VF Risk at STEMI Rises with Above-Moderate Alcohol Intake

May 14, 2014

SAN FRANCISCO, CA — Anyone drinking more than modestly, no more than a glass of wine or one shot of whiskey per day, has a significantly increased risk of sudden cardiac death (SCD) over that of nondrinkers, should they suffer an ST-segment-elevation MI, suggests a case-control study of STEMI patients presenting to Denmark hospitals over several years[1].

Despite the popular perception and observational evidence that modest drinking can protect against heart disease, at least in the general population, "It's a risk factor for cardiac arrest when you have a myocardial infarction," Dr Reza Jabbari (Copenhagen University Hospital, Denmark) told heartwire . Even moderate alcohol ingestion is proarrhythmic, he said, in people who go on to develop an acute MI.

Reporting here at the Heart Rhythm Society 2014 Scientific Sessions , Jabbari and his colleagues looked at people in Denmark presenting with a first acute STEMI who went on to reperfusion therapy with PCI; anyone aged >80 years was excluded. They were separated into cases (n=219) and controls (n=441) on the basis of whether or not they experienced ventricular fibrillation (VF) within the first 12 hours after symptom onset but before PCI.

Cases averaged seven units of alcohol per week—that is, seven drinks—with a unit defined as "one beer, a single measure of spirits, or a glass of wine." That compared with a mean of three among controls (p<0.001).

In multivariate analysis, alcohol intake was directly correlated with occurrence of VF: for each weekly unit of alcohol consumed, the odds ratio for VF went up 2.4% (OR 1.024, 95% CI 1.010–1.030, p=0.001). The risk in drinkers, compared with nondrinkers, was nonsignificant for up to seven drinks per week but significant for higher intake levels.

Hazard Ratio* (95% CI) for Sudden Cardiac Death by Weekly Alcohol Intake vs Nondrinkers

Weekly alcohol-intake units HR (95% CI) p
1–7 1.30 (0.80–2.20) 0.300
8–14 2.30 (1.20–4.20) 0.008
> 15 3.30 (1.80–5.90) <0.001
*Adjusted for age, sex, smoking, infarct location, atrial fibrillation, family history of sudden death, pre-STEMI statin use, hypercholesterolemia, hypertension, TIMI flow, and pre-STEMI angina
One alcohol unit (12 g) defined as one beer, a single measure of spirits, or a glass of wine

Jabbari, who cautioned that the findings are limited to a STEMI population of white European ancestry, observed that the general population isn't usually screened for sudden-death risk, so it may be prudent for people with a lot of CV risk factors to "be more careful about how much alcohol they drink during a week."

At greater than seven drinks per week, he proposed, those with hypertension, hypercholesterolemia, atrial fibrillation, and/or a family history of sudden death, for example, might well consider they will be at increased risk of dying should they have a heart attack. Moreover, the guidelines should possibly be adjusted to restrict sanctioned intake, especially in men, to less than one drink per day for those with multiple CV risk factors.

Neither Jabbari nor his coauthors had disclosures.

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