Alcohol Consumption and Risk of Atrial Fibrillation
Alcohol Consumption and Risk of Atrial Fibrillation
Over 12 years of follow-up (859,420 person-years), we ascertained 7,245 incident AF cases (4,488 in men and 2,757 in women). Compared with men and women with light alcohol consumption, those with high consumption (>21 drinks/week) were younger and more likely to have a postsecondary education, to be current smokers, and to have a history of diabetes, hypertension, CHD, or heart failure (Online Table 1 http://content.onlinejacc.org/data/Journals/JAC/930568/03048_mmc1.docx).
The associations of alcohol drinking status and consumption of total alcohol and different alcoholic beverages with risk of AF are presented in Table 1. Because the association between alcohol consumption and AF did not differ by sex (p for interaction = 0.74), all analyses were conducted for men and women combined. Compared with current alcohol drinkers of less than 1 drink/week, consumption of 15 to 21 drinks/week and >21 drinks/week was associated with a statistically significant 14% and 39%, respectively, increased risk of AF. The association between alcohol consumption and AF was somewhat stronger after excluding those with a diagnosis of CHD or heart failure at baseline (Table 1). For specific alcoholic beverages, consumption of more than 14 drinks/week of liquor or wine was associated with increased risk of AF (Table 1). There was no association with beer. When comparing the RRs in the highest categories, the RR for liquor differed statistically significantly from that of beer (p = 0.03), whereas no statistically significant difference was observed between liquor and wine (p = 0.54) or wine and beer (p = 0.10).
Binge drinking (consumption of ≥5 drinks on a single occasion) was identified in 18% of current drinkers and was associated with an increased AF risk after adjustment for age, sex, education, smoking, BMI, family history of MI before 60 years of age, and histories of CHD, heart failure, diabetes, and hypertension (multivariable RR: 1.13; 95% CI: 1.05 to 1.22). The association between binge drinking and AF was similar after further adjustment for frequency of consumption of each alcoholic beverage (multivariable RR: 1.12; 95% CI: 1.04 to 1.21) or for total alcohol consumption (drinks/week) (multivariable RR: 1.11; 95% CI: 1.03 to 1.20). Binge drinking of liquor (multivariable RR: 1.10; 95% CI: 1.02 to 1.19) and wine (multivariable RR: 1.24; 95% CI: 1.08 to 1.43), but not beer (multivariable RR: 1.02; 95% CI: 0.79 to 1.30), was associated with increased AF risk in a multivariable model adjusted for the other AF risk factors, mutually for liquor, wine, and beer, and for frequency of consumption of each alcoholic beverage.
When examining the association between total alcohol consumption and AF risk after excluding binge drinkers, the association was slightly attenuated but remained; multivariable RRs (95% CI) were 1.11 (95% CI: 0.98 to 1.26) for 15 to 21 drinks/week and 1.34 (95% CI: 1.17 to 1.53) for >21 drinks/week compared with current drinkers of <1 drink/week.
Seven prospective studies, including our own study, with a total of 12,554 cases of AF were eligible for inclusion in the meta-analysis (Online Fig. 1 http://content.onlinejacc.org/data/Journals/JAC/930568/03048_mmc1.docx). Characteristics of the included studies are presented in Table 2 . Alcohol consumption was assessed through a self-administered questionnaire in 6 studies and by interviews in 1 study.
In a meta-analysis of all studies, we observed a linear dose-response relationship between alcohol consumption and AF risk, with no evidence of departure from linearity (p = 0.85). All studies reported a positive association, with an overall 8% (6% to 10%) increase in AF risk per 1 drink/day increment in alcohol consumption (Central Illustration). There was no heterogeneity among studies (p = 0.93) and no evidence of publication bias (p = 0.70). Results were identical when we combined the results by using a fixed effects model. Excluding our own study, which contributed 40% of the statistical weight, the overall results did not change (RR: 1.08; 95% CI: 1.05 to 1.10). Results were similar for studies conducted in the United States (RR: 1.09; 95% CI: 1.04 to 1.14) and Europe (RR: 1.08; 95% CI: 1.06 to 1.10). When stratified by sex, the RRs of AF were 1.08 (95% CI: 1.06 to 1.11) for men (5 studies) and 1.08 (95% CI: 1.03 to 1.13) for women (6 studies), without heterogeneity among studies (men: p = 0.89; women: p = 0.71).
(Enlarge Image)
Central Illustration.
Forest Plot of Relative Risks of Atrial Fibrillation Per 1 Drink/Day Increment in Alcohol Consumption
Relative risks (RR) of atrial fibrillation per 1 drink/day increment in alcohol consumption, in individual prospective studies. Squares indicate study-specific relative risk estimates (size of the square reflects the study-specific statistical weight); horizontal lines indicate 95% confidence intervals (CI); diamond indicates the overall relative risk with its 95% confidence interval.
