0.75 [0.70, 0.81] for nondrinkers and 0.83 [0.74, 0.93] for abstainers, respectively).
Conclusions:
Current alcohol consumption was associated with an increased risk of ischemic stroke in patients with newly diagnosed AF, and alcohol abstinence after AF diagnosis could reduce the risk of ischemic stroke. Lifestyle intervention, including attention to alcohol consumption, should be encouraged as part of a comprehensive approach to AF management to improve clinical outcomes.
Perspective:
The impact of alcohol on total strokes (ischemic, embolic, hemorrhagic) or relationship with recurrent AF and anticoagulation was not evaluated. It is logical that abstinence of alcohol could reduce recurrent AF, which is a risk factor for ischemic strokes, and reduce stroke risk factors including hypertension, diabetes, and sleep apnea. Most importantly, alcohol use might well have been under-reported. South Koreans drink 13.7 shots of liquor per week on average, which is the most in the world.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiovascular Care Team, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Alcohol Abstinence, Alcohol Drinking, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Brain Ischemia, Ischemic Stroke, Life Style, Primary Prevention, Risk Factors, Stroke
< Back to Listings
