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Mirijello A, Sestito L, Antonelli M, Gasbarrini A, Addolorato G. Identification and management of acute alcohol intoxication. Eur J Intern Med 2023; 108:1-8. [PMID: 35985955 DOI: 10.1016/j.ejim.2022.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/03/2022] [Accepted: 08/11/2022] [Indexed: 02/07/2023]
Abstract
Acute alcohol intoxication (AAI) is a harmful clinical condition, potentially life-threatening, secondary to the intake of large amounts of alcohol. Clinical manifestations of AAI are characterized by behavioural and neurological symptoms, even if its effects involve several organs and apparatus. Moreover, severe alcohol intoxication can produce a global neurological impairment leading to autonomic dysfunction, respiratory depression, coma and cardiac arrest. The evaluation of blood alcohol concentrations (BAC) is useful to confirm the suspicion of intoxication, both for clinical and legal reasons. Most of patients with AAI are referred to Emergency Departments due to behavioural, social, traumatic or clinical complications. Patient's stabilization is the first step in the management of AAI, in order to support vital functions and to prevent complications. Metadoxine represents a useful drug to increase ethanol metabolism and elimination. Given that AAI could represent a sentinel event of chronic alcohol abuse, patients presenting with acute intoxication should be screened for the presence of an underlying alcohol use disorder and referred to and an alcohol addiction unit to start a multidisciplinary treatment to achieve long term alcohol abstinence. The present review will focus on clinical features, diagnostic criteria and treatment strategies of AAI.
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Affiliation(s)
- Antonio Mirijello
- Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Luisa Sestito
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Mariangela Antonelli
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Giovanni Addolorato
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy.
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Wong CX, Tu SJ, Marcus GM. Alcohol and Arrhythmias. JACC Clin Electrophysiol 2023; 9:266-279. [PMID: 36858701 DOI: 10.1016/j.jacep.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/12/2022] [Indexed: 03/03/2023]
Abstract
The association between alcohol consumption and abnormalities of heart rate and rhythm has long been recognized. Significant attention has focused on the risk of atrial fibrillation (AF) and sudden cardiac death (SCD) with excessive alcohol intake. Recent studies have advanced our understanding of these relationships and provided additional insights into potentially arrhythmogenic mechanisms. However, considerable uncertainty remains, such as the level of consumption at which harm begins and whether alcohol plays a role in other arrhythmias. This review characterizes the spectrum of conduction abnormalities and heart rhythm disorders in relation to alcohol consumption. In addition, it discusses the latest epidemiologic and experimental evidence, the potential importance of beverage type and constituent ingredients, and conflicting information on drink definitions, thresholds, and recommendations.
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Affiliation(s)
- Christopher X Wong
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA; Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Samuel J Tu
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Gregory M Marcus
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
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Chung JW, Lee SR, Choi EK, Park SH, Lee H, Choi J, Han M, Ahn HJ, Kwon S, Lee S, Han K, Kim S, Oh S, Lip GYH. Cumulative Alcohol Consumption Burden and the Risk of Stroke in Young Adults: A Nationwide Population-Based Study. Neurology 2023; 100:e505-e515. [PMID: 36323515 PMCID: PMC9931082 DOI: 10.1212/wnl.0000000000201473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/12/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Alcohol consumption is one of the important modifiable risk factors for stroke in young adults. The association between the cumulative burden of alcohol consumption and its impact on incident stroke in young adults is unknown. We aimed to investigate the association between cumulative alcohol burden and the risk for stroke among young adults. METHODS Using data from the Korean National Health Insurance Service database, patients age between 20 and 39 years, who underwent 4 consecutive annual health examinations between 2009 and 2012, were included. The cumulative alcohol burden score of moderate-to-heavy drinking was evaluated by assigning a score of 1 for alcohol consumption ≥105 g/wk at the health examination each year and calculating the sum of 4 years (0-4). The main outcome was incident stroke and its subtypes, ischemic stroke, and hemorrhagic stroke during the follow-up period. RESULTS Of 1 536 668 patients (mean age of 29.5 years, 71.5% male, and median follow-up of 6-year), 3 153 experienced an incident stroke (incidence rate, 0.37 per 1,000 person-years). After multivariable adjustment, patients with alcohol burden scores of 2, 3, and 4, who consumed more than 105 g/wk of alcohol for 2, 3, and 4 years, demonstrated significantly higher risks for stroke (hazard ratio [HR] 1.19, 95% CI 1.05-1.34 for 2; HR 1.22, 95% CI 1.09-1.38 for 3; HR 1.23, 95% CI 1.10-1.38 for 4) compared with those with a burden score of 0. This positive dose-response relationship was primarily driven by hemorrhagic rather than ischemic stroke. High alcohol burden scores (i.e., 2, 3, and 4) were significantly associated with higher risks for hemorrhagic stroke (HR 1.30, 95% CI 1.10-1.54 for 2; HR 1.42, 95% CI 1.21-1.67 for 3; HR 1.36, 95% CI 1.16-1.59 for 4) compared with a burden score of 0. DISCUSSION Young adults who engaged in moderate-to-heavy drinking demonstrated a higher risk for incident stroke, especially hemorrhagic stroke. Reducing alcohol consumption should be emphasized in young adults with heavy drinking habits as part of any stroke prevention strategy.
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Affiliation(s)
- Jae-Wook Chung
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - So-Ryoung Lee
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Eue-Keun Choi
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark.
| | - Sang-Hyeon Park
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - HuiJin Lee
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - JungMin Choi
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark.
| | - Minju Han
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Hyo-Jeong Ahn
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Soonil Kwon
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - SeungWoo Lee
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Kyungdo Han
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Sunhwa Kim
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Seil Oh
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Gregory Y H Lip
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
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Brilliant J, Yadav R, Akhtar T, Calkins H, Trayanova N, Spragg D. Clinical and Structural Factors Affecting Ablation Outcomes in Atrial Fibrillation Patients - A Review. Curr Cardiol Rev 2023; 19:83-96. [PMID: 36999694 PMCID: PMC10518883 DOI: 10.2174/1573403x19666230331103153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/16/2023] [Accepted: 02/02/2023] [Indexed: 04/01/2023] Open
Abstract
Catheter ablation is an effective and durable treatment option for patients with atrial fibrillation (AF). Ablation outcomes vary widely, with optimal results in patients with paroxysmal AF and diminishing results in patients with persistent or long-standing persistent AF. A number of clinical factors including obesity, hypertension, diabetes, obstructive sleep apnea, and alcohol use contribute to AF recurrence following ablation, likely through modulation of the atrial electroanatomic substrate. In this article, we review the clinical risk factors and the electro-anatomic features that contribute to AF recurrence in patients undergoing ablation for AF.
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Affiliation(s)
- Justin Brilliant
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Ritu Yadav
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Tauseef Akhtar
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Natalia Trayanova
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - David Spragg
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD 21287, United States
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Haas EA, Saad MJA, Santos A, Vitulo N, Lemos WJF, Martins AMA, Picossi CRC, Favarato D, Gaspar RS, Magro DO, Libby P, Laurindo FRM, Da Luz PL. A red wine intervention does not modify plasma trimethylamine N-oxide but is associated with broad shifts in the plasma metabolome and gut microbiota composition. Am J Clin Nutr 2022; 116:1515-1529. [PMID: 36205549 PMCID: PMC9761755 DOI: 10.1093/ajcn/nqac286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/16/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gut microbiota profiles are closely related to cardiovascular diseases through mechanisms that include the reported deleterious effects of metabolites, such as trimethylamine N-oxide (TMAO), which have been studied as diagnostic and therapeutic targets. Moderate red wine (RW) consumption is reportedly cardioprotective, possibly by affecting the gut microbiota. OBJECTIVES To investigate the effects of RW consumption on the gut microbiota, plasma TMAO, and the plasma metabolome in men with documented coronary artery disease (CAD) using a multiomics assessment in a crossover trial. METHODS We conducted a randomized, crossover, controlled trial involving 42 men (average age, 60 y) with documented CAD comparing 3-wk RW consumption (250 mL/d, 5 d/wk) with an equal period of alcohol abstention, both preceded by a 2-wk washout period. The gut microbiota was analyzed via 16S rRNA high-throughput sequencing. Plasma TMAO was evaluated by LC-MS/MS. The plasma metabolome of 20 randomly selected participants was evaluated by ultra-high-performance LC-MS/MS. The effect of RW consumption was assessed by individual comparisons using paired tests during the abstention and RW periods. RESULTS Plasma TMAO did not differ between RW intervention and alcohol abstention, and TMAO concentrations showed low intraindividual concordance over time, with an intraclass correlation coefficient of 0.049 during the control period. After RW consumption, there was significant remodeling of the gut microbiota, with a difference in β diversity and predominance of Parasutterella, Ruminococcaceae, several Bacteroides species, and Prevotella. Plasma metabolomic analysis revealed significant changes in metabolites after RW consumption, consistent with improved redox homeostasis. CONCLUSIONS Modulation of the gut microbiota may contribute to the putative cardiovascular benefits of moderate RW consumption. The low intraindividual concordance of TMAO presents challenges regarding its role as a cardiovascular risk biomarker at the individual level. This study was registered at clinical trials.gov as NCT03232099.
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Affiliation(s)
- Elisa A Haas
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mario J A Saad
- Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Andrey Santos
- Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Nicola Vitulo
- Department of Biotechnology, Verona University, Verona, Italy
| | - Wilson J F Lemos
- Bioresources Unit, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Tulln, Austria
| | - Aline M A Martins
- Department of Medical Science, University of Brasília (UnB), Brasília, Brazil
| | | | - Desidério Favarato
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renato S Gaspar
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniéla O Magro
- Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Francisco R M Laurindo
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Protasio L Da Luz
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Lin AL, Nah G, Tang JJ, Vittinghoff E, Dewland TA, Marcus GM. Cannabis, cocaine, methamphetamine, and opiates increase the risk of incident atrial fibrillation. Eur Heart J 2022; 43:4933-4942. [PMID: 36257330 DOI: 10.1093/eurheartj/ehac558] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is now regarded as a preventable disease, requiring a search for modifiable risk factors. With legalization of cannabis and more lenient laws regarding the use of other illicit substances, investigation into the potential effects of methamphetamine, cocaine, opiate, and cannabis exposure on incident AF is needed. METHODS AND RESULTS Using Office of Statewide Health Planning and Development databases, a longitudinal analysis was performed of adult Californians ≥18 years of age who received care in an emergency department, outpatient surgery facility, or hospital from 1 January 2005 to 31 December 2015. Associations between healthcare coding for the use of each substance and a new AF diagnosis were assessed. Among 23,561,884 patients, 98 271 used methamphetamine, 48 701 used cocaine, 10 032 used opiates, and 132 834 used cannabis. Of the total population, 998 747 patients (4.2%) developed incident AF during the study period. After adjusting for potential confounders and mediators, use of methamphetamines, cocaine, opiates, and cannabis was each associated with increased incidence of AF: hazard ratios 1.86 [95% confidence interval (CI) 1.81-1.92], 1.61 (95% CI 1.55-1.68), 1.74 (95% CI 1.62-1.87), and 1.35 (95% CI 1.30-1.40), respectively. Negative control analyses in the same cohort failed to reveal similarly consistent positive relationships. CONCLUSION Methamphetamine, cocaine, opiate, and cannabis uses were each associated with increased risk of developing incident AF. Efforts to mitigate the use of these substances may represent a novel approach to AF prevention.
