In patients with newly diagnosed atrial fibrillation (AF), current alcohol consumption was associated with a higher risk of ischemic stroke than patients who never drank or stopped drinking after their diagnosis, according to a population-based cohort study published in the European Heart Journal .
For the study, the investigators analyzed patient data from the Korean National Health Insurance Service (KNHIS) and the National Health Screening database linked to the KNHIS. The study included patients 20 years of age and older who were newly diagnosed with atrial fibrillation from January 1, 2010 to December 31, 2016 and who had a health evaluation within 2 years before and after their diagnosis.
Investigators divided the patients into 3 alcohol consumption groups based on patient-reported questionnaires during the 2 health exams: nondrinkers; Abstainers from alcohol after AF diagnosis; and current drinkers, including persistent drinkers and new drinkers after the AF diagnosis. Investigators collected data on the amount of alcohol consumption per week using patient questionnaires and classified alcohol consumption as mild (0 to <105 g), moderate (105 to <210 g) and heavy (210 g or more).
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The primary endpoint was the incidence of ischemic stroke during the follow-up period. Investigators tracked patients from the second health evaluation within 2 years of their AF diagnosis to the onset of an ischemic stroke, death, or the end of the study period on December 31, 2017, whichever comes first.
Of 97,869 newly diagnosed atrial fibrillation patients enrolled in the study, 51% were nondrinkers, 13% were abstainers, and 36% were current drinkers. The mean age was 61.3 years and 62.4% were men. During the 310,926 person-years follow-up, 3120 patients (10 per 1000 person-years) were diagnosed with ischemic stroke. After 5 years of follow-up, abstainers and nondrinkers were associated with a lower risk of ischemic stroke than current drinkers, with a difference in incidence rate (by inverse probability of treatment weighting) [IPTW]) of −2.03 (−3.25 to −0.82) for teetotalers and −2.98 (−3.81 to −2.15) for non-drinkers per 1000 person-years; and incidence rate ratios (according to IPTW) of 0.75 (0.70 to 0.81) for non-drinkers and 0.83 (0.74 to 0.93) for abstainers versus current drinkers.
Of the current drinkers, 58.8% were mild drinkers, 23.5% were moderate drinkers, and 17.8% were heavy drinkers at the second health check-up. Previous heavy drinkers had a significantly higher risk of ischemic stroke than nondrinkers, even if they had stopped drinking after their AF diagnosis (adjusted hazard ratio [aHR], 1,433; 95% CI, 1,122-1,831).
All current drinkers had a significantly higher risk of ischemic stroke compared to nondrinkers regardless of the amount of alcohol they consumed weekly, and there was a linear dose-response relationship between the amount of current alcohol consumption and the risk for one ischemic stroke.
Given the significant number of newly diagnosed AF patients who continued to be alcoholics in this study (36%), and given the research linking alcohol use to the incidence of stroke in AF, the study authors encouraged the inclusion of “Lifestyle changes in the treatment of patients with AF ”with a focus on“ proactive reduction and abstinence from alcohol consumption ”.
The study was limited by its focus on ischemic stroke rather than hemorrhagic stroke because of the way data was reported in the source databases.
Disclosure: Some study authors stated links with biotech, pharmaceutical, and / or device companies. For a full list of specifications, see the original reference.
reference
Lee SR, Choi EK, Jung JH, Han KD, Oh S, Lip GYH. Lower risk of stroke after alcohol abstinence in patients with atrial fibrillation: a nationwide population-based cohort study. Published online June 7, 2021. Eur Heart J. doi: 10.1093 / eurheartj / ehab315
This article originally appeared on The Cardiology Advisor
