Risk Thresholds for Alcohol Consumption and Atrial Fibrillation

Quick Takes

  • Low consumption of total alcohol up to approximately 7 UK standard drinks (56 g alcohol)/week, equivalent to 4 US standard drinks/week, was associated with the lowest risk of atrial fibrillation (AF).
  • Low consumption of red and white wine consumption, and very low consumption of spirits, may not be associated with an increased risk of AF; in contrast, any intake of beer or cider may be associated with harm.

Study Questions:

What is the association of low-level alcohol consumption and incident atrial fibrillation (AF) in middle-aged adults, and does this association differ by the type of alcoholic drink?

Methods:

The authors explored data in the UK Biobank, a prospective cohort study of about 500,000 individuals aged 40–69 years in the United Kingdom. Total alcohol and beverage-specific consumption was calculated as UK standard drinks (8 g alcohol) per week. Incident AF events were assessed through hospitalization and death records, and dose-response associations were characterized using Cox regression models with correction for regression dilution bias.

Results:

The analysis included 403,281 individuals. Over a median follow-up period of 11.4 years, a total of 21,312 incident AF events occurred. A J-shaped association of total alcohol consumption was observed, with lowest risk with fewer than 7 drinks/week. Beer/cider consumption starting at any alcohol level appeared to increase the risk of incident AF. In contrast, consumption of red wine, white wine, and spirits up to 10, 8, and 3 drinks/week, respectively, was not associated with increased risk.

Conclusions:

Low levels of alcohol consumption were associated with lowest AF risk. Low consumption of red and white wine and very low consumption of spirits may not be associated with increased AF risk, whereas any consumption of beer/cider may be associated with harm.

Perspective:

Moderate to high consumption of alcohol, and especially binge drinking, have been associated with increased risk of incident AF. Prior studies have been contradictory as far as the association of small amounts of alcohol consumption, where some showed increased risk, while others showed no increase in risk of AF. The present study suggests that a J-shaped relationship exists between total alcohol consumption and risk of AF. In contrast, a number of prior studies showed a linear dose-dependent relationship. Drinking red or white wine, in this study, appears to be potentially safer than beer or cider. It should be noted that standard drinks differ between the UK and the US, with 56 g alcohol/week being equal to 7 UK standard drinks and only 4 US standard drinks. The study’s findings may not apply to more diverse populations, and further research is needed given the potential impact of alcohol consumption on the incidence of AF.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Alcoholic Beverages, Alcohol Drinking, Arrhythmias, Cardiac, Atrial Fibrillation, Beer, Binge Drinking, Ethanol, Incidence, Primary Prevention, Risk, Wine


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