The next issue of The Medical Letter will celebrate the arrival of a new guideline from the American College of Cardiology and the American Heart Association by devoting the entire issue to atrial fibrillation, which is often referred to as the most common arrhythmia in the world. This year’s guideline puts considerable emphasis on the modification of risk factors for this arrhythmia (a long-ago campaign to call it a dysrhythmia, which would of course be more accurate, never caught on). Among those risk factors, alcohol stands out, not only as the best known (the holiday heart syndrome) but also as a possible contributor to several of the others (obesity, hypertension, inactivity, sleep apnea).
Ruffling through PubMed, I came across an interesting article from the Journal of the American College of Cardiology with the same title as you see at the top of this page, but with the intriguing subtitle, “A Sobering Review.” The article (A Voskoboinik et al. J Am Coll Cardiol 2016; 68:267) included many interesting facts, beginning with the information from a survey that 53% of Americans regularly consume alcohol (no surprise there), but also that 44% of drinkers consumed at least 5 drinks on a single occasion in the last month of the survey, which qualifies as binge drinking. A meta-analysis of 7 studies in a total of more than 850,000 subjects found that each extra alcoholic drink per day was associated with an 8% increase in the incidence of atrial fibrillation. Among patients who already have atrial fibrillation, alcohol is the strongest predictor of recurrence, and moderate to heavy consumption of alcohol is the strongest risk factor for progression from paroxysmal to permanent atrial fibrillation. For the latest guidance on the management of atrial fibrillation, watch for the next issue of The Medical Letter.
It sounds as though the best medical advice for patients with atrial fibrillation would be not to drink. It would be interesting to know what percentage of practitioners dispense that advice to their patients. For a useful article on treatment of alcohol use disorder, see our article on this subject.
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