Alcohol consumption and risk of cardiovascular outcomes and bleeding in patients with established atrial fibrillation.

Reddiess, Philipp; Aeschbacher, Stefanie; Meyre, Pascal; Coslovsky, Michael; Kühne, Michael; Rodondi, Nicolas; Baretella, Oliver; Beer, Jürg H; Kobza, Richard; Moschovitis, Giorgio; Di Valentino, Marcello; Müller, Cyrill; Steiner, Fabienne; Bonati, Leo H; Sticherling, Christian; Osswald, Stefan; Conen, David (2021). Alcohol consumption and risk of cardiovascular outcomes and bleeding in patients with established atrial fibrillation. CMAJ, 193(4), E117-E123. Canadian Medical Association 10.1503/cmaj.200778

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BACKGROUND

Little is known about the association between alcohol consumption and risk of cardiovascular events in patients with established atrial fibrillation (AF). The main aim of the current study was to investigate the associations of regular alcohol intake with incident stroke or systemic embolism in patients with established AF.

METHODS

To assess the association between alcohol consumption and cardiovascular events in patients with established AF, we combined data from 2 comparable prospective cohort studies that followed 3852 patients with AF for a median of 3.0 years. Patients were grouped into 4 categories of daily alcohol intake (none, > 0 to < 1, 1 to < 2 and ≥ 2 drinks/d). The primary outcome was a composite of stroke and systemic embolism. Secondary outcomes were all-cause mortality, myocardial infarction, hospital admission for acute heart failure, and a composite of major and clinically relevant nonmajor bleeding. Associations were assessed using time-updated, multivariable-adjusted Cox proportional hazards models.

RESULTS

Mean age (± standard deviation) was 71 ± 10 years (28% were women and 84% were on oral anticoagulants). We observed 136 confirmed strokes or systemic emboli. Compared with nondrinkers, adjusted hazard ratios for the primary outcome event were 0.87, 95% confidence interval (CI) 0.55-1.37 for > 0 to < 1 drinks/d; 0.70, 95% CI 0.39-1.25 for 1 to < 2 drinks/d; and 0.96, 95% CI 0.56-1.67 for ≥ 2 drinks/d (p for linear [quadratic] trend 0.71 [0.22]). There was no significant association between alcohol consumption and bleeding, but there was a nonlinear association with heart failure (p for quadratic trend 0.01) and myocardial infarction (p for quadratic trend 0.007).

INTERPRETATION

In patients with AF, we did not find a significant association between low to moderate alcohol intake and risk of stroke or other cardiovascular events. Our findings do not support special recommendations for patients with established AF with regard to alcohol consumption.

TRIAL REGISTRATION

ClinicalTrials.gov, no. NCT02105844.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Rodondi, Nicolas

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

0820-3946

Publisher:

Canadian Medical Association

Funders:

[4] Swiss National Science Foundation ; [116] Swiss Heart Foundation = Schweizerische Herzstiftung

Language:

English

Submitter:

Christine Baumgartner

Date Deposited:

15 Mar 2021 12:27

Last Modified:

24 Mar 2021 20:51

Publisher DOI:

10.1503/cmaj.200778

PubMed ID:

33667180

BORIS DOI:

10.48350/153364

URI:

https://boris.unibe.ch/id/eprint/153364

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