Illicit drug use, excess alcohol intake may elevate risk for AF hospitalization
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The use of illicit drugs and excess alcohol was associated with elevated risk for hospitalization for incident atrial fibrillation, according to two studies presented at the American Heart Association Scientific Sessions.
“Both studies are a stark reminder that a higher level of alcohol consumption, as well as any type of illicit drug use, can result in cardiac rhythm disturbances,” Rakesh Gopinathannair, MD, MA, FAHA, director of cardiac electrophysiology laboratories at the Kansas City Heart Rhythm Institute and chair of the AHA’s Electrocardiography and Arrhythmias Committee, said in an AHA press release. “This is welcome data on the harmful impact of heavy alcohol use and any kind of recreational drug use, either methamphetamine, cocaine, cannabis or opiates.”
Illicit drug use and incident AF
For a retrospective observational analysis, researchers evaluated 23.5 million adult hospitalizations and ED visits from 2005 to September 2015, utilizing California’s Office of Statewide Health Planning and Development database to investigate the relationship between methamphetamine, cocaine, opiate and cannabis use and incident AF.
Within this large cohort, methamphetamine use was coded in 98,271 cases, cocaine use in 48,700 cases, opiate use in 10,032 cases and cannabis use in 132,834 cases.
Methamphetamine (HR = 1.86; 95% CI, 1.81-1.92), cocaine (HR = 1.61; 95% CI, 1.55-1.68), opiate (HR = 1.74; 95% CI, 1.62-1.87) and cannabis use (HR = 1.35; 95% CI, 1.3-1.4) were significantly associated with risk for incident AF (P < .0001 for all), according to the results.
“As the substances looked at in the study ranged from stimulants to depressants, it was surprising that we were able to observe an increased association of new-onset AF with all four substances, as it begs the question as to how mechanistically these substances are working to lead to the increased association that we observed,” Anthony Lin, MD, resident physician at the University of California, San Francisco, told Healio. “Importantly, we ran the same analyses with several other disease states that served as negative controls, so the increased association we observed with methamphetamine, cocaine, opiates and cannabis seemed to be related to the substances themselves rather than false-positive results. The pro-arrhythmogenic risks of methamphetamine, cocaine, opiates and cannabis warrant continued discussion in the medical and scientific communities and further exploration is required to better elucidate the causal links between these substances and the arrythmias observed.”
Incident AF was more likely among white individuals compared with Black, Hispanic or Asian/Pacific Islander individuals (P < .0001 for all), and was more likely to occur in men compared with women (P < .0001).
Moreover, researchers reported that the cumulative likelihood of incident AF increased over time for all four substances.
“Our findings show that there is still a lot to understand about the arrhythmogenic risks associated with many substances seen in our world today,” Lin told Healio. “Given these associations that we observed in a large and diverse administrative database, future research should be directed at understanding the physiologic implications of these stimulants and depressants on the heart. Additionally, our work supports the continued medical and community efforts aimed at reducing substance dependence and shows that these efforts may have the potential to reduce long-term CV complications associated with AF, as well as aid in the reduction of associated health care expenditures.”
Alcohol and incident AF
Sidney Aung, BA, fourth-year medical student in the division of cardiology at the University of California, San Francisco, conducted an instrumental variable analysis using data from commercially available breathalyzer devices (BACtrack) from 2014 to 2016 to identify specific dates or nationally recognized events linked to elevated alcohol consumption. Then, utilizing California’s Office of Statewide Health Planning and Development database, researchers cross-evaluated these dates with ED visits for incident AF from 2005 to 2015.
The analysis included more than 1.2 million breath alcohol measurements from 36,158 individuals.
“While we know that alcohol consumption over many years can increase the risk of an ultimate diagnosis of atrial fibrillation, we found evidence that acute alcohol consumption substantially heightens the risk of an emergency department visit for atrial fibrillation in the general population,” Aung said in a press release. “The study also provided the first objective evidence that acute alcohol consumption increases the risk for a first atrial fibrillation event.”
Researchers identified eight recurring events associated with elevated alcohol consumption: New Year’s Day, Martin Luther King Jr. Day, Super Bowl Sunday, initiation of daylight savings time, July 4, Christmas, FIFA World Cup and Father’s Day.
The excess alcohol consumption observed during these recuring events was associated with 719 additional ED visits for incident AF per 100,000 person-years (95% CI, 189-1,249; P aggregate = .008)
The association between excess drinking during these yearly events and new-onset AF was strong, with 1,757 additional ED visits per 100,000 person years (95% CI, 945-2,569; P < .001), according to the results.
“Studying the short-term relationships between alcohol consumption and discrete atrial fibrillation episodes has proven difficult given the need for time-sensitive assessments,” Aung said in the release. “This study might also influence other investigators to pursue other novel ways of evaluating this relationship.”
Reference:
- Aung S, et al. Presentation P1221/3046. Presented at: American Heart Association Scientific Sessions; Nov. 13-15, 2021 (virtual meeting).
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Lin A, et al. Presentation V145. Presented at: American Heart Association Scientific Sessions; Nov. 13-15, 2021 (virtual meeting).
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