中等量の飲酒はAFのリスクを上昇させない

高血圧性心疾患患者において週10単位を超えるアルコールを飲むことにより心房細動のリスクが上昇する
Drinking more than 10 alcohol units per week increases the risk of atrial fibrillation in persons with hypertensive heart disease
高血圧のエンドポイント減少を目的としたロサルタン治療（Losartan Intervention For Endpoint reduction in Hypertension：LIFE）スタディの結果がESC 2009で発表され、大量のアルコール摂取により高血圧および左室肥大を有する患者において新規発症の心房細動のリスクが上昇することが示された。この二重盲検無作為化パラレルグループスタディでは、心電図上左室肥大の認められた高血圧患者9,193人を組み入れた（男性46%；平均年齢67歳、平均血圧174/98mmHg）。患者はロサルタンまたはアテノロールを基本とした降圧療法を受け、平均4.8年間追跡された。ベースライン時点で8,831人がAF既往歴および心電図上AF所見を有しておらず、従って、スタディ中にAFを発症するリスクを有していた。353人において新規発症のAFが心電図上認められた。これは、ベースラインの飲酒量が週10単位を超えるもので5.7%（20人）であり、飲酒量の少ない者または飲酒をしない者において3.9%（333人）であった。飲酒量が週10単位を超えることで新規発症のAFのリスクが増加した（p=0.042）。飲酒量が週10単位を超えることにより新規発症のAFのリスクが、AF新規発症の他のリスクと関係なく80%増加した（HR 1.8[1.2、2.9]、p=0.009）。
Full Text

The Losartan Intervention For Endpoint reduction in Hypertension (LIFE) study shows that high intake of alcohol is associated with an increased risk of new-onset atrial fibrillation (AF) in hypertensive patients with left ventricular hypertrophy, measured by electrocardiography (ECG).

Binge drinking can induce atrial fibrillation. Long-term moderate alcohol consumption appears not to increase the risk of new-onset AF; a threshold effect has, however, been suggested with a significantly increased risk of AF among the heaviest drinkers with an alcohol intake of more than 28-35 drinks per week.

People with atrial fibrillation (AF) have increased risk of hospitalization or death due to stroke, myocardial infarction or heart failure. The incidence of new-onset AF is increased in persons with hypertension and even more if left ventricular hypertrophy has developed. Medical treatment of hypertension reduces new-onset AF and treatment with the angiotensin receptor blocker losartan is more effective than the beta-1 selective blocker atenolol in this respect. However, it is unclear how smoking and alcohol intake influence the risk of new AF during antihypertensive treatment.

In LIFE, a double-blinded, randomized, parallel-group study, 9,193 hypertensive patients (46% men; mean age 67 years, mean blood pressure 174/98 mmHg) with ECG-documented left ventricular hypertrophy, received either losartan- or atenolol-based blood pressure lowering therapy, and were followed for a mean time of 4.8 years. The study was funded by Merck & Co and took place in Scandinavia, the United Kingdom and the United States in 1995-2001. At baseline 8,831 patients neither had a history of AF nor AF by ECG, and were thus at risk of developing this condition during the study.

ECG confirmed new-onset AF in 353 patients. This occurred in 5.7% of patients with baseline alcohol intake above 10 units per week (n = 20) versus 3.9% patients with lower or no alcohol intake (n = 333). Intake of alcohol above 10 units per week increased the risk for new-onset AF in univariate Cox regression analysis, with hazard ratio (HR) (95% CI) 1.6 (1.0, 2.5) p=0.042. In multivariate Cox regression, intake of alcohol above 10 units/week resulted in an 80% increased risk of new-onset AF (HR 1.8 (1.2, 2.9), p = 0.009) independently of the other factors associated to risk of new-onset AF (age, male gender, treatment allocation to losartan versus atenolol, and change over time in systolic blood pressure, Cornell ECG measure of left ventricular hypertrophy and heart rate). Smoking was not associated with more new atrial fibrillation, and the effect of alcohol did not interact with the effect of smoking.

"Our results show that an intake of alcohol above 10 units per week increases the risk of new-onset AF, hence drinking up to 10 alcohol units/week does not increase the risk of new-onset atrial fibrillation in hypertensive patients with ECG left ventricular hypertrophy" says Inger Ariansen.