Alcohol and Risk for Heart Failure, Atrial Fibrillation

Oct 11, 2017
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Authors:
Di Castelnuovo A, Costanzo S, Bonaccio M, et al.
Citation:
Moderate Alcohol Consumption Is Associated With Lower Risk for Heart Failure But Not Atrial Fibrillation. JACC Heart Fail 2017;Oct 11:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

What is the relationship between alcohol consumption and the risk of heart failure (HF) and atrial fibrillation (AF)?

Methods:

The subjects of this population-based study in Italy were 22,824 individuals ≥35 years (mean age 55 years, 48% males) with no history of HF or AF. Based on the responses to a detailed questionnaire, alcohol consumption was categorized as: <1 alcohol equivalent (AE)/day; ≥1-≤2 AEs/day; >2-4 AEs/day; and ≥4 AEs/day. Incident cases of HF or AF during a median follow-up of 8.2 years were identified based on discharge diagnoses and a national mortality registry.

Results:

HF occurred in 4.1% of individuals. By multivariate analysis that corrected for several potential confounding variables, consumption of ≥2-4 AEs/day was associated with a 20% lower risk of HF. The other alcohol-intake categories did not have a significant association with HF. AF occurred in 2.45% of individuals. By multivariate analysis, none of the alcohol-intake categories was associated with AF.

Conclusions:

Moderate consumption of alcohol (2-4 AEs/day) is associated with a lower risk of HF. There is no relationship between alcohol consumption and the risk of AF.

Perspective:

The mechanism by which alcohol consumption lowers the risk of HF in unclear. Potential mechanisms include the effects of alcohol on endothelial function, insulin sensitivity, high-density lipoprotein cholesterol, and atrial natriuretic peptide. The preferred form of alcohol in this study was wine, which may contain other beneficial ingredients. Several prior studies reported that consumption of >1 AE/day increases the risk of AF. It is possible that this was not confirmed in the present study due to a major limitation (i.e., failure to capture cases of AF in outpatients).

Keywords: Alcohol Drinking, Alcohols, Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Natriuretic Factor, Cholesterol, HDL, Heart Failure, Insulin Resistance, Primary Prevention, Risk, Wine


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