Alcohol and Risk for Heart Failure, Atrial Fibrillation

Study Questions:

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


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.


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.


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.


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).

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Nonstatins, Acute Heart Failure

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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