COMMENTARY

Alcohol, AFib, and Women: A Hazardous Mix?

JoAnn E. Manson, MD, DrPH

Disclosures

February 18, 2020

This transcript has been edited for clarity.

Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital in Boston, Massachusetts. I'd like to talk with you about a recent report in the New England Journal of Medicine that provides the most compelling evidence to date that alcohol consumption is causally related to atrial fibrillation (AF), and that by reducing or abstaining from alcohol, the burden from AF can be reduced.

Previous epidemiologic studies have shown evidence of a link between alcohol consumption and AF—even a dose-response gradient—but this is the first time that a randomized trial has shown that reducing alcohol consumption can lower the burden of AF.

This randomized trial was conducted in Australia. It was a small trial—only 140 participants—and all had to have at least two prior episodes of AF (either paroxysmal or persistent) and had to be in normal sinus rhythm at baseline, receiving rhythm-control therapy. About one third were post ablation therapy. They also had to have a moderate to high alcohol consumption. On average, they had about 17 drinks per week or a little more than two drinks per day. They had to agree to be randomized to modify their alcohol consumption.

One half were randomized to continue their usual alcohol intake and the other half had to abstain from alcohol. During the 6-month follow-up period, there was good separation between the two groups in terms of alcohol consumption. The control group continued to have an average of about two drinks per day (about 13 drinks per week) and the intervention group had on average about two drinks per week, and 61% were totally abstinent from alcohol consumption.

Over the follow-up period, there was a lower rate of AF occurrence, longer time to recurrence, lower overall burden of AF in terms of time in AF, and a lower rate of hospitalization for AF in the group that was randomized to abstain from alcohol and had lowered their alcohol intake.

This randomized trial provides strong evidence that alcohol consumption is a modifiable risk factor for AF and AF recurrence, and that it's important to counsel our patients about this association and encourage alcohol reduction in those with recurrent AF, especially those who have moderate to high alcohol consumption, and women in particular.

Women are known to have a higher risk for stroke from AF and a higher risk for cardiovascular disease mortality. Also, alcohol has been linked to an increased risk for breast cancer, and women have a greater susceptibility to liver disease. Women metabolize alcohol more slowly, so one drink a day in a man is the equivalent of two drinks a day in a woman. Although we may encourage all of our patients with AF and moderate to high alcohol intake to reduce alcohol consumption, this may be a particularly important message for women.

Thank you so much for your attention. This is JoAnn Manson.

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