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Limited alcohol consumption improves survival in incident HF
Patients with incident HF who limit their alcohol consumption have an improved rate of survival compared with people who abstain from alcohol over a long period of time, according to a study published in JAMA Network Open.
“People who develop heart failure at an older age and never drank shouldn’t start drinking,” David L. Brown, MD, FACC, professor of medicine at John T. Milliken Department of Internal Medicine at Washington University School of Medicine in St. Louis, said in a press release. “Our study suggests people who have had a daily drink or two before their diagnosis of heart failure can continue to do so without concern that it’s causing harm. Even so, that decision should always be made in consultation with their doctors.”
Incident HF
Justin S. Sadhu, MD, MPHS, FACC, assistant professor of medicine at John T. Milliken Department of Internal Medicine at Washington University School of Medicine in St. Louis, and colleagues analyzed data from 393 patients (mean age, 79 years; 54% women) with HF from the Cardiovascular Health Study who were diagnosed during the first 10 years of the study.
Patients underwent clinical examinations at baseline from 1989 through 1993, which were then performed annually for 9 years. Alcohol consumption was determined at baseline, and periodically throughout follow-up. Patients were then categorized as abstainers (42.7%), former drinkers (24.4%), those who consume seven drinks or fewer per week (28.5%) and patients who consume more than seven drinks per week (4.3%). Telephone calls were conducted twice per year to collect information on clinical events.
Men comprised 32.1% of the long-term abstainers, 49% of former drinkers, 58% of those who drank one to seven drinks per week and 82.4% of those who drank more than seven drinks per week (P for trend < .001). White patients comprised 78% of long-term abstainers, 92.7% of former drinkers, 92% of those who drank one to seven drinks per week and 94.1% of those who drank more than seven drinks per week (P for trend < .001).
High-income individuals made up 22% of the long-term abstainers, 43.8% of former drinkers, 47.3% of those who drank one to seven drinks per week and 64.7% of those who drank more than seven drinks per week (P for trend < .001).
Patients who consumed more alcohol were more likely to have more years of education, with a mean of 12 years (P for trend < .001).
Less common factors
Patients with diabetes were less common in those who reported long-term abstinence (32.1%), former drinkers (26%), drank between one drink and seven drinks per week (22.3%) and drank more than seven drinks per week (5.9%; P for trend = .01).
There were more former smokers (P for trend = .006) and fewer never smokers (P for trend < .001) across alcohol consumption categories.
Compared with patients who abstained from alcohol, those who reported drinking fewer than seven drinks per week had an additional mean survival of 383 days (95% CI, 17-748; P = .04).
There was a significant inverted U-shape association between alcohol consumption and survival, although the effect was limited to patients who consumed more than seven drinks per week.
In a multivariable model, estimates of mean time from HF diagnosis to death was 2,640 days for those who never drank (95% CI, 1,967-3,313), 3,046 days for patients who consumed between zero and seven drinks per week (95% CI, 2,372-3,719) and 2,806 days for those who consumed more than seven drinks per week (95% CI, 1,879-3,734; P = .02). The longest survival was seen in patients who drank 10 drinks per week after an HF diagnosis (95% CI, 2,806-3,956).
“Given the possibility of health benefits with limited alcohol consumption following this diagnosis, further efforts to determine optimal levels of alcohol consumption in adults with HF and whether this differs by age, sex, left ventricular ejection fraction or cause of HF are warranted,” Sadhu and colleagues wrote. – by Darlene Dobkowski
Disclosures: Sadhu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.