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One Alcoholic Drink a Day - linked to an increased risk of atrial fibrillation

Perhaps it's time to cut back on your favorite cocktail.

According to a study published in the European Heart Journal, consuming a moderate amount of alcohol was linked to an increased risk of atrial fibrillation.

Otherwise knowns as AFib, the chronic condition is defined by the American Heart Association (AHA) as "a quivering or irregular heartbeat that can lead to blood clots, stroke, heart failure and other heart-related complications."

What else did the study reveal?

Researchers examined the data from nearly 108,000 adults from Sweden, Norway, Finland, Denmark, and Italy over a 28-year period. The volunteers, who entered the study at an average age of 48, underwent routine check-ups where they offered a range of personal information, such as medical history and lifestyle, including alcohol intake.

During the halfway point (around year 14), 5,854 of the men and women developed AFib. In fact, the alcohol and AFib association was seen for all types of alcoholic beverages—wine, beer, and spirits. Researchers discovered that those who drank an average of one alcoholic beverage each day (approximately 4 ounces of wine, 11 ounces of beer, or 1.3 ounces of spirit) showed a 16% increased risk of this cardiovascular condition compared to adults who do not consume alcohol.

And the more one drank, the odds of being diagnosed with AFib went up. Two beverages a day was linked to a 28% increased risk, and someone who consumed four or more alcoholic drinks per day faced a 47% increased risk.

Doesn't red wine offer a host of health benefits?

Interestingly, a number of studies over the years have touted wine as a heart-healthy choice. One 2019 study published in the journal Molecules found that the antioxidant and anti-inflammatory phenolic compounds in red wine may help prevent cardiovascular diseases. Also, professors from Louisiana State University announced in 2018 that they were developing stents (tiny tubes inserted into a blocked narrow artery) made from resveratrol and quercetin—two antioxidants found naturally in red wine—to prevent blood clotting and inflammation.

"In conclusion, we were slightly surprised that neither overall alcohol consumption—nor wine consumption in particular—were protective (of AFib) if consumed at low doses because they have been reported to be protective against, for example, heart attack," Professor Renate Schnabel, senior study author and consultant cardiologist at the University Heart and Vascular Center, Hamburg-Eppendorf in Germany, tells Eat This, Not That!

"However, earlier reports already suggested that there may not be a beneficial effect for atrial fibrillation, but did not have enough power to examine very low regular alcohol consumption. Our large study could now demonstrate that there may not be a threshold below which alcohol consumption may be protective."

Schnabel points out that he and his team were unaware of the type of wine the participants drank, though. In addition, other elements related to wine consumption, such as socioeconomic status, lifestyle habits, and nutrition, also play a role in one's heart health.

"Therefore, factors other than the type of alcohol itself may have led to inconsistent associations in different studies," he adds.

How common is A-Fib?

The AHA states that at least 2.7 million Americans are currently living with AFib. According to statistics from the Centers for Disease Control and Prevention (CDC), this heart condition is the cause of more than 454,000 hospitalizations each year in the U.S., and the agency calculates that 12.1 million Americans are likely to be diagnosed with AFib in 2030.

The research

Acute alcohol consumption induces autonomic imbalance reflected by sinus tachycardia, predisposing to arrhythmia.10 Electrolyte disturbance and alterations of the acid-base balance are further pro-arrhythmic triggers. Chronic alcohol consumption is known to be correlated with changes in cardiac structure and function including cardiomyopathy.

Increased alcohol intake is accompanied by higher frequency of hypertension and obesity.14

Circulating cardiac biomarkers are quantitative measures which shed light on current cardiac pathophysiology. Troponin reflects myocardial injury, while N-terminal pro-B-type natriuretic peptide (NT-proBNP) indicates often chronic, subclinical wall stress.15 A recent study demonstrated that both biomarkers showed distinct patterns in relation to alcohol consumption.15 Whereas troponin concentrations decreased with higher alcohol consumption, NT-proBNP increased.15

In a meta-analysis of seven prospective studies, even one alcoholic drink per day increased AF incidence by a relative risk of 1.08.9 Kodama et al.2 meta-analysed 14 studies concluding that alcohol abstinence is most favorable for AF risk reduction.

Importantly, in the ARIC study, it could be demonstrated that every decade of abstinence from alcohol in former drinkers was related to a 20% lower rate of AF development.24 In a randomized trial, abstinence from alcohol reduced AF recurrences in regular drinkers.25 We did not observe large differences in the associations by type of alcoholic beverages and AF risk. All were related to an increased risk of AF.

Abstract There is inconsistent evidence on the relation of alcohol intake with incident atrial fibrillation (AF), in particular at lower doses. We assessed the association between alcohol consumption, biomarkers, and incident AF across the spectrum of alcohol intake in European cohorts.

Methods and results  In a community-based pooled cohort, we followed 107 845 individuals for the association between alcohol consumption, including types of alcohol and drinking patterns, and incident AF. We collected information on classical cardiovascular risk factors and incident heart failure (HF) and measured the biomarkers N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin I. The median age of individuals was 47.8 years, 48.3% were men. The median alcohol consumption was 3 g/day. N = 5854 individuals developed AF (median follow-up time: 13.9 years). In a sex- and cohort-stratified Cox regression analysis alcohol consumption was non-linearly and positively associated with incident AF. The hazard ratio for one drink (12 g) per day was 1.16, 95% CI 1.11–1.22, P < 0.001. Associations were similar across types of alcohol. In contrast, alcohol consumption at lower doses was associated with reduced risk of incident HF. The association between alcohol consumption and incident AF was neither fully explained by cardiac biomarker concentrations nor by the occurrence of HF.

Conclusions  In contrast to other cardiovascular diseases such as HF, even modest habitual alcohol intake of 1.2 drinks/day was associated with an increased risk of AF, which needs to be considered in AF prevention.



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