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Affiliation(s)
- Anthony L Lin
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Gregory Nah
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Janet J Tang
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Thomas A Dewland
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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Yan J, Ai X. Holiday Heart Syndrome, Atrial Fibrillation, and RyR2 Antagonist. J Cardiovasc Pharmacol 2022; 80:636-638. [PMID: 35976144 PMCID: PMC10508393 DOI: 10.1097/fjc.0000000000001352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Holiday Heart Syndrome (HHS) refers to binge alcohol-associated cardiac arrhythmia of which atrial fibrillation (AF) being the most occurred arrhythmia type. Excessive alcohol consumption is a serious public health and economic issue in the US and globally. Despite a tremendous education effort, binge drinking among the population of young and older adults continues to rise. During this current COVID-19 pandemic, social isolation has significantly increased alcohol consumption nationwide. In this issue, Greco et al. reported a straightforward study on the role of RyR2 dysfunction in binge alcohol-evoked AF using an HHS rat model, and evaluated the anti-AF potential of dantrolene, an RyR channel blocker. However, further investigations including off-target effects of dantrolene and therapeutic potential of other RyR2 blockers in AF are needed.
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Affiliation(s)
- Jiajie Yan
- Department of Physiology and Cell Biology, College of Medicine/Wexner
Medical Center, 5078 Graves Hall, 333 W. 10th Avenue, Columbus, Ohio 43210
USA
| | - Xun Ai
- Department of Physiology and Cell Biology, College of Medicine/Wexner
Medical Center, 5078 Graves Hall, 333 W. 10th Avenue, Columbus, Ohio 43210
USA
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Jiang H, Mei X, Jiang Y, Yao J, Shen J, Chen T, Zhou Y. Alcohol consumption and atrial fibrillation risk: An updated dose-response meta-analysis of over 10 million participants. Front Cardiovasc Med 2022; 9:979982. [PMID: 36247447 PMCID: PMC9561500 DOI: 10.3389/fcvm.2022.979982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe treatment of atrial fibrillation (AF) has made significant progress, but the prevention of AF has not received the attention it deserves. A few recent large-sized studies have conducted dose response analysis and reported different conclusions from previous studies on alcohol consumption and AF risk.ObjectivesThe aim of this study is to examine the potential non-linear association between alcohol consumption and risk of AF and explore the potential differences of gender.MethodsIn this updated dose-response meta-analysis, PubMed, Embase and Cochrane databases were searched until June 2022. Risk estimates were reported as relative risk (RR) with 95% confidence intervals (CIs). The random-effects restricted cubic spline models are used to evaluate the potential non-linear association between alcohol consumption and AF risk.ResultsA total of 10,151,366 participants with 214,365 cases of AF enrolled in 13 prospective studies. The overall meta-analysis showed that a 1 drink/day increase in alcohol consumption increased the risk of AF by 6% (RR: 1.06; 95% CI: 1.03–1.08). In gender subgroup analysis, pooled results were different between men (RR: 1.08; 95% CI: 1.05–1.11) and women (RR: 1.05; 95% CI: 0.96–1.14). A linear relationship between alcohol consumption and risk of AF was found in men (p = 0.87) while a J-shaped curve was observed in women (p = 0.00). Regional subgroup analysis yielded broadly comparable results in Americas (RR: 1.07; 95% CI: 1.03–1.12), Europe (RR: 1.04; 95% CI: 0.99–1.1) and Asia (RR: 1.07; 95% CI: 0.99–1.14).ConclusionThe relationship between AF risk and alcohol consumption is linear in men, while a potential non-linear J-shaped relationship is shown in women.Condensed abstractWe conducted a dose-response meta-analysis on the relationship between alcohol consumption and risk of atrial fibrillation. We merged the data of over 10 million participants and found gender differences in the pattern of association with AF and alcohol consumption. The relationship between AF risk and alcohol consumption is linear in men, while a potential non-linear J-shaped relationship is shown in women. In summary, this research is vital in furthering our understanding of the role of alcohol consumption in new-onset AF, especially among different genders.
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Evbayekha EO, Nriagu BN, Alugba G, Okobi OE, Okorare O, Nsofor G, Ngoladi IA, Igweike C, Boms MG, Onyechi NP, Abubakar AM, Olamilehin E, Afolabi AR, Udo UA, Ohikhuai EE. Percutaneous Coronary Intervention Outcomes Among Patients With Alcoholic Cardiomyopathy: An Analysis of the National Inpatient Sample. Cureus 2022; 14:e29490. [PMID: 36312622 PMCID: PMC9595240 DOI: 10.7759/cureus.29490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction High consumption of alcohol has an enormous toll on the health status of individuals. A direct affectation of cardiac integrity concerns cardiologists, primary care physicians, and the healthcare system because this increases the disease burden. Alcoholic cardiomyopathy (ACM) results from the enormous consumption of alcohol over a long period of time. The prevalence varies between regions and sex and ranges between 4% and 40%. Viewing the entire spectrum of cardiomyopathies, ACM makes up about 4% of all cardiomyopathies. However, it causes dilated-type cardiomyopathy and is the second most common cause of dilated cardiomyopathy. We sought to explore the outcomes of percutaneous coronary intervention (PCI) among patients with ACM. Methods This was a retrospective, cross-sectional study of the National Inpatient Sample (NIS) for hospital discharges in the United States between 2012 and 2014. We identified the number of patients with a primary or secondary diagnosis of ACM using the International Classification of Diseases, Ninth Revision (ICD-9) code of 4.255. Using the ICD-9 codes for PCI (00.66, 36.01, 36.02, 36.05, 36.06, 36.07, and 17.55), we identified patients diagnosed with ACM who underwent a PCI (ACPCI). The racial and sexual prevalence, hospital length of stay (LOS), mortality, cost of hospitalization, and cardiovascular outcomes (ventricular fibrillation (VF) and atrial fibrillation (AF)) were compared between patients with and without ACM who underwent a PCI. Results A total of 2,488,293 PCIs were performed between 2012 and 2014. Of these, there were a total of 161 admissions for ACM. About 93% (151) of the ACM PCI group were men. Ethnic distribution revealed a majority of Caucasians with 69% (98), and blacks and Asians at 13.4% (19) and 11.3% (16), respectively. The mean age was 59.8 (SD = 9). The patients with ACPCI were likely to stay longer in the hospital, with an average stay of 6.6 days (SD = 6.2) compared to patients without ACM undergoing PCI (NOACPCI) (3.7 days; SD = 5.0) (p = 0.0001). The mean cost of hospital admission for patients with ACPCI was $120,225 (SD = 101,044), while that of those without ACM who underwent PCI (NOACPCI) was $87,936 (SD = 83,947) (p = 0.0001). A higher death rate during hospitalization (3.7%) was recorded in the ACPCI category vs. 2.3% in patients without ACM who underwent PCI (p = 0.0001). Patients with ACPCI had a higher prevalence of AF (30.4%) than VF (7.5%). Conclusion The ACPCI group had overall poorer hospital outcomes. The majority affected were older Caucasian men with an increased prevalence of AF, higher cost of hospitalization, and longer hospital stays. Further studies are needed to explore the burden of long-term alcohol consumption on cardiovascular disease treatment outcomes.
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Han M, Lee SR, Choi EK, Choi J, Chung J, Park SH, Lee H, Ahn HJ, Kwon S, Lee SW, Han KD, Oh S, Lip GYH. Habitual Alcohol Intake and Risk of Atrial Fibrillation in Young Adults in Korea. JAMA Netw Open 2022; 5:e2229799. [PMID: 36053532 PMCID: PMC9440398 DOI: 10.1001/jamanetworkopen.2022.29799] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Guidelines recommend that all risk factors for early-onset atrial fibrillation, including lifestyle factors, be proactively managed, considering the poor prognosis of the disease. Not much is known about the association of cumulative alcohol intake with the risk of atrial fibrillation in young adults aged 20 to 39 years, especially among heavy drinkers. OBJECTIVE To explore the association of alcohol consumption with the risk of incident atrial fibrillation in young adults. DESIGN, SETTING, AND PARTICIPANTS Using the National Health Insurance Service database, a nationwide population-based cohort study of adults aged 20 to 39 years without prior atrial fibrillation who underwent 4 serial annual health examinations between 2009 and 2012 was conducted. The cumulative alcohol consumption burden over 4 years was calculated by assigning 1 point to more than moderate drinking (≥105 g of alcohol per week) each year. Additionally, a semiquantitative cumulative burden was calculated by assigning 0, 1, 2, and 3 points to non, mild (<105 g per week), moderate (105-210 g per week), and heavy (≥210 g per week) drinking, respectively. Data were analyzed from May to June 2021. EXPOSURE Amount of alcohol intake in 4 years. MAIN OUTCOMES AND MEASURES The primary outcome was incident atrial fibrillation during the follow-up period. RESULTS A total of 1 537 836 participants (mean [SD] age 29.5 [4.1] years, 1 100 099 [71.5%] male) were included in the final analysis. According to the 4-year cumulative burden of alcohol consumption stratified by moderate to heavy drinking, 889 382 participants (57.8%) were in the burden 0 group, 203 374 participants (13.2%) in the burden 1 group, 148 087 participants (9.6%) in the burden 2 group, 144 023 participants (9.4%) in the burden 3 group, and 152 970 participants (9.9%) in the burden 4 group. During a median (IQR) follow-up of 6.13 (4.59-6.48) years, atrial fibrillation was newly diagnosed in 3066 participants (0.36 per 1000 person-years). Participants with a cumulative burden of 4 points who continued more than moderate drinking for 4 years showed a 25% higher risk of atrial fibrillation compared with 0-point participants who kept non-to-mild drinking over 4 years (adjusted HR, 1.25; 95% CI, 1.12-1.40). In a semiquantitative analysis, participants who sustained heavy drinking for 4 consecutive years were associated with a 47% higher atrial fibrillation risk than those who remained nondrinkers over 4 years (aHR, 1.47, CI 1.18-1.83). CONCLUSIONS AND RELEVANCE Persistent moderate to heavy drinking and higher cumulative alcohol consumption burden might increase the risk of atrial fibrillation even in young adults aged 20 to 39 years.
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Affiliation(s)
- Minju Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - JungMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaewook Chung
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hyeon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - HuiJin Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Woo Lee
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y. H. Lip
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Teppo K, Jaakkola J, Biancari F, Halminen O, Putaala J, Mustonen P, Haukka J, Linna M, Kinnunen J, Luojus A, Itäinen-Strömberg S, Penttilä T, Niemi M, Hartikainen J, Airaksinen KJ, Lehto M. Mental health conditions and use of rhythm control therapies in patients with atrial fibrillation: a nationwide cohort study. BMJ Open 2022; 12:e059759. [PMID: 36041755 PMCID: PMC9438075 DOI: 10.1136/bmjopen-2021-059759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Mental health conditions (MHCs) have been associated with undertreatment of unrelated medical conditions, but whether patients with MHCs face disparities in receiving rhythm control therapies for atrial fibrillation (AF) is currently unknown. We assessed the hypothesis that MHCs are associated with a lower use of antiarrhythmic therapies (AATs). DESIGN A nationwide retrospective registry-based cohort study. SETTING The Finnish AntiCoagulation in Atrial Fibrillation cohort included records on all patients with AF in Finland during 2007-2018 identified from nationwide registries covering all levels of care as well as drug purchases. MHCs of interest were diagnosed depression, bipolar disorder, anxiety disorder, schizophrenia and any MHC. PARTICIPANTS We identified 239 222 patients (mean age 72.6±13.2 years; 49.8% women) with incident AF, in whom the prevalence of any MHC was 19.9%. OUTCOMES Primary outcome was use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. RESULTS Lower overall use of any AAT emerged in patients with any MHC than in those without MHC (16.9% vs 22.9%, p<0.001). Any MHC, depression, bipolar disorder, anxiety disorder and schizophrenia were all associated with lower incidence of any AAT with adjusted subdistribution HRs of 0.790 (95% CI 0.771 to 0.809), 0.817 (0.796 to 0.838), 0.811 (0.789 to 0.835), 0.807 (0.785 to 0.830) and 0.795 (0.773 to 0.818), respectively. Adjusted rates of AAD, cardioversion and catheter ablation use were lower in all MHC groups compared with patients without MHC. The findings in patients with any MHC were confirmed in propensity score matching analysis. CONCLUSIONS Among patients with AF, a clear disparity exists in AAT use between those with and without MHCs. TRIAL REGISTRATION NUMBER ClinicalTrials Identifier: NCT04645537; ENCePP Identifier: EUPAS29845.
