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 Eliminating most alcohol consumption dramatically cuts the number of
episodes of the potentially-deadly heart rhythm disturbance among
moderate and heavy drinkers, according to results of a six-month
Australian study of 140 volunteers published in The New England
Journal of Medicine.
While atrial fibrillation (AF), or Afib, reappeared in 73% of the
people who averaged 13 drinks per week, the rate dropped to 53%
among patients in the abstinence group - who weren't supposed to
drink at all but, on average, consumed two drinks weekly.
In addition, among the people trying to abstain, it took longer for
their next episode of Afib to occur.
"What this study shows is the potential impact of alcohol reduction
or abstinence in people with symptomatic heart rhythm problems,"
co-author Dr. Peter Kistler of The Alfred Hospital in Melbourne told
Reuters Health by phone. People with Afib symptoms who have 10
drinks per week should be advised to abstain or reduce their alcohol
use, he said.
"Alcohol is not only a marker of increased risk of AF (as shown
before, based on observational studies), but it seems to be also a
real risk factor for AF, because if we 'treat' (in this case stop
taking alcohol), we have a significant reduction in both the AF
burden and the recurrence of AF," Dr. Renato Lopes, a professor of
medicine at Duke University Medical Center in Durham, North
Carolina, who wasn't involved in the study, said in an email.
Afib occurs when the upper chambers of the heart beat erratically.
It is the most common heart rhythm problem and a leading cause of
stroke. In some people, it comes and goes. Symptoms include
weakness, shortness of breath and palpitations.
Doctors try to treat it by controlling blood pressure and other
factors, but the new study "presents a compelling argument for
alcohol abstinence as part of the successful management of atrial
fibrillation," writes Dr. Anne Gillis of the University of Calgary
in an editorial accompanying the study. "Nevertheless, the sobering
reality is that for many persons with atrial fibrillation, total
abstinence from alcohol may be a difficult goal to achieve."
In fact, the researchers were originally planning to follow patients
for 12 months, but they couldn't find enough volunteers willing to
abstain from alcohol for that long.
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The findings are not completely surprising. Population-based
research had suggested that every drink (12 ounces of beer, 5 ounces
of wine or a 1.5 ounce of distilled spirits) increases the risk of
atrial fibrillation by 8%. The new randomized trial was designed to
be a definitive test.
The Kistler team found it typically took 120 days for Afib to
reappear in the non-drinking group versus 87 days in the group that
wasn't instructed to reduce alcohol consumption.
At the six-month mark, the hearts of the drinkers spent 1.2% of the
time in Afib versus 0.5% of the time among volunteers assigned to
abstinence.
Two thirds of the volunteers were taking antiarrhythmic drugs. The
group allowed to continue to drink reduced their alcohol consumption
a bit anyway. In the abstinence group, 61% were able to cut out
alcohol completely but one quarter of the volunteers couldn't get
their weekly consumption below two drinks per week.
"Those who completely abstained had more benefit or a greater
reduction in atrial fibrillation compared to those who reduced their
intake but continued to drink," Kistler noted. "If we had had
complete abstinence, I think the difference would have been even
greater."
The non-drinkers also lost an average of 8 pounds more than the
drinkers and saw a significant drop in blood pressure.
Doctors often advise patients that having a drink a day can be good
for the heart, but that should not apply to Afib patients, Kistler
said. Even in patients with heart disease, the new results "still
suggest that they reduce their alcohol intake substantially."
SOURCE: https://bit.ly/2tcSOJ1 The New England Journal of Medicine,
online January 1, 2020.
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