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Rasoul D, Ajay A, Abdullah A, Mathew J, Lee Wei En B, Mashida K, Sankaranarayanan R. Alcohol and Heart Failure. Eur Cardiol 2023; 18:e65. [PMID: 38213665 PMCID: PMC10782426 DOI: 10.15420/ecr.2023.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/10/2023] [Indexed: 01/13/2024] Open
Abstract
Alcohol is the most frequently consumed toxic substance in the world and remains a major global public health issue, with one in three adults consuming it worldwide. Alcohol use is a leading risk factor for disease, contributing to over 60 acute and chronic health conditions, with a particularly complex association with cardiovascular disease. Chronic excessive alcohol consumption is associated with a range of cardiac complications, including decreased myocardial contractility, hypertension, arrhythmias, MI and heart failure. However, low-level alcohol consumption is believed to have a protective effect against ischaemic heart disease and diabetes. In most cohort studies, small to moderate amounts of alcohol consumption have not been linked to heart failure, indicating a threshold effect of alcohol with individual (possibly genetic) predisposition rather than a continuous effect of exposure. This review article explores the potential benefits of alcohol on the heart, the association between alcohol use and alcoholic cardiomyopathy and the epidemiology, clinical correlates and management of alcoholic cardiomyopathy.
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Affiliation(s)
- Debar Rasoul
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
- Liverpool Centre for Cardiovascular Science, University of LiverpoolLiverpool, UK
| | - Ashwin Ajay
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
| | - Alend Abdullah
- Cardiology Department, The Dudley Group NHS Foundation TrustDudley, UK
| | - Jean Mathew
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
| | - Benjamin Lee Wei En
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
| | | | - Rajiv Sankaranarayanan
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
- Liverpool Centre for Cardiovascular Science, University of LiverpoolLiverpool, UK
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Andersson C, Schou M, Gustafsson F, Torp-Pedersen C. Alcohol Intake in Patients With Cardiomyopathy and Heart Failure: Consensus and Controversy. Circ Heart Fail 2022; 15:e009459. [PMID: 35593142 DOI: 10.1161/circheartfailure.121.009459] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Alcohol is often cited to be a common cause of cardiomyopathy and heart failure. However, in most available population-based studies, a modest-to-moderate alcohol consumption has been associated with favorable effects on the cardiovascular system, including a lowered risk of heart failure, compared with no alcohol consumption. Available genetic epidemiological data have not supported a causal association between alcohol consumption and heart failure risk, suggesting that alcohol may not be a common cause of heart failure in the community. Data linking alcohol intake with cardiomyopathy risk are sparse, and the concept of alcoholic cardiomyopathy stems mainly from case series of selected patients with dilated cardiomyopathy, where a large proportion reported a history of excessive alcohol intake. This state-of-the-art paper addresses the current knowledge of the epidemiology of alcoholic cardiomyopathy and the role of alcohol intake in patients with non-alcohol-related heart failure. It also offers directions to future research in the area. The review questions the validity of current clinical teaching in the area. It is not well known how much alcohol is needed to cause disease, and the epidemiological pathways linking alcohol consumption to cardiomyopathy and heart failure are not well understood. Until more evidence becomes available, caution is warranted before labeling patients as having alcoholic cardiomyopathy due to a risk of neglecting other contributors, such as genetic causes of cardiomyopathy. In non-alcohol-related heart failure, it is unknown whether total abstinence is improving outcomes (compared with moderate drinking). Ideally, randomized clinical trials are needed to answer this question.
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Affiliation(s)
- Charlotte Andersson
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University, MA (C.A.)