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Affiliation(s)
| | - Jussi Jaakkola
- University of Turku, Turku, Finland
- Satakunta Central Hospital, Pori, Finland
| | - Fausto Biancari
- Helsingin seudun yliopistollinen keskussairaala Sydän- ja keuhkokeskus, Helsinki, Finland
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | | | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Pirjo Mustonen
- Heart Center, TYKS Turun yliopistollinen keskussairaala, Turku, Finland
| | | | | | - Janne Kinnunen
- Department of Neurology, University of Helsinki, Helsinki, Finland
| | | | | | | | - Mikko Niemi
- Department of Clinical Pharmacology, University of Helsinki, Helsinki, Finland
- Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland
| | - Juha Hartikainen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | | | - Mika Lehto
- Helsinki University Hospital Heart and Lung Center, Helsinki, Finland
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Ohlrogge AH, Frost L, Schnabel RB. Harmful Impact of Tobacco Smoking and Alcohol Consumption on the Atrial Myocardium. Cells 2022; 11:cells11162576. [PMID: 36010652 PMCID: PMC9406618 DOI: 10.3390/cells11162576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Tobacco smoking and alcohol consumption are widespread exposures that are legal and socially accepted in many societies. Both have been widely recognized as important risk factors for diseases in all vital organ systems including cardiovascular diseases, and with clinical manifestations that are associated with atrial dysfunction, so-called atrial cardiomyopathy, especially atrial fibrillation and stroke. The pathogenesis of atrial cardiomyopathy, atrial fibrillation, and stroke in context with smoking and alcohol consumption is complex and multifactorial, involving pathophysiological mechanisms, environmental, and societal aspects. This narrative review summarizes the current literature regarding alterations in the atrial myocardium that is associated with smoking and alcohol.
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Affiliation(s)
- Amelie H. Ohlrogge
- Department of Cardiology, University Heart and Vascular Centre Hamburg, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Lars Frost
- Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, 8600 Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Renate B. Schnabel
- Department of Cardiology, University Heart and Vascular Centre Hamburg, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
- Correspondence:
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Eckstein ML, Zimmermann P, Erlmann MP, Wachsmuth NB, Haupt S, Zimmer RT, Schierbauer J, Herz D, Aberer F, Sourij H, Obermayer-Pietsch B, Moser O. Glucose and Fructose Supplementation and Their Acute Effects on Electrocardiographic Time Intervals during Anaerobic Cycling Exercise in Healthy Individuals: A Secondary Outcome Analysis of a Double-Blind Randomized Crossover-Controlled Trial. Nutrients 2022; 14:nu14163257. [PMID: 36014763 PMCID: PMC9414006 DOI: 10.3390/nu14163257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
The impact of glucose and fructose supplementation on acute cardiac effects during cardiopulmonary exercise testing (CPET) is a topic that is rarely investigated. The aim of the presented secondary outcome analysis of a double-blind, randomized crossover-controlled trial was to investigate the impact of glucose (Glu), fructose (Fru), glucose and fructose (GluFru), and sucralose on electrocardiogram (ECG), heart rate variability (HRV), premature ventricular complexes (PVCs), and heart rate turn points (HRTP) during CPET. Fourteen healthy individuals (age 25.4 ± 2.5 years, body mass index (BMI) 23.7 ± 1.7 kg/m2, body mass (BM) of 76.3 ± 12.3 kg) participated in this study, of which 12 were included for analysis. Participants received 1 g/kg BM of Glu, 1 g/kg BM of Fru, 0.5 g/kg BM of GluFru (each), and 0.2 g sucralose dissolved in 300 mL 30 min prior to each exercise session. No relevant clinical pathology or significant inter-individual differences between our participants could be revealed for baseline ECG parameters, such as heart rate (HR) (mean HR 70 ± 16 bpm), PQ interval (146 ± 20 ms), QRS interval (87 ± 16 ms) and the QT (405 ± 39 ms), and QTc interval (431 ± 15 ms). We found preserved cardiac autonomic function by analyzing the acute effects of different Glu, Fru, GluFru, or sucralose supplementation on cardiac autonomic function by Schellong-1 testing. SDNN and RMSSD revealed normal sympathetic and parasympathetic activities displaying a balanced system of cardiac autonomic regulation across our participating subjects with no impact on the metabolism. During CPET performance analyses, HRV values did not indicate significant changes between the ingested drinks within the different time points. Comparing the HRTP of the CPET with endurance testing by variable metabolic conditions, no significant differences were found between the HRTP of the CPET data (170 ± 12 bpm), Glu (171 ± 10 bpm), Fru (171 ± 9 bpm), GluFru (172 ± 9 bpm), and sucralose (170 ± 8 bpm) (p = 0.83). Additionally, the obtained time to reach HRTP did not significantly differ between Glu (202 ± 75 s), Fru (190 ± 88 s), GluFru (210 ± 89 s), and sucralose (190 ± 34 s) (p = 0.59). The significance of this study lies in evaluating the varying metabolic conditions on cardiac autonomic modulation in young healthy individuals. In contrast, our participants showed comparable cardiac autonomic responses determined by ECG and CPET.
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Affiliation(s)
- Max L. Eckstein
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
| | - Paul Zimmermann
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany
| | - Maximilian P. Erlmann
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
| | - Nadine B. Wachsmuth
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
| | - Sandra Haupt
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
| | - Rebecca T. Zimmer
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
| | - Janis Schierbauer
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
| | - Daniel Herz
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
| | - Felix Aberer
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Harald Sourij
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Barbara Obermayer-Pietsch
- Endocrinology Lab Platform, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany
- Cardiovascular Diabetology Research Group, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
- Correspondence: ; Tel.: +49-921-55-3465
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Yang L, Chen Y, Huang W. Hub Genes Identification, Small Molecule Compounds Prediction for Atrial Fibrillation and Diagnostic Model Construction Based on XGBoost Algorithm. Front Cardiovasc Med 2022; 9:920399. [PMID: 35911532 PMCID: PMC9329605 DOI: 10.3389/fcvm.2022.920399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and engenders significant global health care burden. The underlying mechanisms of AF is remained to be revealed and current treatment options for AF have limitations. Besides, a detection system can help identify those at risk of developing AF and will enable personalized management.Materials and MethodsIn this study, we utilized the robust rank aggregation method to integrate six AF microarray datasets from the Gene Expression Omnibus database, and identified a set of differentially expressed genes between patients with AF and controls. Potential compounds were identified by mining the Connectivity Map database. Functional modules and closely-interacted clusters were identified using weighted gene co-expression network analysis and protein–protein interaction network, respectively. The overlapped hub genes were further filtered. Subsequent analyses were performed to analyze the function, biological features, and regulatory networks. Moreover, a reliable Machine Learning-based diagnostic model was constructed and visualized to clarify the diagnostic features of these genes.ResultsA total of 156 upregulated and 34 downregulated genes were identified, some of which had not been previously investigated. We showed that mitogen-activated protein kinase and epidermal growth factor receptor inhibitors were likely to mitigate AF based on Connectivity Map analysis. Four genes, including CXCL12, LTBP1, LOXL1, and IGFBP3, were identified as hub genes. CXCL12 was shown to play an important role in regulation of local inflammatory response and immune cell infiltration. Regulation of CXCL12 expression in AF was analyzed by constructing a transcription factor-miRNA-mRNA network. The Machine Learning-based diagnostic model generated in this study showed good efficacy and reliability.ConclusionKey genes involving in the pathogenesis of AF and potential therapeutic compounds for AF were identified. The biological features of CXCL12 in AF were investigated using integrative bioinformatics tools. The results suggested that CXCL12 might be a biomarker that could be used for distinguishing subsets of AF, and indicated that CXCL12 might be an important intermediate in the development of AF. A reliable Machine Learning-based diagnostic model was constructed. Our work improved understanding of the mechanisms of AF predisposition and progression, and identified potential therapeutic avenues for treatment of AF.
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Sha R, Rong B, Zhang K, Chen T, Wang J, Han W, Liu H, Liu A, Lin M, Zhong J. The role of alcohol consumption on echocardiographic and electrophysiologic changes in atrial fibrillation. Echocardiography 2022; 39:794-802. [DOI: 10.1111/echo.15366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rina Sha
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Bing Rong
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Kai Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Tongshuai Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Juntao Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
- Department of Cardiology Qilu Hospital (Qingdao) Cheeloo College of Medicine Shandong University Qingdao China
| | - Wenqiang Han
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Huiyu Liu
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Aihua Liu
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
| | - Mingjie Lin
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
- Peking University First Hospital Beijing China
| | - Jingquan Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function Research Chinese Ministry of Education Chinese National Health Commission and Chinese Academy of Medical Sciences The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine Department of Cardiology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
- Department of Cardiology Qilu Hospital (Qingdao) Cheeloo College of Medicine Shandong University Qingdao China
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Lifestyle Modification and Atrial Fibrillation: Critical Care for Successful Ablation. J Clin Med 2022; 11:jcm11092660. [PMID: 35566788 PMCID: PMC9099891 DOI: 10.3390/jcm11092660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023] Open
Abstract
Management of atrial fibrillation (AF) requires a comprehensive approach due to the limited success of medical or procedural approaches in isolation. Multiple modifiable risk factors contribute to the development and progression of the underlying substrate, with a heightened risk of progression evident with inadequate risk factor management. With increased mortality, stroke, heart failure and healthcare utilisation linked to AF, international guidelines now strongly support risk factor modification as a critical pillar of AF care due to evidence demonstrating the efficacy of this approach. Effective lifestyle management is key to arrest and reverse the progression of AF, in addition to increasing the likelihood of freedom from arrhythmia following catheter ablation.
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Linz B, Hertel JN, Jespersen T, Linz D. Mechanisms and therapeutic opportunities in atrial fibrillation in relationship to alcohol use and abuse. Can J Cardiol 2022; 38:1352-1363. [DOI: 10.1016/j.cjca.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 12/24/2022] Open
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Zhang HZ, Shao B, Wang QY, Wang YH, Cao ZZ, Chen LL, Sun JY, Gu MF. Alcohol Consumption and Risk of Atrial Fibrillation: A Dose-Response Meta-Analysis of Prospective Studies. Front Cardiovasc Med 2022; 9:802163. [PMID: 35282366 PMCID: PMC8907587 DOI: 10.3389/fcvm.2022.802163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/01/2022] [Indexed: 01/21/2023] Open
Abstract
Background This study aimed to investigate the dose-response association between alcohol consumption and atrial fibrillation (AF) risk. Methods PubMed, Embase, Cochrane Library, and Web of Science were systematically searched using keywords related to alcohol and AF from the establishment of databases up to 1 March 2021. Prospective studies examining the impact of alcohol on the risk of AF with hazard ratios (HRs) were included. Restricted cubic spline regression was performed to quantify the dose-response relationship between alcohol consumption and AF risk. Results Thirteen eligible studies were included in the meta-analysis, with a total of 645,826 participants and 23,079 cases of AF. When compared with non-/seldom-drinkers, the pooled adjusted HRs of AF were 1.30 (95% confidence interval [CI]: 1.20–1.41) and 1.00 (95% CI: 0.96–1.05) for high and low alcohol consumption, respectively. Moderate alcohol intake significantly increased the risk of AF in males (HR, 1.21; 95% CI: 1.10–1.33) but not in females (HR, 1.02; 95% CI: 0.91–1.14). The cubic spline regression analysis illustrated that the risk of AF significantly increased with daily alcohol intake in a Non-linear manner (R2 = 0.64, P = 5.785 × 10−12). Conclusion This study revealed a Non-linearly positive association between alcohol intake and the risk of AF. Low alcohol intake was not associated with the development of AF, whereas moderate alcohol intake significantly increased the risk of AF in males but not in females. Our meta-analysis highlighted that alcohol consumption should be restricted to a low level to reduce the risk of AF.
