Alcohol Abuse Increases Risk of Heart Attack, Atrial Fibrillation and Heart Failure

Despite Myths, Reducing Alcohol Intake Could Reduce Cardiovascular Disease

By Scott Maier

alcohol is poured into a glassAlcohol abuse may increase the risk for heart attack, atrial fibrillation (AF) and congestive heart failure, according to UC San Francisco researchers, who say efforts to reduce this condition could result in meaningful reductions of overall cardiovascular disease.

Their study, which evaluated the health data of more than 14.7 million Americans, appears in the Jan. 10, 2017, issue of the Journal of the American College of Cardiology (JACC).

“While generally believed that alcohol is protective against heart attacks, these findings demonstrate that excessive alcohol consumption may actually substantially increase risk,” said senior author Gregory Marcus, MD, MAS, a UCSF Health cardiologist and director of clinical research in the UCSF Division of Cardiology. “And, while alcohol as a risk factor for AF and heart failure has long been known, we sought to leverage these millions of patient records to provide an assessment of the patient characteristics that might influence that risk.”

Despite advances in prevention and treatments, cardiovascular disease continues to be the most prevalent threat to U.S. health, comprising more than a quarter of all deaths. More than 500,000 Americans suffered a first-time heart attack in 2015, and an estimated 6 million are affected by AF, the most common cardiac arrhythmia. There also are more than 870,000 new congestive heart failure diagnoses annually.

With an aging population and better detection techniques, all three diseases are on the rise, leading to a combined projected cost of nearly $400 billion per year by 2030.

Alcohol and Heart Health

Alcohol is the most commonly consumed U.S. drug. Several studies have suggested moderate levels of alcohol consumption may help prevent heart attacks and congestive heart failure. However, even low to moderate levels of consumption has been shown to increase AF.

“Alcohol in excess should not be considered cardio-protective but rather cardio-toxic, contributing to heightened risk for all three major, yet distinct, cardiac adverse outcomes,” said Marcus, endowed professor of AF research in the UCSF School of Medicine. “Treatment of alcohol abuse should be recognized as part of a preventive strategy in modifying the risk of cardiac disease.”

Gregory Marcus
Gregory Marcus, MD, MAS

An estimated 10 million to 15 million Americans suffer from alcohol abuse. Alcohol abuse is a pattern of drinking resulting in harm to one’s health, interpersonal relationships or ability to work.

In their JACC study, Marcus and his colleagues utilized the Healthcare Cost and Utilization Project (HCUP) to analyze California residents age 21 and older who received ambulatory surgery, emergency or inpatient medical care in the state from 2005 to 2009.

Considered the nation’s most comprehensive source of hospital data, HCUP is a family of databases and related software tools and products sponsored by the Agency for Healthcare Research and Quality. The databases include codes for alcohol abuse.

The researchers identified subgroups associated with heart attack, AF and congestive heart failure and determined the risk of an alcohol abuse diagnosis on these three diseases. They then compared them with already established cardiovascular risk factors, such as high blood pressure and diabetes.

Abuse Associated with Increased Risks

Among 14,727,591 residents in the database, 268,084 (1.8 percent) were coded with an alcohol abuse diagnosis. The researchers’ analysis found that alcohol abuse was associated with an increased risk of heart attack, AF and congestive heart failure of at least a similar magnitude to well-established risk factors for each disease.

Specifically, those California residents with alcohol abuse had more than three times the risk of AF, much higher than the majority of well-established risk factors. For heart attack and congestive heart failure, the risk from alcohol abuse was similar to multiple well-established risk factors such as diabetes and high blood pressure.

Further, individuals without the conventional risk factors for cardiovascular disease exhibited a disproportionately enhanced risk for all three conditions.

Extrapolating data to the estimated prevalence of each disease, the complete eradication of alcohol abuse could result in more than 73,000 fewer cases of atrial fibrillation, 34,000 fewer heart attacks and 91,000 fewer congestive heart failure patients in the United States.

Among the study limitations, the researchers note that the data cannot prove causality, and they were unable to determine the specific quantity of alcohol that may be harmful. However, they point out the patients with alcohol abuse used in this study already have been identified by the health care system as having a problem with alcohol. They further highlight that unlike the great majority of research examining the health effects of alcohol, the current study does not rely on individuals or patients self-reporting the amount they drink. They said more research is needed to understand the mechanisms by which alcohol influences the risk of cardiac disease in specific populations.

Other contributors to the JACC study were lead author Isaac Whitman, MD, Gregory Nah, MA, and Eric Vittinghoff, PhD, of UCSF; Vratika Agarwal, MD, Staten Island University Hospital; Jonathan Dukes, MD, Cardiology Associates Medical Group and former UCSF cardiology clinical fellow; and Thomas Dewland, MD, Oregon Health & Science University and former UCSF resident and cardiology electrophysiology fellow.

Financial support was provided by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under award number R01AA022222 and 1F32HL129759-01.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises three top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospitals in San Francisco and Oakland, and other partner and affiliated hospitals and healthcare providers throughout the Bay Area.