Acute alcohol use during holidays, special events may drive AF episodes
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Acute alcohol consumption in the general population is associated with higher risk for discrete atrial fibrillation episodes, as well as risk for new-onset AF, according to data published in Nature Cardiovascular Research.
Identifying modifiable exposures or behaviors that immediately influence whether an episode of AF will happen could help prevent morbidity associated with the disease, Gregory M. Marcus, MD, MAS, associate chief of cardiology for research and endowed professor of atrial fibrillation research at the University of California, San Francisco, and colleagues wrote in the study background. Studying the relationships between acute alcohol consumption and individual AF episodes has historically proved difficult to conduct, given the need for real-time data linking alcohol consumption and discrete episodes of AF.
“These data demonstrate that immediate alcohol consumption as a predictor of any given atrial fibrillation episode is not just relevant to select individuals but is demonstrable at a population level with meaningful effects on overall health care utilization,” Marcus told Healio. “This research also provides objective evidence that acute alcohol consumption leads to first-time episodes of atrial fibrillation among those without previous evidence of the disease.”
Assessing blood alcohol content data
Marcus and colleagues analyzed time-specific and date-specific blood alcohol content data collected from 2014 to 2016 from 36,158 customers (18,833 residing in the U.S.) using a commercially available, Bluetooth-enabled breathalyzer (BACtrack). Researchers identified eight recurrent and nationally recognized events associated with increased alcohol consumption: The researchers determined that the breathalyzer users consumed more alcohol than usual on eight different holidays or days of recurrent national events: New Year’s Day, Martin Luther King Jr. Day, Super Bowl Sunday, initiation of daylight saving time, July 4, Christmas, FIFA World Cup and Father’s Day. Using the events as instrumental variables, researchers assessed ED visits for AF in California, using Poisson regression models to compare rates of AF and new-onset AF during and 6 days after instrumental variable events.
“In the broad general population encompassing all Californians, we wanted to test the hypothesis that during the dates and events we first identified as being associated with elevated alcohol consumption in the breathalyzer users, we would also see more [ED] visits for atrial fibrillation,” Marcus said in a press release. “This would imply that there is a nearly immediate relationship between excess alcohol consumption and more atrial fibrillation within the population.”
Within the cohort, median blood alcohol concentration was 0.04%; users obtained a median of 4.06 measurements per year.
After adjustment for calendar day of week and calendar month and accounting for the age, sex and race, there were more than 700 additional ED visits for AF per 100,000 person-years among the California general population during and shortly after instrumental variable-identified events associated with more alcohol intake (P = .008).
“After the same multivariable adjustment, statistically significantly more AF was observed during each of several individual events associated with more alcohol consumption,” the researchers wrote.
‘Consider the risk’
A negative control analysis examining another common heart rhythm problem — supraventricular tachycardia — did not reveal the same relationships, suggesting a unique association between alcohol and AF risk, Marcus said.
“These findings have implications for anyone that decides to drink heavily, suggesting they need to consider the risk that such an exposure could result in a life-changing arrhythmia episode,” Marcus told Healio. “A randomized trial of light drinking vs. abstinence is needed to understand the net effects, with perhaps some benefits and some risks, of consuming alcohol in moderation. There is no question that drinking in excess is overall harmful, atrial fibrillation being now one of the most rigorously studied adverse consequences among many.”
Other analyses have suggested that alcohol consumption can increase AF risk. As Healio previously reported, a study published in European Heart Journal in February 2021 showed as little as one alcoholic drink per day may confer elevated risk for development of AF, regardless of age and other CV risk factors.
For more information:
Gregory M. Marcus, MD, MAS, can be reached at greg.marcus@ucsf.edu; Twitter: @gregorymmarcus.
Perspective
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Renate B. Schnabel, MD, MSc
Marcus and colleagues are to be congratulated on their continuous efforts to unravel the relation or possible causality of alcohol consumption and AF. In their elegant study using the concept of instrumental variables of nationally recognized events, they correlated Bluetooth-enabled breathalyzer alcohol concentrations with near-term ED visits for AF episodes in California. A higher number of overall AF episodes and new-onset AF was observed. This phenomenon, known under the term “holiday heart syndrome” since 1978, can thus be demonstrated at scale. The study adds important evidence on an increased risk for arrhythmia with acute alcohol consumption. Compared with other CV diseases, neither acute nor chronic alcohol intake appears to be beneficial in AF.
The mechanisms, which are very likely specific to the arrhythmia, need to be elucidated.
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