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Affiliation(s)
- Heng-Zhi Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Shao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qi-Yu Wang
- School of Mathematical Science, University of Nottingham, Nottingham, United Kingdom
| | - Yi-Han Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ze-Zhong Cao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu-Lu Chen
- Department of Anatomy, Histology, and Embryology, Nanjing Medical University, Nanjing, China
| | - Jin-Yu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mu-Feng Gu
- Department of Anatomy, Histology, and Embryology, Nanjing Medical University, Nanjing, China
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Tijskens M, Bergonti M, Spera F, Ascione C, Saenen J, Huybrechts W, Miljoen H, Riva S, Wittock A, Heidbuchel H, Tondo C, Sarkozy A. Etiology and Outcome of Catheter Ablation in Patients With Onset of Atrial Fibrillation <45 Years of Age. Am J Cardiol 2022; 166:45-52. [PMID: 34961604 DOI: 10.1016/j.amjcard.2021.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022]
Abstract
Etiologic factors and long-term outcomes of catheter ablation of atrial fibrillation (AF) in young patients have not been well characterized. This study aimed to analyze the etiologic factors and outcomes of pulmonary vein isolation (PVI) in patients with young-onset AF (young-AF, defined as having first documented episode <45 years). Consecutive patients with young-AF undergoing PVI (n = 197) in 2 academic centers were enrolled and followed for 36.1 ± 24.5 months. A control group of patients with AF onset ≥45 years (n = 554) was included. The most frequent risk factors in young-AF were intensive exercise (25%), moderate-to-heavy alcohol consumption (23%), and familial AF (22%). Compared with patients with AF onset ≥45-year, patients with young-AF were more often men (82% vs 66%, p <0.001), had more frequently paroxysmal AF (81% vs 60%, p <0.001), had less left atrial dilatation (40.9 ± 6.2 mm vs 44.2 ± 7.2 mm, p <0.001), and had lower 4-year recurrence rate after last PVI procedure (22% vs 45%, p <0.001). In young-AF, structural heart disease (SHD) was the only independent predictor of recurrence. Patients with young-AF selected to undergo cryoballoon (CB) ablation were younger (35.0 ± 7.7 vs 36.6 ± 6.7 years, p = 0.035) and had less persistent AF (6% vs 24%, p = 0.004) and coronary artery disease (2% vs 7%, p = 0.02) compared with radiofrequency ablation. After excluding patients with persistent AF and SHD, there was no difference in single procedural success between radiofrequency or CB PVI (27% vs 17%, p = 0.11). In conclusion, patients with young-AF have diverse etiologies and high single and multiprocedural PVI successes. SHD is the only independent predictor of recurrence. In patients with young-AF, there is a selection bias for CB ablation.
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Alcohol Consumption and the Risk of Incident Atrial Fibrillation: A Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12020479. [PMID: 35204570 PMCID: PMC8871230 DOI: 10.3390/diagnostics12020479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 12/21/2022] Open
Abstract
Alcohol consumption is a known, modifiable risk factor for incident atrial fibrillation (AF). However, it remains unclear whether the protective effect of moderate alcohol consumption-that has been reported for various cardiovascular diseases also applies to the risk for new-onset AF. The purpose of this meta-analysis was to evaluate the role of different drinking patterns (low: <14 grams/week; moderate: <168 grams/week; and heavy: >168 grams/week) on the risk for incident AF. Major electronic databases were searched for observational cohorts examining the role of different drinking behaviors on the risk for incident AF. We analyzed 16 studies (13,044,007 patients). Incident AF rate was 2.3%. Moderate alcohol consumption significantly reduced the risk for new-onset AF when compared to both abstainers (logOR: −0.20; 95%CI: −0.28–−0.12; I2: 96.71%) and heavy drinkers (logOR: −0.28; 95%CI: −0.37–−0.18; I2: 95.18%). Heavy-drinking pattern compared to low also increased the risk for incident AF (logOR: 0.14; 95%CI: 0.01–0.2; I2: 98.13%). Substantial heterogeneity was noted, with more homogeneous results documented in cohorts with follow-up shorter than five years. Our findings suggest a J-shaped relationship between alcohol consumption and incident AF. Up to 14 drinks per week seem to decrease the risk for developing AF. Because of the substantial heterogeneity observed, no robust conclusion can be drawn. In any case, our results suggest that the association between alcohol consumption and incident AF is far from being a straightforward dose-response effect.
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Jiang Q, Chen ML. Risk of Incident Atrial Fibrillation in ALDH2-Deficient Variant Carriers. JACC: ASIA 2022; 2:71-72. [PMID: 36340253 PMCID: PMC9627933 DOI: 10.1016/j.jacasi.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Effect of the ALDH2 Variant on the Prevalence of Atrial Fibrillation in Habitual Drinkers. JACC: ASIA 2022; 2:62-70. [PMID: 36340257 PMCID: PMC9627901 DOI: 10.1016/j.jacasi.2021.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/12/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022]
Abstract
Background Alcohol—a risk factor for atrial fibrillation (AF)—is metabolized by aldehyde dehydrogenase 2 (ALDH2). Dysfunctional alleles of ALDH2 (ALDH2-deficient variants) are prevalent among East Asians. Objectives Because the prevalence of AF is estimated to be high in ALDH2-deficient variant carriers, we investigated the correlation between AF and ALDH2-deficient variant carriers, including the association with habitual alcohol consumption. Methods A total of 656 consecutive patients were included in this investigation. ALDH2 genotypes were divided into ALDH2 homozygous wild-type (∗1/∗1), ALDH2 heterozygous-deficient allele (∗1/∗2), and ALDH2 homozygous-deficient allele (∗2/∗2). Multivariate analyses were applied to determine the correlation between ALDH2 genotype and AF. Results ALDH2∗1/∗2 and ALDH2∗2/∗2 carriers who were ALDH2-deficient variant carriers comprised 199 (30.3%) and 27 (4.1%) patients, respectively. Among these patients, the proportions of habitual alcohol consumption were 26.1% and 0%, respectively. Multivariate analysis revealed that ALDH2∗1/∗2 itself was not a risk factor for AF (odds ratio [OR]: 1.28; P = 0.21). However, habitual alcohol consumption in ALDH2∗1/∗2 carriers was an independent risk factor of AF (OR: 4.13; P = 0.001). Contrary to expectations, ALDH2∗2/∗2 itself had a lower incidence of AF among other risk factors (OR: 0.37; P = 0.03). Conclusions Although the ALDH2∗1/∗2 itself was not associated with AF, ALDH2∗1/∗2 carriers with habitual alcohol consumption could experience AF because of slow alcohol metabolism. In contrast, ALDH2∗2/∗2 itself had a lower incidence of AF. This might be related to the absence to habitual alcohol consumption in ALDH2∗2/∗2 carriers because of the negligible activity of ALDH2. Thus, abstaining from alcohol consumption might prevent the development of AF in patients who are ALDH2∗1/∗2 carriers.
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Liao JN, Lim SS, Chen TJ, Tuan TC, Chen SA, Chao TF. Modified Taiwan Atrial Fibrillation Score for the Prediction of Incident Atrial Fibrillation. Front Cardiovasc Med 2022; 8:805399. [PMID: 35155613 PMCID: PMC8831699 DOI: 10.3389/fcvm.2021.805399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/27/2021] [Indexed: 12/23/2022] Open
Abstract
Background We have proposed the Taiwan AF score consisting of age, male sex, hypertension, heart failure, coronary artery disease, end-stage renal disease, and alcoholism to predict incident atrial fibrillation (AF) in Asian population. We hypothesized that the modified Taiwan AF score (mTaiwan AF score) excluding alcoholism remained useful for predicting new onset AF. Methods A total of 7,220,654 subjects aged ≥ 40 years without a past history of cardiac arrhythmia were identified from a national cohort, and 438,930 incident AF occurred during a 16-year follow-up with an incidence of 0.42 per 100 person-years. The mTaiwan AF score ranging between −2 and 14 and its predictive accuracy of incident AF was analyzed. Results The areas under the receiver operating characteristic curve (AUCs) of the mTaiwan AF scores in predicting AF are 0.861 for 1-year follow-up, 0.829 for 5-year follow-up, 0.795 for 10-year follow-up, and 0.751 for 16-year follow-up. The risk of incident AF increased from 0.05%/year for patients with a score of −2 to 6.98%/year for those having a score of 14. Patients were classified into three groups based on the tertile values of the mTaiwan AF scores—group 1 (score −2-3), group 2 (score 4-9) and group 3 (score 10-14). The annual risks of incident AF were 0.20, 1.33, and 3.36% for group 1, 2, and 3, respectively. Compared to patients in group 1, the hazard ratios of incident AF were 5.79 [95% confidence interval (CI) 3.75-7.75] for group 2 and 8.93 (95% CI 6.47-10.80) for group 3. Conclusions We demonstrated that the mTaiwan AF score based on age and clinical comorbidities could be used to predict incident AF in Asian population.
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Affiliation(s)
- Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Su-Shen Lim
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Tze-Fan Chao
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Alcohol consumption in relation to the incidence of atrial fibrillation in an elderly Chinese population. J Geriatr Cardiol 2022; 19:52-60. [PMID: 35233223 PMCID: PMC8832043 DOI: 10.11909/j.issn.1671-5411.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol consumption is a known modifiable risk factor for atrial fibrillation. The association, however, might differ according to gender. We investigated gender-specific associations between alcohol consumption and incident atrial fibrillation in an elderly Chinese population. METHODS Our study participants were elderly residents (≥ 65 years) recruited from five community health centers in the urban area of Shanghai (n = 6,618). Alcohol intake was classified as never drinkers and current light-to-moderate (< 40 g/day) and heavy drinkers (≥ 40 g/day). Atrial fibrillation was detected by a 30-s single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG. RESULTS During a median of 2.1 years (interquartile range: 2.0-2.2) follow-up, the incidence rate of atrial fibrillation was 1.10% in all study participants. It was slightly but non-significantly higher in men (n = 2849) than women (n = 3769, 1.30% vs. 0.96%, P = 0.19) and in current drinkers (n = 793) than never drinkers (n = 5825, 1.64% vs. 1.03%,P = 0.12). In both unadjusted and adjusted analyses, there was interaction between sex and current alcohol intake in relation to the incidence of atrial fibrillation (P < 0.0001). After adjustment for confounding factors, current drinkers had a significantly higher incidence rate of atrial fibrillation than never drinkers in women (12.96% [7/54] vs. 0.78% [29/3715], adjusted odds ratio [OR] = 10.25, 95% confidence interval [CI]: 3.54-29.67,P < 0.0001), but not in men (0.81% [6/739] vs. 1.47% [31/2110], OR = 0.62, 95% CI: 0.25-1.51,P = 0.29). CONCLUSIONS Our study showed a significant association between alcohol intake and the incidence of atrial fibrillation in elderly Chinese women, but not men.