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital (M.S.), University of Copenhagen, Denmark
| | - Finn Gustafsson
- The Heart Centre, Rigshospitalet (F.G.), University of Copenhagen, Denmark
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3
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Iakunchykova O, Schirmer H, Leong D, Malyutina S, Ryabikov A, Averina M, Kudryavtsev A, Kornev M, Voronina E, Paramonov A, Wilsgaard T, Leon D. Heavy alcohol drinking and subclinical echocardiographic abnormalities of structure and function. Open Heart 2021; 8:openhrt-2020-001457. [PMID: 34083387 PMCID: PMC8174503 DOI: 10.1136/openhrt-2020-001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/14/2021] [Indexed: 11/12/2022] Open
Abstract
Objective The aim of the study is to assess changes in heart structure and function associated with heavy alcohol use by comparing echocardiographic indices in a population-based sample to those in patients admitted to an inpatient facility with severe alcohol problems. Methods and results We used data from the Know Your Heart study (2015–2017) which is a cross-sectional study that recruited 2479 participants aged 35–69 years from the general population of the city of Arkhangelsk in Northwest Russia and 278 patients from the Arkhangelsk Regional Psychiatric Hospital with a primary diagnosis related to chronic alcohol use (narcology clinic subsample). The drinking patterns of the population-based sample were characterised in detail. We used regression models controlling for age, sex, smoking, education and waist to hip ratio to evaluate the differences in echocardiographic indices in participants with different drinking patterns. The means of left ventricular end-diastolic diameter and indexed left atrial systolic diameter were increased among heavy drinkers (narcology clinic subsample), while mean left ventricular ejection fraction was decreased in this group compared with the population-based sample. In contrast, the harmful and hazardous drinkers in the population-based sample did not differ from non-problem drinkers with respect to echocardiographic indices of systolic and diastolic function. Conclusions Extremely heavy drinking is associated with a specific set of structural and functional abnormalities of the heart that may be regarded as precursors of alcohol-related dilated cardiomyopathy.
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Affiliation(s)
- Olena Iakunchykova
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lorenskog, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Darryl Leong
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sofia Malyutina
- Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Research Institute of Internal and Preventive Medicine, Novosibirsk, Russian Federation.,Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - Andrew Ryabikov
- Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Research Institute of Internal and Preventive Medicine, Novosibirsk, Russian Federation.,Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - Maria Averina
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Alexander Kudryavtsev
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Innovative Programs, Northern State Medical University, Arkhangelsk, Russia
| | - Mikhail Kornev
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ekaterina Voronina
- Branch of Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Research Institute of Internal and Preventive Medicine, Novosibirsk, Russian Federation
| | - Andrey Paramonov
- Central Scientific Research Laboratory, Northern State Medical University, Arkhangelsk, Russian Federation
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - David Leon
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,International Laboratory For Population and Health, National Research University Higher School of Economics, Moscow, Russia
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4
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van Oort S, Beulens JW, van der Heijden AAWA, Elders PJM, Stehouwer CDA, van de Luitgaarden IAT, Schrieks IC, Grobbee DE, van Ballegooijen AJ. Moderate and heavy alcohol consumption are prospectively associated with decreased left ventricular ejection fraction: The Hoorn Study. Nutr Metab Cardiovasc Dis 2020; 30:132-140. [PMID: 31672450 DOI: 10.1016/j.numecd.2019.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Data on the prospective relationship of alcohol consumption at more moderate levels with systolic and diastolic function are scarce. We aimed to examine the prospective association of alcohol consumption with echocardiographic measures of cardiac structure and function, in individuals with and without type 2 diabetes (T2DM). METHODS AND RESULTS We included 778 participants from the Hoorn Study (aged 68.4 ± 7.2 years, 49% women), a population-based prospective cohort study, oversampled for people with impaired glucose metabolism or T2DM. Self-reported alcohol consumption was collected at baseline with a validated food-frequency questionnaire and categorized into: none (0/week), light (>0-≤30 g/week), light-to-moderate (>30-≤70 g/week), moderate (>70-≤140 g/week), and heavy drinkers (>140 g/week). Echocardiography was performed at baseline (N = 778) and after 8 years follow-up (N = 404). Multiple linear regression was used to study the association between alcohol consumption and echocardiographic measures (left ventricular ejection fraction (LVEF), left atrial volume index (LAVI) and left ventricular mass index (LVMI)), adjusted for confounders. Moderate and heavy alcohol consumption were associated with a decreased LVEF of -3.91% (CI: -7.13;-0.69) for moderate and -4.77% (-8.18;-1.36) for heavy drinkers compared to light drinkers. No associations were found between alcohol consumption, LVMI and LAVI. Modified Poisson regression showed a trend that higher alcohol consumption amounts were associated with a higher risk of incident systolic dysfunction (LVEF≤50%) (P-for-trend 0.058). CONCLUSION The findings provide longitudinal evidence that moderate and heavy alcohol consumption are associated with decreased LVEF and trend towards a higher risk of incident LV systolic dysfunction, compared to light drinkers.