Results
Prospective Study
Over 12 years of follow-up (859,420 person-years), we ascertained 7,245 incident AF cases (4,488 in men and 2,757 in women). Compared with men and women with light alcohol consumption, those with high consumption (>21 drinks/week) were younger and more likely to have a postsecondary education, to be current smokers, and to have a history of diabetes, hypertension, CHD, or heart failure (Online Table 1 http://content.onlinejacc.org/data/Journals/JAC/930568/03048_mmc1.docx).
The associations of alcohol drinking status and consumption of total alcohol and different alcoholic beverages with risk of AF are presented in Table 1. Because the association between alcohol consumption and AF did not differ by sex (p for interaction = 0.74), all analyses were conducted for men and women combined. Compared with current alcohol drinkers of less than 1 drink/week, consumption of 15 to 21 drinks/week and >21 drinks/week was associated with a statistically significant 14% and 39%, respectively, increased risk of AF. The association between alcohol consumption and AF was somewhat stronger after excluding those with a diagnosis of CHD or heart failure at baseline (Table 1). For specific alcoholic beverages, consumption of more than 14 drinks/week of liquor or wine was associated with increased risk of AF (Table 1). There was no association with beer. When comparing the RRs in the highest categories, the RR for liquor differed statistically significantly from that of beer (p = 0.03), whereas no statistically significant difference was observed between liquor and wine (p = 0.54) or wine and beer (p = 0.10).
Binge drinking (consumption of ≥5 drinks on a single occasion) was identified in 18% of current drinkers and was associated with an increased AF risk after adjustment for age, sex, education, smoking, BMI, family history of MI before 60 years of age, and histories of CHD, heart failure, diabetes, and hypertension (multivariable RR: 1.13; 95% CI: 1.05 to 1.22). The association between binge drinking and AF was similar after further adjustment for frequency of consumption of each alcoholic beverage (multivariable RR: 1.12; 95% CI: 1.04 to 1.21) or for total alcohol consumption (drinks/week) (multivariable RR: 1.11; 95% CI: 1.03 to 1.20). Binge drinking of liquor (multivariable RR: 1.10; 95% CI: 1.02 to 1.19) and wine (multivariable RR: 1.24; 95% CI: 1.08 to 1.43), but not beer (multivariable RR: 1.02; 95% CI: 0.79 to 1.30), was associated with increased AF risk in a multivariable model adjusted for the other AF risk factors, mutually for liquor, wine, and beer, and for frequency of consumption of each alcoholic beverage.
When examining the association between total alcohol consumption and AF risk after excluding binge drinkers, the association was slightly attenuated but remained; multivariable RRs (95% CI) were 1.11 (95% CI: 0.98 to 1.26) for 15 to 21 drinks/week and 1.34 (95% CI: 1.17 to 1.53) for >21 drinks/week compared with current drinkers of <1 drink/week.
Dose-response Meta-analysis
Seven prospective studies, including our own study, with a total of 12,554 cases of AF were eligible for inclusion in the meta-analysis (Online Fig. 1 http://content.onlinejacc.org/data/Journals/JAC/930568/03048_mmc1.docx). Characteristics of the included studies are presented in Table 2 . Alcohol consumption was assessed through a self-administered questionnaire in 6 studies and by interviews in 1 study.
In a meta-analysis of all studies, we observed a linear dose-response relationship between alcohol consumption and AF risk, with no evidence of departure from linearity (p = 0.85). All studies reported a positive association, with an overall 8% (6% to 10%) increase in AF risk per 1 drink/day increment in alcohol consumption (Central Illustration). There was no heterogeneity among studies (p = 0.93) and no evidence of publication bias (p = 0.70). Results were identical when we combined the results by using a fixed effects model. Excluding our own study, which contributed 40% of the statistical weight, the overall results did not change (RR: 1.08; 95% CI: 1.05 to 1.10). Results were similar for studies conducted in the United States (RR: 1.09; 95% CI: 1.04 to 1.14) and Europe (RR: 1.08; 95% CI: 1.06 to 1.10). When stratified by sex, the RRs of AF were 1.08 (95% CI: 1.06 to 1.11) for men (5 studies) and 1.08 (95% CI: 1.03 to 1.13) for women (6 studies), without heterogeneity among studies (men: p = 0.89; women: p = 0.71).
(Enlarge Image)
Central Illustration.
Forest Plot of Relative Risks of Atrial Fibrillation Per 1 Drink/Day Increment in Alcohol Consumption
Relative risks (RR) of atrial fibrillation per 1 drink/day increment in alcohol consumption, in individual prospective studies. Squares indicate study-specific relative risk estimates (size of the square reflects the study-specific statistical weight); horizontal lines indicate 95% confidence intervals (CI); diamond indicates the overall relative risk with its 95% confidence interval.