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Thakkar S, Patel HP, Boppana LKT, Faisaluddin M, Rai D, Sheth AR, Kumar A, Kutom F, Zahid S, Baibhav B, Dani SS, Rao M, DeSimone CV, Deshmukh A. Arrhythmias in patients with in-hospital alcohol withdrawal are associated with increased mortality: Insights from 1.5 million hospitalizations for alcohol withdrawal syndrome. Heart Rhythm O2 2022; 2:614-621. [PMID: 34988506 PMCID: PMC8703122 DOI: 10.1016/j.hroo.2021.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Atrial arrhythmias are commonly noted in patients with alcohol withdrawal syndrome (AWS), requiring inpatient admission. Objective The burden of arrhythmias and the association with in-hospital outcomes are incompletely defined in patients hospitalized with AWS. Methods The nationwide inpatient sample database was accessed from September 2015 to December 2018 to identify hospitalizations for AWS. We studied a cohort of patients with arrhythmias noted during hospitalization using the appropriate International Classification of Diseases, Tenth Revision billing codes. We compared patient characteristics, outcomes, and hospitalization costs between alcohol withdrawal hospitalizations with and without documented arrhythmias. Propensity score matching (PSM) and multivariate regression were performed to control confounders and develop odds ratios (OR), respectively. Results Among 1,511,155 hospitalization with AWS, 146,825 (9.72%) had concurrent arrhythmias. After PSM, we identified 135,540 cases in each group. Hospitalizations with AWS and concurrent arrhythmias had higher in-hospital mortality (4.19% vs 1.95%, OR 1.76, confidence interval [CI] 1.67–1.85, P < .0001). The most common arrhythmia was atrial fibrillation (66.7%). Arrhythmias in AWS were also associated with poorer in-hospital outcomes, including a higher risk of acute heart failure (8.40% vs 4.58%, OR 1.97, CI 1.90–2.05, P < .0001), acute kidney injury (21.32% vs 15.27%, OR 1.39, CI 1.36–1.43, P < .0001), and acute respiratory failure (9.19% vs 5.49%, OR 1.70, CI 1.64–1.76, P < .0001) requiring intubation. The length of hospital stay (6 days vs 4 days P < .0001) and cost of hospital care ($12,615 [$6683–$27,330] vs $7860 [$4482–$15,868], P < .0001) were higher in AWS with arrhythmias. Conclusion Arrhythmia in AWS is associated with higher in-hospital mortality and poorer in-hospital outcomes.
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Affiliation(s)
- Samarthkumar Thakkar
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Harsh P Patel
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, Illinois
| | | | - Mohammad Faisaluddin
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Aakash R Sheth
- Department of Internal Medicine, Louisiana State University, Shreveport, Louisiana
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Fadee Kutom
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, Illinois
| | - Salman Zahid
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Bipul Baibhav
- Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York
| | - Sourbha S Dani
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Mohan Rao
- Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York
| | | | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Yang JH, Jeong JA, Kweon SS, Lee YH, Choi SW, Ryu SY, Nam HS, Park KS, Kim HY, Shin MH. Causal Association Between Alcohol Consumption and Atrial Fibrillation: A Mendelian Randomization Study. Korean Circ J 2022; 52:220-230. [PMID: 35129315 PMCID: PMC8907994 DOI: 10.4070/kcj.2021.0269] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/16/2021] [Accepted: 11/30/2021] [Indexed: 11/11/2022] Open
Abstract
Previous observational studies presented a positive association between alcohol and atrial fibrillation (AF). However, previous studies using genetic polymorphisms on the causal relationship between alcohol consumption and AF have reported conflicting results. This study evaluated the causality between alcohol consumption and AF using the aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism. In 8,964 cohort participants, genetic analysis and Mendelian randomization analysis using the ALDH2 genotypes showed a significant causal association between alcohol consumption and AF in men. Background and Objectives Previous observational studies presented a positive association between alcohol and atrial fibrillation (AF). However, previous studies using genetic polymorphisms on the causal relationship between alcohol consumption and AF have reported conflicting results. This study aimed to evaluate the causality between alcohol consumption and AF using the aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism, which is the genetic variant with the most potent effect on drinking behavior. Methods A total of 8,964 participants from the Dong-gu Study were included in the present study. The causal association between alcohol consumption and AF was evaluated through a Mendelian randomization (MR) analysis using the ALDH2 rs671 polymorphism as an instrumental variable. Results No significant relationship between alcohol consumption and AF was found in the observational analysis. However, the genetic analysis using the ALDH2 polymorphism showed a significant association in men. In the MR analysis, genetically predicted daily alcohol consumption was positively related to AF. Conclusions MR analysis revealed a significant association between the amount of alcohol consumption and AF, which suggests that the association may be causal.
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Affiliation(s)
- Jung-Ho Yang
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Ji-An Jeong
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Seong-Woo Choi
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - So-Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - Hae-Sung Nam
- Department of Preventive Medicine, Chungnam National University Medical School, Daejeon, Korea
| | - Kyeong-Soo Park
- Cardiocerebrovascular Center, Mokpo Jung-Ang Hospital, Mokpo, Korea
| | - Hye-Yeon Kim
- Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
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Russo AM. Alcohol intake and risk of stroke in atrial fibrillation: the lesser the better, but this is not enough. Eur Heart J 2021; 42:4769-4771. [PMID: 34590689 DOI: 10.1093/eurheartj/ehab657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Andrea M Russo
- Division of Cardiovascular Disease, Cooper Medical School of Rowan University, Camden, NJ, USA
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Yang L, Chen H, Shu T, Pan M, Huang W. Risk of incident atrial fibrillation with low-to-moderate alcohol consumption is associated with gender, region, alcohol category: a systematic review and meta-analysis. Europace 2021; 24:729-746. [PMID: 34864980 DOI: 10.1093/europace/euab266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS The association between low-to-moderate alcohol consumption and atrial fibrillation (AF) has yet to be fully elucidated. The main purpose of this meta-analysis was to estimate the risk of incident AF related to low-to-moderate alcohol consumption. METHODS AND RESULTS A meta-analysis was performed on 13 publications discussing the estimated risk for AF with habitual low-to-moderate alcohol intake in 10 266 315 participants. Graphical augmentations to the funnel plots were used to illustrate the potential impact of additional evidence on the current meta-analysis. Thirteen eligible studies were included in this meta-analysis. We found that moderate alcohol consumption was associated with an increased risk of incident AF in males [hazard ratio (HR) 1.09, 95% confidence interval (CI): 1.07-1.11, P < 0.00001], Europeans (HR 1.32, 95% CI: 1.23-1.42, P < 0.00001), and Asians (HR 1.09, 95% CI: 1.07-1.11, P < 0.00001). Moderate beer consumption was associated with an increased risk of developing AF (HR 1.11, 95% CI: 1.02-1.21, P = 0.01). Low alcohol consumption conferred an increased risk of AF in males (HR 1.14, 95% CI: 1.01-1.28, P = 0.04) and Europeans (HR 1.12, 95% CI: 1.07-1.17, P < 0.00001). CONCLUSIONS This analysis represents the increased risk of incident AF in males, Europeans, and Asians at moderate alcohol consumption levels and in males and Europeans at low alcohol consumption levels. Those who drink any preferred alcohol beverage at moderate levels should be cautious for incident AF. More studies are warranted to find those factors that influence alcohol's effect on predisposing AF.
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Affiliation(s)
- Lingzhi Yang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Huaqiao Chen
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Tingting Shu
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Mingyong Pan
- College of Mathematics and Statistics, Chongqing University, No. 174 Shazhengjie, Shapingba District, Chongqing, 400044, China
| | - Wei Huang
- Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
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Kim IS, Choi YJ, Choi EY, Min PK, Yoon YW, Lee BK, Hong BK, Rim SJ, Kwon HM, Kim JY. Comparison of risk profiles for new-onset atrial fibrillation between patients aged <60 and ≥60 years. PLoS One 2021; 16:e0258770. [PMID: 34793457 PMCID: PMC8601466 DOI: 10.1371/journal.pone.0258770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) has a heterogeneous pathophysiology according to individual patient characteristics. This study aimed to identify the effects of widely known risk factors on AF incidence according to age and to elucidate the clinical implications of these effects. METHODS AND RESULTS We analyzed data from 501,668 subjects (≥18years old) without AF and valvular heart disease from the Korean National Health Insurance Service-National Sample Cohort. The total population was divided into two groups according to age, <60years and ≥60years. AF occurred in 0.7% of the overall population (3,416 of 501,668) during the follow-up period (mean 47.6 months). In Cox regression analysis, age, male sex, previous ischemic stroke, heart failure, and hypertension were related to increased risk of new-onset AF in both age groups. Especially in the <60years age group, risk of new-onset AF was increased by relatively modifiable risk factors: obesity (body mass index ≥25kg/m2; hazard ratio[HR] 1.37 [1.22-1.55], p<0.001, interaction p<0.001), and hypertension (HR 1.93[1.69-2.22], p<0.001, interaction p<0.001). Although interactions were not significant, chronic obstructive pulmonary disease (HR 1.41[1.24-1.60], p<0.001) and chronic kidney disease (HR 1.28[1.15-1.41], p<0.001) showed increased trends of the risk of new-onset AF in the ≥60years age group. CONCLUSION The risk profile for new-onset AF was somewhat different between the <60years and the ≥60years age groups. Compared to the ≥60years group, relatively modifiable risk factors (such as obesity and hypertension) had a greater impact on AF incidence in the <60years age group. Different management strategies to prevent AF development according to age may be needed.
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Affiliation(s)
- In-Soo Kim
- Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeon-Jik Choi
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, Catholic University College of Medicine, Seoul, Republic of Korea
| | - Eui-Young Choi
- Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Ki Min
- Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Won Yoon
- Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byoung Kwon Lee
- Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bum-Kee Hong
- Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se-Joong Rim
- Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuck Moon Kwon
- Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Youn Kim
- Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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80
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Fuchs FD, Fuchs SC. The Effect of Alcohol on Blood Pressure and Hypertension. Curr Hypertens Rep 2021; 23:42. [PMID: 34762198 DOI: 10.1007/s11906-021-01160-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To examine the acute and chronic effects of alcohol on blood pressure (BP) and the incidence of hypertension. We discuss the most current understanding of the mechanisms underlining these effects and their associations with the putative cardioprotective effects of consumption of low-to-moderate amounts of alcoholic beverages. RECENT FINDINGS A recent meta-analysis confirmed findings of experimental studies, demonstrating an acute biphasic effect of ethanol on BP, decreasing up to 12 h of ingestion and increasing after that. This effect is mediated by vagal inhibition and sympathetic activation. A meta-analysis found that chronic consumption of alcoholic beverages was associated with a high incidence of hypertension in men and women; it also found that, in women, the risk begins at moderate alcohol consumption. The risks of alcohol consumption are higher in Blacks than in Asians or Caucasians. The mechanism underlying the chronic effects of alcohol on BP, and particularly the differential effect on Blacks, is still unknown. Short-term trials showed that alcohol withdrawal promotes BP reduction; however, the long-term effectiveness of interventions that aim to lower BP through the restriction of alcohol consumption has not been demonstrated. The harmful effects of alcohol on BP do not support the putative cardioprotective effect of low-to-moderate consumption of alcoholic beverages. The absence of a tangible mechanism of protection, and the possibility that this beneficial effect is biased by socioeconomic and other characteristics of drinkers and abstainers, calls into question the hypothesis that consuming low amounts of alcoholic beverages improves cardiovascular health. The evidence from investigations with various designs converge regarding the acute biphasic effect of ethanol on BP and the risk of chronic consumption on the incidence of hypertension, particularly for Blacks. These effects do not support the putative cardioprotective effect of consumption of low-to-moderate amounts of alcoholic beverages. Mechanisms of chronic BP increase and the demonstration of long-term benefits of reducing alcohol intake as a means to treat hypertension remain open questions.
