What is the clinical evidence from this study?

Study design: Cohort. Population: Established atrial fibrillation (n=3852). Intervention: Alcohol consumption vs. Nondrinkers. Primary outcome: Composite of stroke and systemic embolism (HR 0.87, 95% CI 0.55-1.37, p=0.71 for linear trend).

January 24, 2021Open Access

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

PRPhilipp ReddiessUniversity of Zurich SAStefanie AeschbacherElectrophysiology PMPascal MeyreElectrophysiology

Key Result

In patients with established atrial fibrillation, consuming >0 to <1 alcoholic drink per day did not significantly alter the risk of stroke or systemic embolism compared to nondrinkers (HR 0.87).

Study Design

Type

Cohort (n=3,852)

Multicenter

Yes

Structured PICO

Does regular alcohol intake affect the risk of stroke or systemic embolism in patients with established atrial fibrillation?

Population

3,852 patients with established atrial fibrillation, mean age 71 ± 10 years, 28% women, 84% on oral anticoagulants.

Intervention

Regular alcohol intake categorized as > 0 to < 1, 1 to < 2, and ≥ 2 drinks/day.

Comparator

Nondrinkers (0 drinks/day).

Outcome

Composite of stroke and systemic embolism.composite

Low to moderate alcohol intake is not significantly associated with an increased risk of stroke, systemic embolism, or bleeding in patients with established atrial fibrillation.

Main Result

Effect estimate: HR 0.87 (95% CI 0.55-1.37)

Absolute Event Rate: 0.9% vs 1.29%

p-value: p=0.71 for linear trend

Limitations

Potential residual confounding due to the observational study design
Alcohol consumption was self-reported, raising the possibility of systematic underreporting
Virtually all participants were White, limiting generalizability to other ethnic groups
Wide confidence intervals around some of the hazard ratios
Small number of heavy or binge drinkers included in the study

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 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 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

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