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Affiliation(s)
- Sabine van Oort
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands.
| | - Joline W Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Amber A W A van der Heijden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Inge A T van de Luitgaarden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ilse C Schrieks
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Adriana J van Ballegooijen
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands; Department of Nephrology, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands
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Park SK, Moon K, Ryoo JH, Oh CM, Choi JM, Kang JG, Chung JY, Young Jung J. The association between alcohol consumption and left ventricular diastolic function and geometry change in general Korean population. Eur Heart J Cardiovasc Imaging 2019; 19:271-278. [PMID: 28459993 DOI: 10.1093/ehjci/jex091] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/26/2017] [Indexed: 12/11/2022] Open
Abstract
Aims The adverse effect of heavy alcohol intake on cardiovascular disease is well established. However, there is only limited information about the risk of subclinical left ventricular (LV) abnormality according to alcohol consumption. Thus, this study was to investigate the association between alcohol consumption and LV functional and structural abnormality. Methods and results Study participants were 49 714 Korean adults received echocardiogram as an item of health check-up program. They were stratified into 6 groups according to alcohol consumption; non (life time never drinker), occasional (<1 g/day), light (1-15 g/day), moderate (15-30 g/day), heavy (30-60 g/day), and very heavy (>60 g/day) drinker. Multiple logistic regression analysis was used to assess the odd ratios (ORs) for LV hypertrophy (LVH), increased relative wall thickness (RWT) and impaired LV diastolic (LVD) function with a reference of non-drinker. Additionally, the adjusted mean values of echocardiographic parameters were evaluated to assess LV diastolic function and structure. In logistic regression analysis, very heavy alcohol drinker had the highest adjusted ORs for LVH, increased RWT and impaired LVD function in all participants and male subgroup (P < 0.05). The dose dependent relationship was found between alcohol consumption and impaired LVD function in all participants and gender subgroups. There was no specific pattern of relationship to suggest the favourable effect of light alcohol drinking on heart. Conclusion Increased alcohol intake had the adverse effect on LV function and structure. However, potential favourable effect of light alcohol intake was not observed. Prospective studies are required to investigate long-term effect of alcohol consumption on subclinical LV change.
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Affiliation(s)
- Sung Keun Park
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 04514 Seoul, Republic of Korea
| | - Kanghee Moon
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, 02453 Seoul, Korea
| | - Jae-Hong Ryoo
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, 02453 Seoul, Korea
| | - Chang-Mo Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, 02453 Seoul, Korea
| | - Joong-Myung Choi
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, 02453 Seoul, Korea
| | - Jeong Gyu Kang
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of medicine, 78 Saemunan-gil, Jongro-Gu, Seoul 110-746, Korea
| | - Ju Youn Chung
- Department of Industrial Design, Chonbuk National University, College of Arts, 28644 Jeollabuk-do, Korea
| | - Ju Young Jung
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, 02453 Seoul, Korea.,Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of medicine, 78 Saemunan-gil, Jongro-Gu, Seoul 110-746, Korea
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Gémes K, Janszky I, Strand LB, László KD, Ahnve S, Vatten LJ, Dalen H, Mukamal KJ. Light-moderate alcohol consumption and left ventricular function among healthy, middle-aged adults: the HUNT study. BMJ Open 2018; 8:e020777. [PMID: 29724742 PMCID: PMC5988097 DOI: 10.1136/bmjopen-2017-020777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To investigate the association between alcohol consumption and left ventricular (LV) function in a population with low average alcohol intake. DESIGN, SETTING AND PARTICIPANTS A total of 1296 healthy participants, free from cardiovascular diseases, were randomly selected from the third wave of the Norwegian HUNT study (2006-2008) and underwent echocardiography. After validation of the inclusion criteria, 30 participants were excluded due to arrhythmias or myocardial or valvular pathology. Alcohol consumption, sociodemographic and major cardiovascular risk factors were assessed by questionnaires and clinical examination in the HUNT3. General linear models were used to analyse the cross-sectional associations between alcohol intake and LV indices. PRIMARY AND SECONDARY OUTCOME MEASURES LV functional and structural indices were measured with tissue Doppler and speckle tracking echocardiography. RESULTS We observed no associations between alcohol consumption and multivariable-adjusted LV functional indices. Excluding abstainers who reported regular alcohol consumption 10 years prior to the baseline did not change the results. Alcohol consumption was positively associated with LV mass indices (p<0.01 for linear trend of the means); there was no such association among participants with non-risky drinking characteristics (p=0.67 for linear trend of the means). CONCLUSIONS We found no clear evidence that light-moderate alcohol consumption is associated with measures of LV function, although our results indicate that consumption, especially when marked by binge drinking, is progressively associated with greater LV mass.