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Affiliation(s)
- Flávio Danni Fuchs
- Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Ramiro Barcelos 2350, Porto Alegre, 90035-900, Brazil. .,Graduate Program in Cardiovascular Sciences, School of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
| | - Sandra Costa Fuchs
- Graduate Program in Cardiovascular Sciences, School of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
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Gagnon LR, Sadasivan C, Perera K, Oudit GY. Cardiac Complications of Common Drugs of Abuse: Pharmacology, Toxicology and Management. Can J Cardiol 2021; 38:1331-1341. [PMID: 34737034 DOI: 10.1016/j.cjca.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular complications from drugs of abuse are becoming more apparent due to increased usage worldwide. Substance abuse can cause both acute and chronic cardiovascular complications and is increasing in prevalence especially in young adults. These substances contribute to the development of acute coronary syndrome, type II myocardial injury, arrhythmias, cardiomyopathies and have numerous other cardiovascular complications. Although no screening guidelines exist, clinical awareness of these potential complications and their prevention, clinical presentation, diagnosis, and treatment are critically important. Management of cardiovascular disease should be coupled with appropriate social and mental health interventions to provide sustained clinical benefit. The higher the number of substances used recreationally, the greater the risk of premature heart disease. Epidemiological studies showed that 1 in 5 young adults misuse several substances and often start using at younger ages with a greater risk for adverse health outcomes over the long-term. The aim of this review is to highlight the basic epidemiology, cardiac complications, and disease-specific treatment options of commonly abused substances including methamphetamine, cocaine, alcohol, anabolic-androgenic steroids, cannabis, and tobacco.
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Affiliation(s)
- Luke R Gagnon
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Chandu Sadasivan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin Perera
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
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Kurata N, Masuda M, Kanda T, Asai M, Iida O, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Matsuda Y, Hata Y, Uematsu H, Mano T. Left Atrial Localized Low-Voltage Areas Indicate Whole Left Atrial Electrophysiological Degeneration in Atrial Fibrillation Patients. Circ J 2021; 86:192-199. [PMID: 34707070 DOI: 10.1253/circj.cj-21-0527] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The efficacy of ablation targeting low-voltage areas (LVAs) is controversial, although LVA presence is well known to be associated with atrial fibrillation (AF) recurrence after ablation. AF substrate may not localize within LVAs.Methods and Results:This observational study enrolled 405 consecutive patients who underwent an initial AF ablation procedure. The left atrial (LA) voltage map was obtained after pulmonary vein isolation. LVAs were defined as areas with voltage <0.5 mV. To estimate whole LA electrophysiological degeneration, mean regional voltage at each of the 6 regions and LA total conduction velocity were measured. LVAs existed in 143 of 405 (35.3%) patients. Patients with LVAs demonstrated lower mean regional voltages throughout all 6 regions compared to those without LVAs (1.3 [1.8, 0.8] vs. 0.6 [1.0, 0.2] mV for the anterior wall, P<0.001). In contrast, LA conduction velocity was lower in patients with LVAs than in those without (0.89 [1.01, 0.74] vs. 0.93 [1.03, 0.87] m/s, P<0.001). Multivariate analysis revealed that low LA total conduction velocity and a higher number of regions with mean voltage reduction were independently associated with AF recurrence, although LVA presence was not. CONCLUSIONS Patients with localized LA LVAs were characterized by whole LA electrophysiological degeneration as assessed by mean regional voltage and conduction velocity. In addition, whole LA electrophysiological degeneration parameters were well associated with AF recurrence.
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Affiliation(s)
| | | | | | | | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center
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83
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Shin DG, Kang MK, Han D, Choi S, Cho JR, Lee N. Enlarged left atrium and decreased left atrial strain are associated with atrial fibrillation in patients with hyperthyroidism irrespective of conventional risk factors. Int J Cardiovasc Imaging 2021; 38:613-620. [PMID: 34705162 DOI: 10.1007/s10554-021-02450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to investigate factors associated with AF in patients with hyperthyroidism beyond heart failure (HF), coronary heart disease (CHD), or valvular diseases. A total of 136 patients (mean age, 52 ± 15 years; 86 [63%] female) who were diagnosed with hyperthyroidism for the first time were enrolled. Patients who had HF, CHD, or significant valvular diseases were excluded. Patients were classified into two groups according to the presence (group 1, n = 40) and absence of AF (group 2, n = 96). AF occurred in 40 (29%) patients and 23 (58%) of these patients showed paroxysmal AF. Among the symptoms of hyperthyroidism, the most common chief complaint was palpitation (30%). Advanced age, presence of prior cerebrovascular events, and presence of palpitations were associated with AF. Larger left atrial volume index (LAVI), increased left ventricular mass index, and decreased left ventricular ejection fraction (LVEF) and S' velocity were associated with AF. Among them, presence of palpitations and increased LAVI were independently associated with the occurrence of AF. In addition, strain analysis, decreased LA expansion index (EI), ejection fraction (EF), peak atrial longitudinal strain, contraction strain, and late diastolic strain rate (A sr) and systolic strain rate (S sr) were associated with the occurrence of AF and LAVI. Presence of palpitations and enlarged left atrium were associated with the occurrence of AF in patients with hyperthyroidism irrespective of conventional risk factors. Additional LA analysis revealed that decreased LA function was associated with AF and enlarged left atrium.
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Affiliation(s)
- Dong Geum Shin
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Min-Kyung Kang
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea.
| | - Donghoon Han
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Seonghoon Choi
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Jung Rae Cho
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Namho Lee
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
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84
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Hung CL, Sung KT, Chang SC, Liu YY, Kuo JY, Huang WH, Su CH, Liu CC, Tsai SY, Liu CY, Lee AS, Pan SH, Wang SW, Hou CJY, Hung TC, Yeh HI. Variant Aldehyde Dehydrogenase 2 ( ALDH2*2) as a Risk Factor for Mechanical LA Substrate Formation and Atrial Fibrillation with Modest Alcohol Consumption in Ethnic Asians. Biomolecules 2021; 11:1559. [PMID: 34827557 PMCID: PMC8615757 DOI: 10.3390/biom11111559] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 12/30/2022] Open
Abstract
Aldehyde dehydrogenase 2 (ALDH2) rs671 polymorphism is a common genetic variant in Asians that is responsible for defective toxic aldehyde and lipid peroxidation metabolism after alcohol consumption. The extent to which low alcohol consumption may cause atrial substrates to trigger atrial fibrillation (AF) development in users with ALDH2 variants remains to be determined. We prospectively enrolled 249 ethnic Asians, including 56 non-drinkers and 193 habitual drinkers (135 (70%) as ALDH2 wild-type: GG, rs671; 58 (30%) as ALDH2 variants: G/A or A/A, rs671). Novel left atrial (LA) mechanical substrates with dynamic characteristics were assessed using a speckle-tracking algorithm and correlated to daily alcohol consumption and ALDH2 genotypes. Despite modest and comparable alcohol consumption by the habitual alcohol users (14.3 [8.3~28.6] and 12.3 [6.3~30.7] g/day for those without and with ALDH2 polymorphism, p = 0.31), there was a substantial and graded increase in the 4-HNE adduct and prolonged PR, and a reduction in novel LA mechanical parameters (including peak atrial longitudinal strain (PALS) and phasic strain rates (reservoir, conduit, and booster pump functions), p < 0.05), rather than an LA emptying fraction (LAEF) or LA volume index across non-drinkers, and in habitual drinkers without and with ALDH2 polymorphism (all p < 0.05). The presence of ALDH2 polymorphism worsened the association between increasing daily alcohol dose and LAEF, PALS, and phasic reservoir and booster functions (all Pinteraction: <0.05). Binge drinking superimposed on regular alcohol use exclusively further worsened LA booster pump function compared to regular drinking without binge use (1.66 ± 0.57 vs. 1.97 ± 0.56 1/s, p = 0.001). Impaired LA booster function further independently helped to predict AF after consideration of the CHARGE-AF score (adjusted 1.68 (95% CI: 1.06-2.67), p = 0.028, per 1 z-score increment). Habitual modest alcohol consumption led to mechanical LA substrate formation in an ethnic Asian population, which was more pronounced in subjects harboring ALDH2 variants. Impaired LA booster functions may serve as a useful predictor of AF in such populations.
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Affiliation(s)
- Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei City 25245, Taiwan
| | - Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Shun-Chuan Chang
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
| | - Yen-Yu Liu
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei City 25245, Taiwan
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - Jen-Yuan Kuo
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Wen-Hung Huang
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Cheng-Huang Su
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Chuan-Chuan Liu
- Department of Physiology Examination, MacKay Memorial Hospital, New Taipei City 25160, Taiwan;
| | - Shin-Yi Tsai
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei City 25245, Taiwan
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Chia-Yuan Liu
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
| | - An-Sheng Lee
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
| | - Szu-Hua Pan
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 10051, Taiwan;
- Genome and Systems Biology Degree Program, Academia Sinica and National Taiwan University, Taipei 10617, Taiwan
- Doctoral Degree Program of Translational Medicine, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Shih-Wei Wang
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
- Institute of Biomedical Sciences, Mackay Medical College, New Taipei City 25245, Taiwan
| | - Charles Jia-Yin Hou
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Ta-Chuan Hung
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- Mackay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan
| | - Hung-I Yeh
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan; (C.-L.H.); (K.-T.S.); (S.-C.C.); (Y.-Y.L.); (J.-Y.K.); (C.-H.S.); (S.-Y.T.); (C.-Y.L.); (A.-S.L.); (S.-W.W.); (C.J.-Y.H.); (T.-C.H.)
- Division of Cardiology, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan;
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Alleyne J, Dopico AM. Alcohol Use Disorders and Their Harmful Effects on the Contractility of Skeletal, Cardiac and Smooth Muscles. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2021; 1:10011. [PMID: 35169771 PMCID: PMC8843239 DOI: 10.3389/adar.2021.10011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/21/2021] [Indexed: 06/14/2023]
Abstract
Alcohol misuse has deleterious effects on personal health, family, societal units, and global economies. Moreover, alcohol misuse usually leads to several diseases and conditions, including alcoholism, which is a chronic condition and a form of addiction. Alcohol misuse, whether as acute intoxication or alcoholism, adversely affects skeletal, cardiac and/or smooth muscle contraction. Ethanol (ethyl alcohol) is the main effector of alcohol-induced dysregulation of muscle contractility, regardless of alcoholic beverage type or the ethanol metabolite (with acetaldehyde being a notable exception). Ethanol, however, is a simple and "promiscuous" ligand that affects many targets to mediate a single biological effect. In this review, we firstly summarize the processes of excitation-contraction coupling and calcium homeostasis which are critical for the regulation of contractility in all muscle types. Secondly, we present the effects of acute and chronic alcohol exposure on the contractility of skeletal, cardiac, and vascular/ nonvascular smooth muscles. Distinctions are made between in vivo and in vitro experiments, intoxicating vs. sub-intoxicating ethanol levels, and human subjects vs. animal models. The differential effects of alcohol on biological sexes are also examined. Lastly, we show that alcohol-mediated disruption of muscle contractility, involves a wide variety of molecular players, including contractile proteins, their regulatory factors, membrane ion channels and pumps, and several signaling molecules. Clear identification of these molecular players constitutes a first step for a rationale design of pharmacotherapeutics to prevent, ameliorate and/or reverse the negative effects of alcohol on muscle contractility.
