Drinking more than 10 alcohol units per week increases the risk of atrial fibrillation in persons with hypertensive heart disease

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.


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