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Affiliation(s)
- Katalin Gémes
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Imre Janszky
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Regional Center for Health Care Improvement, St. Olav's Hospital, Trondheim, Norway
| | - Linn Beate Strand
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Krisztina D László
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Staffan Ahnve
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lars J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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7
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Detection of Acute Changes in Left Ventricular Function by Myocardial Deformation Analysis after Excessive Alcohol Ingestion. J Am Soc Echocardiogr 2018; 30:235-243.e1. [PMID: 28259304 DOI: 10.1016/j.echo.2016.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The effects of acute excessive alcohol ingestion on echocardiographic parameters of left ventricular (LV) function are unclear. METHODS One hundred ninety-nine healthy subjects (44 ± 5 years, 71% male) were prospectively examined within 6 hours after excessive alcohol ingestion as well as after 4 weeks with strict alcohol abstinence. Echocardiography was performed at baseline and follow-up for conventional parameters (left ventricular ejection fraction [LVEF], transmitral E and A Doppler flow velocities, E/A ratio, tissue Doppler velocity lateral and septal (é), E/é ratio, deceleration time of E, and isovolumic relaxation time) and myocardial deformation data (such as global radial and global and layer-specific circumferential [endo and epi global CS] and longitudinal [endo and epi global LS] strain). Multivariate regression was used to assess the impact of independent variables on echocardiographic parameters. RESULTS Alcohol levels were 1.2 ± 0.3 g/L at the time of drinking cessation. After alcohol ingestion endo CS (30% ± 2% vs 37% ± 3%, P = .008) and endo LS (27% ± 4% vs 33% ± 3%, P = .002) were significantly lower at baseline versus follow-up. Blood pressure, LVEF and heart rate, and other echocardiographic parameters did not differ between the two examinations. Alcohol levels were modestly, negatively associated with change in endo CS and endo LS (r = -0.54, 95% CI, -0.63 to -0.43, P < .001; and r = -0.26, 95% CI, -0.39 to -0.14; P < .003, respectively). Alcohol levels were the strongest predictor for endo CS (β = -4.84; 95% CI, -6.31 to -3.37) and endo LS (β = -2.50; 95% CI, -4.32 to -0.68). CONCLUSIONS Acute alcohol ingestion effects endocardial CS and LS, suggesting an acute and transient toxic effect on myocardial deformation, an effect that remains undetected by conventional echocardiographic parameters. The current findings may help clinicians to gain more understanding into the mechanism of developing an alcohol cardiomyopathy and to detect early persistent alcohol-induced myocardial disturbances for an effective therapy in time to prevent harm.
