Excess drinking is a major atrial fibrillation risk factor in young people.
Alcohol may increase the risk of atrial fibrillation (AF) among those 20 to 39 years of age, according to a new study published in JAMA Network Open. The World Health Organization reported that 13.5% of deaths among this age group are related to alcohol consumption. Approximately 48.5% of all heavy drinkers are young adults between 20 and 24 years of age.
“People who drink heavily for 4 consecutive years are probably more likely to drink heavily during rest of their lives, and prolonged exposure to large amounts of alcohol during young ages might lead to left atrial remodeling, a well-known mechanism by which alcohol triggers atrial fibrillation,” the study authors wrote.
AF is associated with cardiovascular disease risk, comorbidities, and can lead to stroke and heart failure. Although the study authors suggest that a globally aging population likely accounts for the rise in AF cases, alcohol is a known risk factor. Alcohol has been found to trigger stimulation the sympathetic nervous system and slows the interatrial electrical conduction concomitant. A severe risk associated with AF is ischemic stroke.
The study authors evaluated participants longitudinally over 4 years in what they believe is the largest study on young adults looking at the relationship between heavy alcohol consumption and AF. Researchers assigned a primary outcome as a new diagnosis of atrial fibrillation during the approximate 6-year follow-up period.
Using the Korean National Health Information Database (NHID), researchers performed a nationwide population-based cohort study of 1,537,836 adults aged 20 to 39 years who never had AF. Covariates were age, sex, underlying comorbidities, body mass index (BMI), smoking status, physical activity, and income level.
Between 2009 and 2012, patients attended 4 health examinations. They scored points associated with cumulative burden of alcohol consumption. Researchers also assigned points, adding 1 per year of moderate to heavy drinking. With this evaluation, the semiquantitative cumulative burden was 0 for people who drank no alcohol, 1 (mild; less than 105 g per week), 2 (moderate; 105-210 g per week), and 3 (heavy; more than 210 g per week).
Participating in 4 or more years of moderate to heavy drinking increased the risk of AF by 25% compared to non or mild drinkers. Among persistent heavy drinkers, this risk was 47% greater than nondrinkers.
During the follow-up period, more than 3000 participants were diagnosed with new-onset AF.
“Generally, participants with a higher cumulative burden of alcohol during the 4-year period showed a higher IR (incidence rate) for AF than those with no burden,” the study authors wrote. Just a score of 1 increased the risk of AF by 14% compared to the non-drinkers who scored 0.
This study has some limitations, one being the possible overestimation or underestimation of diagnoses. Other limitations include homogeneity of participants, all of whom were Asian. The study was self-reported and reflects individual biases, and the results may not account for all comorbidities, according to the authors.
“Young adults with heavy drinking habits should be educated about the hazardousness of AF and its association with heavy drinking,” the investigators concluded in the study.
Han, Minju, Lee, So-Ryoung, Choi, Eue-Keun, et al. Habitual Alcohol Intake and Risk of Atrial Fibrillation in Young Adults in Korea. JAMA Netw Open. 2022;5(9):e2229799. doi:10.1001/jamanetworkopen.2022.29799