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Affiliation(s)
| | - Alex M. Dopico
- Department of Pharmacology, Addiction Science, and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
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Risk Thresholds for Total and Beverage-Specific Alcohol Consumption and Incident Atrial Fibrillation. JACC Clin Electrophysiol 2021; 7:1561-1569. [PMID: 34330672 DOI: 10.1016/j.jacep.2021.05.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study sought to characterize associations of total and beverage-specific alcohol consumption with incident atrial fibrillation (AF). BACKGROUND Although binge drinking and moderate to high consumption of alcohol are both established risk factors for AF, comparatively less is known about the effect of low alcohol consumption and whether associations differ by specific alcoholic beverages. METHODS Using data from the UK Biobank, total and beverage-specific alcohol consumption was calculated as UK standard drinks (8 g alcohol) per week. Past drinkers and those with a history of AF were excluded. Incident AF events were assessed through hospitalization and death records, and dose-response associations were characterized using Cox regression models with correction for regression dilution bias. RESULTS We studied 403,281 middle-aged individuals (52.4% female). Over a median follow-up time of 11.4 years (interquartile range: 10.7-12.3), a total of 21,312 incident AF events occurred. A J-shaped association of total alcohol consumption was observed, with lowest risk of AF with fewer than 7 drinks/week. Beverage-specific analyses demonstrated harmful associations of beer/cider consumption with any consumption. In contrast, consumption of red wine, white wine, and spirits up to 10, 8, and 3 drinks/week, respectively, was not associated with increased risk. CONCLUSIONS In this predominantly White population, low levels of alcohol consumption (<7 UK standard drinks [56 g alcohol]/week) were associated with lowest AF risk. Low consumption of red and white wine and very low consumption of spirits may not be associated with increased AF risk, whereas any consumption of beer/cider may be associated with harm. These findings may have important implications for the primary prevention of AF that should be explored in future studies.
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Ren X, Gao J, Han T, Sun C. Association between risk of type 2 diabetes and changes in energy intake at breakfast and dinner over 14 years: a latent class trajectory analysis from the China health and nutrition Survey, 1997-2011. BMJ Open 2021; 11:e046183. [PMID: 34266840 PMCID: PMC8286767 DOI: 10.1136/bmjopen-2020-046183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the association between the trajectories of energy consumption at dinner versus breakfast and the risk of type 2 diabetes (T2D). DESIGN Cohort study. SETTING The study was conducted in China. PARTICIPANTS A total of 10 727 adults, including 5239 men and 5488 women, with a mean age of 42.7±11.2 years and a mean follow-up time of 9.1 years, met the study criteria and completed a questionnaire about energy intake and diabetes status from the China Health and Nutrition Survey in 1997-2011. PRIMARY OUTCOME MEASURES Participants were divided into subgroups based on the trajectories of the ratio of energy consumption at dinner versus breakfast. Cox multivariate regression models were used to explore the associations between different trajectories and the risk of T2D after adjustment for confounders and their risk factors. Mediation analysis was performed to explore the intermediary effect of triacylglycerol (TG), total cholesterol (TC), uric acid (UA) and apolipoprotein B (ApoB) between the trajectories and the risk of T2D. RESULTS For energy consumption at dinner versus breakfast, compared with a low-stable trajectory, the adjusted HR of T2D in low-increasing from early-stage trajectory was 1.29 (95% CI 1.04 to 1.60). TG, TC, UA and ApoB were significantly higher in low-increasing from early-stage trajectory than other trajectories and play partial regulation roles between trajectories and T2D. CONCLUSIONS This study emphasised the harmful effect of a gradual increase in the ratio of energy consumption at dinner versus breakfast from early stage on the development of T2D and partially mediated by TG, TC, UA and ApoB, highlighting that it is necessary to intake more energy at breakfast compared with dinner to prevent T2D in adults.
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Affiliation(s)
- Xiyun Ren
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin, China
| | - Jian Gao
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin, China
| | - Tianshu Han
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin, China
| | - Changhao Sun
- Department of Nutrition and Food Hygiene, Harbin Medical University, Harbin, China
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Tsigkas G, Apostolos A, Despotopoulos S, Vasilagkos G, Kallergis E, Leventopoulos G, Mplani V, Davlouros P. Heart failure and atrial fibrillation: new concepts in pathophysiology, management, and future directions. Heart Fail Rev 2021; 27:1201-1210. [PMID: 34218400 DOI: 10.1007/s10741-021-10133-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/11/2022]
Abstract
A bidirectional pathophysiological link connects heart failure and atrial fibrillation, creating a frequent and challenging comorbidity, which includes neurohormonal hyperactivation, fibrosis development, and electrophysiologic remodeling, while they share mutual risk factors. Management for these devastating comorbidities includes most of the established treatment measures for heart failure as well as rhythm or rate control and anticoagulation mostly for atrial fibrillation, which can be achieved with either pharmaceutical or non-pharmaceutical approaches. The current manuscript aims to review the existing literature regarding the underlying pathophysiology, to present the novel trends of treatment, and to predict the future perspective of these two linked diseases with the numerous unanswered questions.
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Affiliation(s)
- Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, Patras, Greece.
| | | | | | | | | | | | - Virginia Mplani
- Department of Cardiology, University Hospital of Patras, Patras, Greece
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Abstract
Atrial fibrillation is one of the most common arrhythmias in the adult population, in children, however, only a few case reports of isolated atrial fibrillation exist.1 Aside from post-operative AF due to atrial scar formation or suture lines and atrial enlargement in CHD (e.g., mitral stenosis), alcohol consumption represents a rare cause of AF in adolescents. We report on the latter.
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90
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Csengeri D, Sprünker NA, Di Castelnuovo A, Niiranen T, Vishram-Nielsen JK, Costanzo S, Söderberg S, Jensen SM, Vartiainen E, Donati MB, Magnussen C, Camen S, Gianfagna F, Løchen ML, Kee F, Kontto J, Mathiesen EB, Koenig W, Stefan B, de Gaetano G, Jørgensen T, Kuulasmaa K, Zeller T, Salomaa V, Iacoviello L, Schnabel RB. Alcohol consumption, cardiac biomarkers, and risk of atrial fibrillation and adverse outcomes. Eur Heart J 2021; 42:1170-1177. [PMID: 33438022 PMCID: PMC7982286 DOI: 10.1093/eurheartj/ehaa953] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/10/2020] [Accepted: 11/10/2020] [Indexed: 12/03/2022] Open
Abstract
Aims 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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Affiliation(s)
- Dora Csengeri
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Ngoc-Anh Sprünker
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | | | - Teemu Niiranen
- Division of Medicine, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521 Turku, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, POB 30, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Julie Kk Vishram-Nielsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.,Department of Cardiology, Righospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Denmark
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Via dell´ Elettronica, 86077 Pozzilli, Italy
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, SE-901 87 Umeå, Sweden
| | - Steen M Jensen
- Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, SE-901 87 Umeå, Sweden
| | - Erkki Vartiainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, POB 30, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Maria Benedetta Donati
- Department of Epidemiology and Prevention, IRCCS Neuromed, Via dell´ Elettronica, 86077 Pozzilli, Italy
| | - Christina Magnussen
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), partner site, Hamburg/Kiel/Luebeck, Potsdamer Straße 58, 10785 Berlin, Germany
| | - Stephan Camen
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), partner site, Hamburg/Kiel/Luebeck, Potsdamer Straße 58, 10785 Berlin, Germany
| | - Francesco Gianfagna
- Mediterranea Cardiocentro, Via Orazio 2, 80122 Napoli, Italy.,Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Via Rossi 9, 21100 Varese, Italy
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9019 Tromsø, Norway
| | - Frank Kee
- Center for Public Health, Institute of Clinical Sciences A, Queens University, Grosvenor Road, BT 12 6BJ Belfast, Ireland
| | - Jukka Kontto
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, POB 30, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Ellisiv B Mathiesen
- Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9019 Tromsø, Norway
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Lazarettstraße 36, 80636 Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteinerstraße 29, 80802 Munich, Germany.,Institute of Epidemiology and Medial Biometry, University of Ulm, Helmholtzstraße 22, 89081 Ulm, Germany
| | - Blankenberg Stefan
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), partner site, Hamburg/Kiel/Luebeck, Potsdamer Straße 58, 10785 Berlin, Germany
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Neuromed, Via dell´ Elettronica, 86077 Pozzilli, Italy
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.,Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.,Faculty of Medicine, Aalborg University, Niels Jernes Vej 10, 9220 Aalborg, Denmark
| | - Kari Kuulasmaa
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, POB 30, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Tanja Zeller
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Veikko Salomaa
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, POB 30, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Via dell´ Elettronica, 86077 Pozzilli, Italy.,Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Via Rossi 9, 21100 Varese, Italy
| | - Renate B Schnabel
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246 Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), partner site, Hamburg/Kiel/Luebeck, Potsdamer Straße 58, 10785 Berlin, Germany
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91
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Gorcsan J. Can Left Atrial Strain Forecast Future Fibrillation? JACC Cardiovasc Imaging 2021; 14:145-147. [PMID: 33413884 DOI: 10.1016/j.jcmg.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022]
Affiliation(s)
- John Gorcsan
- Division of Cardiology, Washington University in St. Louis, St. Louis, Missouri, USA.
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92
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Precision Medicine Approaches to Cardiac Arrhythmias: JACC Focus Seminar 4/5. J Am Coll Cardiol 2021; 77:2573-2591. [PMID: 34016268 DOI: 10.1016/j.jacc.2021.03.325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Abstract
In the initial 3 papers in this Focus Seminar series, the fundamentals and key concepts of precision medicine were reviewed, followed by a focus on precision medicine in the context of vascular disease and cardiomyopathy. For the remaining 2 papers, we focus on precision medicine in the context of arrhythmias. Specifically, in this fourth paper we focus on long QT syndrome, Brugada syndrome, and atrial fibrillation. The final (fifth) paper will deal with catecholaminergic polymorphic ventricular tachycardia. These arrhythmias represent a spectrum of disease ranging from common to relatively rare, with very different genetic and environmental causative factors, and with differing clinical manifestations that range from almost no consequences to lethality in childhood or adolescence if untreated. Accordingly, the emerging precision medicine approaches to these arrhythmias vary significantly, but several common themes include increased use of genetic testing, avoidance of triggers, and personalized risk stratification to guide the use of arrhythmia-specific therapies.
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93
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Post-traumatic stress disorder and its association with stroke and stroke risk factors: A literature review. Neurobiol Stress 2021; 14:100332. [PMID: 34026954 PMCID: PMC8122169 DOI: 10.1016/j.ynstr.2021.100332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/27/2021] [Accepted: 04/20/2021] [Indexed: 12/19/2022] Open
Abstract
Stroke is a major cause of mortality and disability globally that has multiple risk factors. A risk factor that has recently gained more attention is post-traumatic stress disorder (PTSD). Literature searches were carried out for updated PTSD information and for the relationship between PTSD and stroke. The review was divided into two sections, one exploring PTSD as an independent risk factor for stroke, with a second concentrating on PTSD's influence on stroke risk factors. The study presents accumulating evidence that shows traumatic stress predicts stroke and is also linked to many major stroke risk factors. The review contributes knowledge to stroke aetiology and acts as a reference for understanding the relationship between PTSD and stroke. The information presented indicates that screening and identification of traumatic experience would be beneficial for directing stroke patients to appropriate psychological and lifestyle interventions. In doing so, the burden of stroke may be reduced worldwide.
