Alcohol and Heart Failure Incidence | Journal Scan

Study Questions:

What is the association between alcohol intake and incident heart failure (HF)?


The study cohort was comprised of 33,760 men of the Swedish Men Study aged between 45–79 years old with no HF, diabetes mellitus, or myocardial infarction at baseline. All former drinkers were excluded from evaluation. All participants completed a food-frequency questionnaire at baseline. HF was defined as hospitalization for or death from HF. Cox proportional hazards models were utilized to estimate multivariable-adjusted rate ratios (IRRs).


A total of 2,916 men were hospitalized for (n = 2,139) or died (n = 777) of incident HF during the follow-up period of the study (from January 1, 1998 through December 31, 2011). The relationship between total alcohol intake and incident HF was U-shaped (p = 0.0004) and the U-shaped trend was seen for beer, wine, and spirits. Consuming 7 to <14 standard drinks per week (light-to-moderate intake) was the nadir with a 19% lower multivariable-adjusted rate of HF compared with never drinking (IRR, 0.81; 95% CI, 0.69-0.96). While wine and spirits no longer appeared protective above 7 drinks per week, beer appeared potentially protective for 7-14 drinks per week. This may be due to drinking patterns—nonbeer drinkers included a higher proportion of never-drinkers than did the nonwine or nonspirit drinkers. Additionally, men in the highest categories of wine (≥14 drinks per week) or spirits (≥7 drinks per week) consumed fairly high levels of total alcohol, with medians of 26.9 and 20 standard drinks per week, respectively. The association between alcohol intake and HF did not differ by self-reported history of hypertension (p-interaction = 0.70), smoking status (p-interaction = 0.37), or self-reported high cholesterol (p-interaction = 0.08).


The study authors concluded that there was a U-shaped relationship between alcohol consumption and HF incidence in Swedish men, with a nadir at light-to-moderate intake.


This is an important study because of the robust methodology—it is a large population-based prospective cohort study that minimized concerns about recall bias; it excluded former drinkers, and had detailed, reproducible, and valid information on consumption of beer, wine, and spirits. Until the findings of this study are reproduced in other cohorts, when patients ask about benefits of light-to-moderate drinking, the advice should be: ‘If you are drinking light-to-moderate amounts, then do not stop doing it; if you are a never-drinker, do not start doing it.’

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Lipid Metabolism, Nonstatins, Acute Heart Failure, Hypertension, Smoking

Keywords: Alcohol Drinking, Alcoholic Intoxication, Alcohols, Cholesterol, Cohort Studies, Heart Failure, Epidemiology, Hospitalization, Hypertension, Incidence, Mortality, Proportional Hazards Models, Prospective Studies, Self Report, Smoking, Wine

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