Risk Thresholds for Total and Beverage-Specific Alcohol Consumption and Incident Atrial Fibrillation.

Objectives: This study sought to characterize associations of total and beverage-specific alcohol consumption with incident atrial fibrillation (AF).
Background: Although binge drinking and moderate to high consumption of alcohol are both established risk factors for AF, comparatively less is known about the effect of low alcohol consumption and whether associations differ by specific alcoholic beverages.
Methods: Using data from the UK Biobank, total and beverage-specific alcohol consumption was calculated as UK standard drinks (8 g alcohol) per week. Past drinkers and those with a history of AF were excluded. Incident AF events were assessed through hospitalization and death records, and dose-response associations were characterized using Cox regression models with correction for regression dilution bias.
Results: We studied 403,281 middle-aged individuals (52.4% female). Over a median follow-up time of 11.4 years (IQR: 10.7-12.3 years), a total of 21,312 incident AF events occurred. A J-shaped association of total alcohol consumption was observed, with lowest risk of AF with fewer than 7 drinks/week. Beverage-specific analyses demonstrated harmful associations of beer/cider consumption with any consumption. In contrast, consumption of red wine, white wine, and spirits up to 10, 8, and 3 drinks/week, respectively, was not associated with increased risk.
Conclusions: In this predominantly White population, low levels of alcohol consumption (<7 U.K. standard drinks [56 g alcohol]/week) were associated with lowest AF risk. Low consumption of red and white wine and very low consumption of spirits may not be associated with increased AF risk, whereas any consumption of beer/cider may be associated with harm. These findings may have important implications for the primary prevention of AF that should be explored in future studies.
Competing Interests: Funding Support and Author Disclosures Dr Gallagher is supported by a Postdoctoral Fellowship from the University of Adelaide. Dr Elliott is supported by an Early Career Fellowship from the National Heart Foundation of Australia. Dr Linz is supported by the Beacon Research Fellowship from the University of Adelaide. Mr Pitman is supported by a Postgraduate Scholarship from the Hospital Research Foundation. Dr Hendriks is supported by an Early Career Fellowship from the National Heart Foundation of Australia and the Derek Frewin Lectureship from the University of Adelaide. Dr Lau is supported by the Robert J. Craig Lectureship from the University of Adelaide. Dr Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia. Dr Wong is supported by a Mid-Career Fellowship from the Hospital Research Foundation and a Postdoctoral Fellowship from the National Heart Foundation of Australia. Dr Hendriks reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Medtronic and Pfizer/Bristol Myers Squibb. Dr Lau reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Abbott Medical, Bayer, Biotronik, Boehringer Ingelheim, Medtronic, Microport, and Pfizer/Bristol Myers Squibb. Dr Sanders has served on the Advisory Boards of Medtronic, Abbott Medical, Boston Scientific, CathRx, and PaceMate; reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Medtronic, Abbott Medical, and Boston Scientific; and reports that the University of Adelaide has received on his behalf research funding from Medtronic, Abbott Medical, Boston Scientific, and Microport. Dr Wong reports that the University of Adelaide has received on his behalf lecture, travel, and/or research funding from Abbott Medical, Bayer, Boehringer Ingelheim, Medtronic, Novartis, Servier, St Jude Medical, and Vifor Pharma. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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