A recent study now seems to offer conclusive answers to the question- is one alcoholic drink still okay for patients with atrial fibrillation (AFib). Turns out, the answer doesn't just depend on the number of alcoholic drinks, but on the type too.

Even as binge drinking and moderate to high alcohol use are both recognised risk factors for atrial fibrillation (AFib), nothing is known regarding the effect of modest alcohol intake, and one of the most frequent questions physicians encounter when treating patients with atrial fibrillation is "Can I just have one drink daily?".

To address this often asked question, Tu et al. has shown in a recent observational study published in JACC Clinical Electrophysiology that modest levels of alcohol intake (7 UK standard drinks [56 g alcohol]/week) were linked with the lowest incidence of AF. Consumption of small quantities of alcohol seemed to protect against AF, however, this protection was mostly seen with wine intake and was not noticed with beer intake.

When examining the connection between alcohol and a range of health outcomes, including acute coronary syndrome, heart failure, and even total mortality, the J-shape correlation has been consistently found. If moderate alcohol intake is linked with a decrease in the risk of these critical endpoints, shouldn't it also be associated with a reduction in the chance of AFib?

The purpose of this research was to investigate the relationships between total and beverage-specific alcohol intake and incidence atrial fibrillation.

Alcohol intake was estimated in terms of UK standard drinks (8 g alcohol) per week using data from the UK Biobank. Individuals who had used alcohol in the past and those with a history of AFib were excluded. The incidence of AFib episodes was determined using hospitalisation and death data, and dose-response relationships were identified.

1. During a median follow-up period of 11.4 years, 403,281 individuals had a total of 21,312 incident AF episodes.
2. A J-shaped relationship between total alcohol intake and risk of AFib was found, with less than seven drinks per week conferring the lowest risk of AFib.
3. Beverage-specific studies revealed negative correlations between beer/cider intake and other types of consumption.
4. In comparison, intake of red wine, white wine, and spirits up to ten, eight, or three drinks per week was not linked with an elevated risk.

What do I inform my patients?

Dewland et al write in an accompanying editorial,

"However, it should be noted that the present study does not always advocate the acceptance of alcohol intake to decrease AFib risk, since it is unclear whether non-drinkers who intentionally consume modest amounts of alcohol would enjoy comparable protection."

The decrease in risk of AF associated with moderate wine intake, but not beer intake, will fuel debate about the beneficial or hazardous chemicals included in these beverages.

Dewland et al further stress,

"The message for secondary AF prevention should be abstention from alcohol, particularly if alcohol is a personal triggering for acute AF events. For primary AF prevention, it is conceivable that considerable alcohol intake is acceptable, although the precise threshold is unknown and is almost certainly extremely low."

This research may have significant consequences for the primary prevention of AF to be studied in future trials.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.