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Alcohol consumption and risk of heart failure: Meta-analysis of 13 prospective studies. Clin Nutr 2017; 37:1247-1251. [PMID: 28554815 DOI: 10.1016/j.clnu.2017.05.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/11/2017] [Accepted: 05/08/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIMS Controversy exists on the association between alcohol consumption and risk of heart failure (HF). We carried out a meta-analysis to summarize available prospective data on alcohol consumption and HF. METHODS We searched PubMed for relevant studies published until January 1, 2017. Relative risk (RR) estimates from individual studies were pooled in a random-effects meta-analysis. RESULTS A total of 13 prospective studies, with 13,738 HF cases and 355,804 participants, were included in the meta-analysis. Light alcohol drinking (0.1-7 drinks/week) was inversely associated with risk of HF (RR, 0.86; 95% confidence interval, 0.81-0.90). There was no statistically significant association between moderate (7.1-14 drinks/week), high (14.1-28 drinks/week), or heavy (>28 drinks/week) alcohol consumption and HF risk. Former drinking was associated with an increased risk of HF compared with never or occasional drinking (RR, 1.22; 95% confidence interval, 1.11-1.33). CONCLUSIONS This meta-analysis found that light alcohol drinking was associated with a lower risk of HF. Former drinking was associated with a higher risk of HF.
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McManus DD, Yin X, Gladstone R, Vittinghoff E, Vasan RS, Larson MG, Benjamin EJ, Marcus GM. Alcohol Consumption, Left Atrial Diameter, and Atrial Fibrillation. J Am Heart Assoc 2016; 5:JAHA.116.004060. [PMID: 27628571 PMCID: PMC5079048 DOI: 10.1161/jaha.116.004060] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Alcohol consumption has been associated with atrial fibrillation (AF) in several epidemiologic studies, but the underlying mechanisms remain unknown. We sought to test the hypothesis that an atrial myopathy, manifested by echocardiographic left atrial enlargement, explains the association between chronic alcohol use and AF. Methods and Results We evaluated the relationship between cumulative alcohol consumption and risk of incident AF in 5220 Offspring and Original Framingham Heart Study participants (mean age 56.3 years, 54% women) with echocardiographic left atrial size measurements. The incidence of AF was 8.4 per 1000 person‐years, with 1088 incident AF cases occurring over a median 6.0 years (25th–75th percentiles 4.0–8.7 years) of follow‐up. After multivariable adjustment for potential confounders, every additional 10 g of alcohol per day (just under 1 drink per day) was associated with a 0.16 mm (95% CI, 0.10–0.21 mm) larger left atrial dimension. Also in multivariable adjusted analysis, every 10 g per day of alcohol consumed was associated with a 5% higher risk of developing new‐onset AF (hazard ratio, 1.05; 95% CI, 1.01–1.09). An estimated 24% (95% CI, 8–75) of the association between alcohol and AF risk was explained by left atrial enlargement. Conclusions Our study of a large, community‐based sample identified alcohol consumption as a predictor of left atrial enlargement and subsequent incident AF. Left atrial enlargement may be an intermediate phenotype along the causal pathway linking long‐term alcohol consumption to AF.
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Affiliation(s)
- David D McManus
- Framingham Heart Study, Framingham, MA Cardiovascular Medicine Division, Departments of Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Xiaoyan Yin
- Framingham Heart Study, Framingham, MA Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Rachel Gladstone
- Division of Cardiology, Department of Medicine, University of California at San Francisco, CA
| | - Eric Vittinghoff
- Division of Cardiology, Department of Epidemiology and Biostatistics, University of California at San Francisco, CA
| | - Ramachandran S Vasan
- Framingham Heart Study, Framingham, MA Preventive Medicine and Cardiology Sections, Boston University School of Medicine, Boston, MA
| | - Martin G Larson
- Framingham Heart Study, Framingham, MA Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Emelia J Benjamin
- Framingham Heart Study, Framingham, MA Department of Epidemiology, Boston University School of Public Health, Boston, MA Preventive Medicine and Cardiology Sections, Boston University School of Medicine, Boston, MA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California at San Francisco, CA
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10
