Drinking patterns of alcohol and risk of major adverse cardiovascular events after an acute coronary syndrome

Elena Tessitore; Mattia Branca; Dik Heg; David Nanchen; Reto Auer; Lorenz Räber; Roland Klingenberg; Stephan Windecker; Thomas F Lüscher; Sebastian Carballo; Christian M Matter; Gerhard Gmel; Kenneth J Mukamal; Nicolas Rodondi; David Carballo; François Mach; Baris Gencer

doi:10.1093/eurjpc/zwad364

Drinking patterns of alcohol and risk of major adverse cardiovascular events after an acute coronary syndrome

Eur J Prev Cardiol. 2023 Nov 23:zwad364. doi: 10.1093/eurjpc/zwad364. Online ahead of print.

Authors

Elena Tessitore¹, Mattia Branca², Dik Heg², David Nanchen³, Reto Auer^{3

4}, Lorenz Räber⁵, Roland Klingenberg^{6

7

8}, Stephan Windecker⁵, Thomas F Lüscher^{9

10}, Sebastian Carballo¹¹, Christian M Matter⁶, Gerhard Gmel¹², Kenneth J Mukamal¹³, Nicolas Rodondi^{4

14}, David Carballo¹, François Mach¹, Baris Gencer^{1

4}

Affiliations

¹ Division of Cardiology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.
² Clinical Trial Unit, University of Bern, Bern, Switzerland.
³ Department of Health promotion and preventions, Center for primary care and public health (Unisanté), University of Lausanne, Lausanne, Switzerland.
⁴ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁵ Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
⁶ Department of Cardiology University Hospital of Zurich, Zurich, Switzerland.
⁷ Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany.
⁸ DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany.
⁹ Royal Brompton & Harefield Hospitals GSTT, Imperial College and Kings College, London, UK.
¹⁰ Center for Molecular Cardiology, Schlieren Campus, University Zurich, Zurich, Switzerland.
¹¹ Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
¹² Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
¹³ Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
¹⁴ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

PMID: 37995305
DOI: 10.1093/eurjpc/zwad364

Abstract

Aim: To evaluate the risk of alcohol consumption after acute coronary syndromes (ACS).

Methods: A total of 6557 patients hospitalized for ACS at 4 Swiss centres were followed over 12 months. Weekly alcohol consumption was collected at baseline and 12 months. Binge drinking was defined as consumption of ≥6 units of alcohol on one occasion. Major adverse cardiovascular events (MACE) were defined as a composite of cardiac death, myocardial infarction, stroke or clinically indicated target vessel coronary revascularization. Cox regression analysis was performed to assess the risk of MACE in patients with heavy (>14 standard units/week), moderate (7-14 standard units per week), light consumption (<1 standard unit/week) or abstinence, and with binge drinking episodes, adjusted for baseline differences.

Results: At baseline, 817 (13.4%) patients reported heavy weekly alcohol consumption. At one-year follow-up, 695/1667 (41.6%) patients reported having at least one or more episodes of binge drinking per month. The risk for MACE was not significantly higher in those with heavy weekly consumption compared to abstinence (8.6% vs. 10.2%, HR 0.97, 95%CI 0.69-1.36) or light consumption (8.6% vs. 8.5 %, HR 1.41, 95%CI 0.97-2.06). Compared to patients with no-binge drinking, the risk of MACE was dose-dependently higher in those with binge drinking with less than one episode per month (9.2% vs 7.8%, HR 1.61, 95%CI 1.23-2.11), or one or more episodes per month (13.6% vs 7.8%, HR 2.17, 95%CI 1.66-2.83).

Conclusion: Binge drinking during the year following an ACS, even less than once per month, is associated with worse clinical outcomes.

Keywords: acute coronary syndromes; alcohol consumption; binge drinking; cardiovascular prevention; lifestyle; secondary cardiovascular prevention.

Plain language summary

The cardiovascular risk of alcohol consumption and of binge drinking episodes after acute coronary syndrome (ACS) has not been established. Our data suggested the following: After ACS, regular weekly alcohol consumption is not associated with the risk of major adverse cardiovascular events (MACE), except for patients reporting binge drinking who have a two-fold increased risk of MACE within one year of the index event.After ACS, episodes of binge drinking, even less than once per month, are associated with worse clinical outcomes. It is not the frequency, but rather the quantity of alcohol intake in a binge drinking episode, that is associated with worse prognosis in patients after an ACS.