15 Whether this pattern is related to AF risk remains to be shown.Ī strong controversy remains for the relation of alcohol consumption with AF in individuals with low alcohol consumption. 15 Whereas troponin concentrations decreased with higher alcohol consumption, NT-proBNP increased. 15 A recent study demonstrated that both biomarkers showed distinct patterns in relation to alcohol consumption. Troponin reflects myocardial injury, while N-terminal pro-B-type natriuretic peptide (NT-proBNP) indicates often chronic, subclinical wall stress. 10 Furthermore, alcohol consumption is predictive of incident HF, which itself is a risk factor for new-onset AF 4, 6 and may help explain known associations.Ĭirculating cardiac biomarkers are quantitative measures which shed light on current cardiac pathophysiology. 14 In younger individuals with low-risk factor burden and heart disease, acute excessive alcohol consumption was not associated with higher AF burden. Increased alcohol intake is accompanied by higher frequency of hypertension and obesity. 12, 13 At the same time, alcohol intake is also associated with the most prevalent risk factors of AF. Habitual alcohol intake has been related to atrial remodelling as an intermediate AF phenotype in the community. Chronic alcohol consumption is known to be correlated with changes in cardiac structure and function including cardiomyopathy.
10 Electrolyte disturbance and alterations of the acid-base balance are further pro-arrhythmic triggers. 10–13 Acute alcohol consumption induces autonomic imbalance reflected by sinus tachycardia, predisposing to arrhythmia. 1 In particular, the association at low levels of alcohol consumption is less clear.įrom a pathophysiological perspective, alcohol may exhibit direct effects on arrhythmogenesis as observed for the holiday heart syndrome. 6 The reported associations with AF range from null associations at lower regular alcohol intake, 5, 7 rather linearly increasing in large meta-analyses 8, 9 to a more J-shaped relation in women. For diseases predisposing to AF such as coronary artery disease 3 or HF 4, 5 low to moderate alcohol consumption seems to be related to a lower incidence, while higher levels of consumption are associated with an increased risk. 1, 2 The effect of alcohol on AF risk has remained ambiguous. See page 1178 for the editorial comment on this article (doi: 10.1093/eurheartj/ehaa955) IntroductionĪtrial fibrillation (AF) is an arrhythmia with a major impact on public health due to its increasing prevalence in ageing populations and its association with adverse outcomes, including stroke and heart failure (HF), with more than a doubling of mortality risk. The association between alcohol consumption and incident AF was neither fully explained by cardiac biomarker concentrations nor by the occurrence of HF.Īlcohol consumption, Atrial fibrillation, Epidemiology, Biomarkers In contrast, alcohol consumption at lower doses was associated with reduced risk of incident HF. Associations were similar across types of alcohol. In a sex- and cohort-stratified Cox regression analysis alcohol consumption was non-linearly and positively associated with incident AF. N = 5854 individuals developed AF (median follow-up time: 13.9 years). The median alcohol consumption was 3 g/day. The median age of individuals was 47.8 years, 48.3% were men.
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. 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.
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