More Than Moderate Alcohol Not Good For The Heart Interview with:

Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS Director of Clinical Research Division of Cardiology Endowed Professor of Atrial Fibrillation Research University of California, San Francisco

Dr. Gregory M Marcus

Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS
Director of Clinical Research
Division of Cardiology
Endowed Professor of Atrial Fibrillation Research
University of California, San Francisco What is the background for this study? What are the main findings?

Response: Moderate alcohol consumption has previously been associated with a decreased risk of heart attack. However, as we have previously shown that individuals who believe alcohol to be good for the heart tend to drink more, there is a concern that these previous data might appear to justify excessive alcohol consumption.

In addition, previous research on the topic of alcohol consumption and heart disease has relied almost entirely on participant self-report, which is known to be particularly unreliable among heavy drinkers. Finally, previous research has sought to study relationships between alcohol and various types of heart disease, but there has not been an emphasis on individual-level characteristics that might influence these relationships. What should readers take away from your report?

Response: The take home message here is that more is not necessarily “better.” We have shown here that not only does excessive alcohol substantially increase the risk for atrial fibrillation and heart failure, but also heart attack, the one phenomenon that previous data has suggested might be mitigated by moderate alcohol consumption.

There is an important silver lining here that we hope to emphasize. Heart disease is now the most common cause of death worldwide, and both atrial fibrillation and heart failure in particular are becoming more significant diseases in the US and around the world. We need to identify readily modifiable risk factors for these diseases. While treating alcohol abuse may not be easy in many circumstances, it is at least theoretically a risk factor that can be modified. We found that alcohol abuse appears to have as strong an influence on heart attack, atrial fibrillation, and heart failure as many other well established risk factors such as diabetes and high blood pressure. The good news is that by the nature of our study design, every single patient with alcohol abuse in our study had already been identified and documented as such in at least one healthcare encounter.

Therefore, this is an important population that may be primed for interventions that could subsequently have a substantial impact in reducing heart attacks, atrial fibrillation, and heart failure. What recommendations do you have for future research as a result of this study?

Response: The next step is two-fold:

First, further investigation into the mechanisms underlying these relationships might reveal novel findings relevant to preventive and therapeutic strategies.

Second, interventions to mitigate excessive alcohol intake and to help individuals with alcohol abuse should be studied in the hopes of substantially reducing the risk of heart attack, atrial fibrillation, and heart failure. Is there anything else you would like to add?

Response: We sought to better understand the mechanisms underlying the relationships between alcohol and heart disease by identifying patient characteristics that might influence the risk of particular types of heart disease in the presence or absence of alcohol abuse. We could identify no patient characteristic that afforded any protection against the harmful effects of alcohol abuse on the risk of heart attack, atrial fibrillation, or heart failure. Those without any known risk factors for these diseases had a higher relative risk of developing each type of heart disease when they abused alcohol. However, alcohol abuse also heightened the risk for heart attack, atrial fibrillation, and heart failure when any conventional risk factors were present.

I receive funding from the NIH and NIAAA to investigate the mechanisms underlying the relationship between alcohol and atrial fibrillation. Thank you for your contribution to the community.

JACC Alcohol Abuse and Cardiac Disease
Journal of the American College of Cardiology

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on January 2, 2017 by Marie Benz MD FAAD