Alcohol consumption and risk of cardiovascular outcomes and bleeding in patients with established atrial fibrillation

Philipp Reddiess; Stefanie Aeschbacher; Pascal Meyre; Michael Coslovsky; Michael Kühne; Nicolas Rodondi; Oliver Baretella; Jürg H Beer; Richard Kobza; Giorgio Moschovitis; Marcello Di Valentino; Cyrill Müller; Fabienne Steiner; Leo H Bonati; Christian Sticherling; Stefan Osswald; David Conen; BEAT-AF and Swiss-AF investigators

doi:10.1503/cmaj.200778

Alcohol consumption and risk of cardiovascular outcomes and bleeding in patients with established atrial fibrillation

CMAJ. 2021 Jan 25;193(4):E117-E123. doi: 10.1503/cmaj.200778.

Authors

Philipp Reddiess¹, Stefanie Aeschbacher¹, Pascal Meyre¹, Michael Coslovsky¹, Michael Kühne¹, Nicolas Rodondi¹, Oliver Baretella¹, Jürg H Beer¹, Richard Kobza¹, Giorgio Moschovitis¹, Marcello Di Valentino¹, Cyrill Müller¹, Fabienne Steiner¹, Leo H Bonati¹, Christian Sticherling¹, Stefan Osswald¹, David Conen²; BEAT-AF and Swiss-AF investigators

Affiliations

¹ Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont.
² Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont. Conend@mcmaster.ca.

Abstract

Background: Little is known about the association between alcohol consumption and risk of cardiovascular events in patients with established atrial fibrillation (AF). The main aim of the current study was to investigate the associations of regular alcohol intake with incident stroke or systemic embolism in patients with established AF.

Methods: To assess the association between alcohol consumption and cardiovascular events in patients with established AF, we combined data from 2 comparable prospective cohort studies that followed 3852 patients with AF for a median of 3.0 years. Patients were grouped into 4 categories of daily alcohol intake (none, > 0 to < 1, 1 to < 2 and ≥ 2 drinks/d). The primary outcome was a composite of stroke and systemic embolism. Secondary outcomes were all-cause mortality, myocardial infarction, hospital admission for acute heart failure, and a composite of major and clinically relevant nonmajor bleeding. Associations were assessed using time-updated, multivariable-adjusted Cox proportional hazards models.

Results: Mean age (± standard deviation) was 71 ± 10 years (28% were women and 84% were on oral anticoagulants). We observed 136 confirmed strokes or systemic emboli. Compared with nondrinkers, adjusted hazard ratios for the primary outcome event were 0.87, 95% confidence interval (CI) 0.55-1.37 for > 0 to < 1 drinks/d; 0.70, 95% CI 0.39-1.25 for 1 to < 2 drinks/d; and 0.96, 95% CI 0.56-1.67 for ≥ 2 drinks/d (p for linear [quadratic] trend 0.71 [0.22]). There was no significant association between alcohol consumption and bleeding, but there was a nonlinear association with heart failure (p for quadratic trend 0.01) and myocardial infarction (p for quadratic trend 0.007).

Interpretation: In patients with AF, we did not find a significant association between low to moderate alcohol intake and risk of stroke or other cardiovascular events. Our findings do not support special recommendations for patients with established AF with regard to alcohol consumption.

Trial registration: ClinicalTrials.gov, no. NCT02105844.

Publication types

Observational Study

MeSH terms

Aged
Aged, 80 and over
Alcohol Drinking / adverse effects*
Alcohol Drinking / epidemiology
Alcohol Drinking / physiopathology
Anticoagulants / adverse effects
Anticoagulants / therapeutic use
Atrial Fibrillation / complications*
Atrial Fibrillation / drug therapy*
Atrial Fibrillation / physiopathology
Cohort Studies
Female
Heart Disease Risk Factors
Hemorrhage / etiology*
Hemorrhage / physiopathology
Humans
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Warfarin / adverse effects
Warfarin / therapeutic use

Substances

Anticoagulants
Warfarin

Associated data

ClinicalTrials.gov/NCT02105844