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94
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Strüven A, Holzapfel C, Stremmel C, Brunner S. Obesity, Nutrition and Heart Rate Variability. Int J Mol Sci 2021; 22:ijms22084215. [PMID: 33921697 PMCID: PMC8072942 DOI: 10.3390/ijms22084215] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
Heart rate variability (HRV) represents the activity and balance of the autonomic nervous system and its capability to react to internal and external stimuli. As a measure of general body homeostasis, HRV is linked to lifestyle factors and it is associated with morbidity and mortality. It is easily accessible by heart rate monitoring and gains interest in the era of smart watches and self-monitoring. In this review, we summarize effects of weight loss, training, and nutrition on HRV with a special focus on obesity. Besides weight reduction, effects of physical activity and dietary intervention can be monitored by parameters of HRV, including its time and frequency domain components. In the future, monitoring of HRV should be included in any weight reduction program as it provides an additional tool to analyze the effect of body weight on general health and homeostasis. HRV parameters could, for example, be monitored easily by implementation of an electrocardiogram (ECG) every two to four weeks during weight reduction period. Indices presumibly showing beneficial changes could be a reduction in heart rate and the number of premature ventricular complexes as well as an increase in standard deviation of normal-to-normal beat intervals (SDNN), just to name some.
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Affiliation(s)
- Anna Strüven
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University Munich, Marchioninistr. 15, 81377 Munich, Germany; (A.S.); (C.S.)
- German Center for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Marchioninistr. 15, 81377 Munich, Germany
| | - Christina Holzapfel
- Institute for Nutritional Medicine, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany;
| | - Christopher Stremmel
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University Munich, Marchioninistr. 15, 81377 Munich, Germany; (A.S.); (C.S.)
- German Center for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Marchioninistr. 15, 81377 Munich, Germany
| | - Stefan Brunner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University Munich, Marchioninistr. 15, 81377 Munich, Germany; (A.S.); (C.S.)
- German Center for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Marchioninistr. 15, 81377 Munich, Germany
- Department of Medicine I, University Hospital Munich, Ziemssenstrasse 1, 80336 Munich, Germany
- Correspondence: ; Tel.: +49-89-4400-52248; Fax: +49-89-4400-75251
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95
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Mittal R, Su L, Ramgobin D, Garg A, Jain R, Jain R. A narrative review of chronic alcohol-induced atrial fibrillation. Future Cardiol 2021; 18:27-34. [PMID: 33860684 DOI: 10.2217/fca-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Alcohol use disorder (AUD) is highly prevalent and can lead to many cardiovascular complications, including arrhythmias. Chronic alcohol use has a dose-dependent relationship with incidence of atrial fibrillation (AF), where higher alcohol intake (>3 drinks a day) is associated with higher risk of AF. Meanwhile, low levels of chronic alcohol intake (<1 drink a day) is not associated with increased risk of AF. Mechanistically, chronic alcohol intake alters the structural, functional and electrical integrity of the atria, predisposing to AF. Increased screening can help identify AUD patients early on and provide the opportunity to educate on chronic alcohol use related risks, such as AF. The ideal treatment to reduce risk of incident or recurrent AF in AUD populations is abstinence.
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Affiliation(s)
- Rea Mittal
- School of Medicine, Pennsylvania State College of Medicine, Hershey, PA17033, USA
| | - Lilly Su
- School of Medicine, Pennsylvania State College of Medicine, Hershey, PA17033, USA
| | - Devyani Ramgobin
- Touro College of Osteopathic Medicine, Middletown, NY 10940, USA
| | - Ashwani Garg
- Department of Internal Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA 17033, USA
| | - Rahul Jain
- Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Rohit Jain
- Department of Internal Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA 17033, USA
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96
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Chen L, Fu G, Jiang C. Mendelian randomization as an approach to assess causal effects of inflammatory bowel disease on atrial fibrillation. Aging (Albany NY) 2021; 13:12016-12030. [PMID: 33824227 PMCID: PMC8109086 DOI: 10.18632/aging.202906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
Background: Despite growing evidence indicating that patients with inflammatory bowel disease (IBD) have an increased risk of atrial fibrillation (AF), owing to the potential biases of confounding effects and reverse causation, the specific relationship between IBD and AF remains controversial. The aim of this study is to determine whether there is a causal effect of IBD on AF. Methods: A two-sample Mendelian randomization (MR) study was performed to evaluate the causal effect of IBD on AF. Statistical summaries for the associations between single nucleotide polymorphisms (SNPs) and traits of interest were obtained from independent consortia with European populations. The dataset of IBD was acquired from genome-wide association studies (GWAS), including more than 75,000 cases and controls. A GWAS with 60,620 AF cases and 970,216 controls was used to identify genetic variation underlying AF. The causal effect was estimated using the multiplicative random effects inverse-variance weighted method (IVW), followed by sensitivity analysis. Results: Using 81 SNPs, there was no evidence to suggest an association between genetically predicted IBD and risk of AF with multiplicative random-effects IVW MR analysis (odds ratio = 1.0000, 95% confidence interval: 0.9994 1.0005, p = 0.88). Conclusion: As opposed to current assumptions, no substantial evidence was found to support a causal role of IBD in the development of AF.
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Affiliation(s)
- LaiTe Chen
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
| | - GuoSheng Fu
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
| | - ChenYang Jiang
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, HangZhou, China
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97
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Stătescu C, Clement A, Șerban IL, Sascău R. Consensus and Controversy in the Debate over the Biphasic Impact of Alcohol Consumption on the Cardiovascular System. Nutrients 2021; 13:nu13041076. [PMID: 33806249 PMCID: PMC8066508 DOI: 10.3390/nu13041076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022] Open
Abstract
In the past few decades, research has focused on the importance of addressing modifiable risk factors as a means of lowering the risk of cardiovascular disease (CVD), which represents the worldwide leading cause of death. For quite a long time, it has been considered that ethanol intake has a biphasic impact on the cardiovascular system, mainly depending on the drinking pattern, amount of consumption, and type of alcoholic beverage. Multiple case-control studies and meta-analyses reported the existence of a "U-type" or "J-shaped" relationship between alcohol and CVD, as well as mortality, indicating that low to moderate alcohol consumption decreases the number of adverse cardiovascular events and deaths compared to abstinence, while excessive alcohol use has unquestionably deleterious effects on the circulatory system. However, beginning in the early 2000s, the cardioprotective effects of low doses of alcohol were abnegated by the results of large epidemiological studies. Therefore, this narrative review aims to reiterate the association of alcohol use with cardiac arrhythmias, dilated cardiomyopathy, arterial hypertension, atherosclerotic vascular disease, and type 2 diabetes mellitus, highlighting literature disagreements over the risk and benefits of low to moderate drinking on the cardiovascular system.
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Affiliation(s)
- Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (C.S.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, 700503 Iași, Romania
| | - Alexandra Clement
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, 700503 Iași, Romania
- Correspondence: ; Tel.: +40-0232-211834
| | | | - Radu Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (C.S.); (R.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M. Georgescu”, 700503 Iași, Romania
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98
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Pan Y, Xu L, Yang X, Chen M, Gao Y. The common characteristics and mutual effects of heart failure and atrial fibrillation: initiation, progression, and outcome of the two aging-related heart diseases. Heart Fail Rev 2021; 27:837-847. [PMID: 33768377 DOI: 10.1007/s10741-021-10095-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/28/2022]
Abstract
Atrial fibrillation (AF) and heart failure (HF) are common chronic diseases noted in humans. AF and HF share several risk factors, such as age, hypertension, obesity, diabetes, and dyslipidemia. They can interact with each other, while both their morbidity and mortality have been considerably increased. And AF and HF often occur together, suggesting a strong association between the two. However, the underlying mechanism behind this association is not well understood. Among them, aging is the most significant common risk factor, which represents an aging heart and is characterized by fibrosis and decreased number of cardiomyocytes, known as senescence-related cardiac remodeling for both atria and ventricles. Finally, it is proposed that cardiac remodeling is the key link between AF and HF.
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Affiliation(s)
- Yuxia Pan
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Li Xu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Xinchun Yang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Mulei Chen
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Yuanfeng Gao
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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99
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Manolis TA, Apostolopoulos EJ, Manolis AA, Melita H, Manolis AS. The proarrhythmic conundrum of alcohol intake. Trends Cardiovasc Med 2021; 32:237-245. [PMID: 33762184 DOI: 10.1016/j.tcm.2021.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 12/31/2022]
Abstract
The arrhythmogenic potential of alcohol consumption that leads to cardiac arrhythmia development includes the induction of both atrial and ventricular arrhythmias, with atrial fibrillation (AF) being the commonest alcohol-related arrhythmia, even with low/moderate alcohol consumption. Arrhythmias occur both with acute and chronic alcohol use. The "Holiday Heart Syndrome" relates to the occurrence of AF, most commonly following weekend or public holiday binge drinking; however, other arrhythmias may also occur, including other supraventricular arrhythmias, and occasionally even frequent ventricular premature beats and a rare occurrence of ventricular tachycardia. Arrhythmias in individuals with alcohol use disorder, in addition to AF, may comprise ventricular arrhythmias (VAs) that may be potentially fatal leading to cardiac arrest. The effects of alcohol on triggering VAs appear to be dose-dependent, observed more commonly in heavy drinkers, both in healthy individuals and patients with underlying structural heart disease, including ischemic heart disease and alcoholic cardiomyopathy. Men appear to be affected at higher dosages of alcohol, while women can suffer from arrhythmias at lower dosages. On the other hand, low to moderate consumption of alcohol may confer some protection from serious VAs and cardiac arrest (J- or U-curve phenomenon); however, abstinence is the optimal strategy. These issues as they relate to alcohol-induced proarrhythmia are herein reviewed, with the large studies and meta-analyses tabulated and the arrhythmogenic mechanisms pictorially illustrated.
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Affiliation(s)
| | | | | | | | - Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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100
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Doshi R, Dave M, Majmundar M, Kumar A, Adalja D, Shariff M, Desai R, Ziaeian B, Vallabhajosyula S. National rates and trends of tobacco and substance use disorders among atrial fibrillation hospitalizations. Heart Lung 2021; 50:244-251. [PMID: 33359929 PMCID: PMC8310779 DOI: 10.1016/j.hrtlng.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Atrial Fibrillation (AF) has been associated with various behavioral risk factors such as tobacco, alcohol, and/or substances abuse. OBJECTIVE The main objective is to describe the national trends and burden of tobacco and substance abuse in AF hospitalizations. Also, this study identifies potential population who are more vulnerable to these substance abuse among AF hospitalizations. METHODS The National Inpatient Sample database from 2007 to 2015 was utilized and the hospitalizations with AF were identified using the international classification of disease, Ninth Revision, Clinical Modification code. They were stratified into without abuse, tobacco use disorder (TUD), substance use disorder (SUD), alcohol use disorder (AUD) and drug use disorder (DUD). RESULTS Of 3,631,507 AF hospitalizations, 852,110 (23.46%) had TUD, 1,851,170 (5.1%) had SUD, 155,681 (4.29%) had AUD and 42,667 (1.17%) had DUD. The prevalence of TUD, SUD, AUD, and DUD was substantially increased across all age groups, races, and gender during the study period. Female sex was associated with lower odds TUD, SUD, AUD, and DUD. Among AF hospitalizations, the black race was associated with higher odds of SUD, and DUD. The younger age group (18-35 years), male, Medicare/Medicaid as primary insurance, and lower socioeconomic status were associated with increased risk of both TUD and SUDs. CONCLUSION TUD and SUD among AF hospitalizations in the United States mainly affects males, younger individuals, white more than black, and those of lower socioeconomic status which demands for the development of preventive strategies to address multilevel influences.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, , 1155 Mill St, W-11, Reno, NV 89502, USA.
| | - Mihir Dave
- Department of Internal Medicine, University of Nevada Reno School of Medicine, , 1155 Mill St, W-11, Reno, NV 89502, USA
| | - Monil Majmundar
- Department of Internal Medicine, Metropolitan Medical Center, New York, NY, USA
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, Gujarat, India
| | - Mariam Shariff
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Rupak Desai
- Department of Cardiology, Atlanta VA Medical Center, Decatur, GA, United States
| | - Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA; Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, MN, USA
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