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Li Z, Guo X, Bai Y, Sun G, Guan Y, Sun Y, Roselle AM. The Association Between Alcohol Consumption and Left Ventricular Ejection Fraction: An Observational Study on a General Population. Medicine (Baltimore) 2016; 95:e3763. [PMID: 27227945 PMCID: PMC4902369 DOI: 10.1097/md.0000000000003763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The results of previous studies on the relation between alcohol consumption and heart failure (HF) have been inconsistent. This study aimed to evaluate the association between alcohol consumption and left ventricular ejection fraction (LVEF) in a general population.A total of 10,824 adults were examined using a multistage cluster sampling method to select a representative sample of individuals who were at least 35-years old. The participants were asked to provide information about their alcohol consumption. Echocardiograms were obtained, and LVEF was calculated using modified Simpson's rule.Of the 10,824 participants included in the present study, 46.1% were males, and the mean participant age was 54 years; age ranged from 35 to 93 years. The overall prevalence of LVEF< 0.50 and LVEF < 0.40 in the studied population was 11.6% and 2.9%, respectively. The prevalence of LVEF < 0.5 and LVEF < 0.04 was higher in both the moderate and heavy drinker groups than in the nondrinker group (P <0.05). Multivariate logistic regression analyses corrected according to the different levels of alcohol consumption showed that moderate and heavy drinkers had an -1.3-fold and 1.2-fold higher risk of LVEF <0.5, respectively, than nondrinkers (OR: 1.381, 95% CI: 1.115-1.711, P = 0.003 for moderate drinkers; OR: 1.246, 95% CI: 1.064-1.460, P = 0.006 for heavy drinkers). Heavy drinkers had an ∼1.5-fold higher risk of decreased LVEF < 0.4 than nondrinkers (OR: 1.482, 95% CI: 1.117-1.965, P = 0.006). Moderate drinkers did not show a risk of decreased LVEF < 0.4 that was significantly higher than that of nondrinkers (OR: 1.183, 95% CI: 0.774-1.808, P = 0.437).According to these results, we concluded that increased alcohol consumption was associated with decreased LVEF compared with no alcohol consumption in this general population.
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Affiliation(s)
- Zhao Li
- From the Department of Cardiology (ZL, XG, GS, YS), the First Hospital of China Medical University; Department of Maternal and Child Health (YB), School of Public Health, China Medical University, Shenyang, Liaoning, China; and Department of Cardiology (YG, AMR), Johns Hopkins University, Baltimore, MD
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Clustering of lifestyle characteristics and their association with cardio-metabolic health: the Lifestyles and Endothelial Dysfunction (EVIDENT) study. Br J Nutr 2015; 114:943-51. [DOI: 10.1017/s0007114515002500] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractLittle is known about the clustering patterns of lifestyle behaviours in adult populations. We explored clusters in multiple lifestyle behaviours including physical activity (PA), smoking, alcohol use and eating habits in a sample of adult population. A cross-sectional and multi-centre study was performed with six participating groups distributed throughout Spain. Participants (n 1327) were part of the Lifestyles and Endothelial Dysfunction (EVIDENT) study and were aged between 20 and 80 years. The lifestyle and cardiovascular risk (CVR) factors were analysed using a clustering method based on the HJ-biplot coordinates to understand the variables underlying these groupings. The following three clusters were identified. Cluster 1: unhealthy, 677 subjects (51 %), with a slight majority of men (58·7 %), who were more sedentary and smokers with higher consumption of whole-fat dairy products, bigger waist circumference as well as higher TAG levels, systolic blood pressure (SBP) and CVR. Cluster 2: healthy/PA, 265 subjects (20 %), including 24·0 % of males with high PA. Cluster 3: healthy/diet, including 29 % of the participants, with a higher consumption of olive oil, fish, fruits, nuts, vegetables and lower alcohol consumption. Using the unhealthy cluster as a reference, and after adjusting for age and sex, the multiple regression analysis showed that belonging to the healthy/PA cluster was associated with a lower waist circumference, body fat percentage, SBP and CVR. In summary, the three clusters were identified according to lifestyles. The ‘unhealthy’ cluster had the least favourable clinical parameters, the ‘healthy/PA’ cluster had good HDL-cholesterol levels and low SBP and the ‘healthy/diet’ cluster had lower LDL-cholesterol levels and clinical blood pressure.
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