• Philipp Reddiess, Stefanie Aeschbacher, Pascal Meyre, Michael Coslovsky, Michael Kühne, Nicolas Rodondi, Oliver Baretella, Jürg H Beer, Richard Kobza, Giorgio Moschovitis, Marcello Di Valentino, Cyrill Müller, Fabienne Steiner, Leo H Bonati, Christian Sticherling, Stefan Osswald, David Conen, and BEAT-AF and Swiss-AF investigators.
• Cardiovascular Research Institute Basel (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald, Conen); Cardiology Division (Reddiess, Aeschbacher, Meyre, Coslovsky, Kühne, Müller, Steiner, Sticherling, Osswald); Clinical Trial Unit Basel, Department of Clinical Research (Coslovsky), University Hospital Basel, Switzerland; Institute of Primary Health Care (BIHAM) (Rodondi), University of Bern; Department of General Internal Medicine (Rodondi), Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine (Beer), Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zürich, Switzerland; Department of Cardiology (Kobza), Luzerner Kantonsspital, Switzerland; Department of Cardiology (Moschovitis), EOC Ospedale Regionale di Lugano, Switzerland; Department of Cardiology (Di Valentino), EOC Ospedale San Giovanni, Bellinzona, Switzerland; Department of Neurology and Stroke Center (Bonati), University Hospital Basel, University of Basel, Switzerland; Population Health Research Institute (Conen), McMaster University, Hamilton, Ont.
• CMAJ. 2021 Jan 25; 193 (4): E117-E123.

BackgroundLittle is known about the association between alcohol consumption and risk of cardiovascular events in patients with established atrial fibrillation (AF). The main aim of the current study was to investigate the associations of regular alcohol intake with incident stroke or systemic embolism in patients with established AF.MethodsTo assess the association between alcohol consumption and cardiovascular events in patients with established AF, we combined data from 2 comparable prospective cohort studies that followed 3852 patients with AF for a median of 3.0 years. Patients were grouped into 4 categories of daily alcohol intake (none, > 0 to < 1, 1 to < 2 and ≥ 2 drinks/d). The primary outcome was a composite of stroke and systemic embolism. Secondary outcomes were all-cause mortality, myocardial infarction, hospital admission for acute heart failure, and a composite of major and clinically relevant nonmajor bleeding. Associations were assessed using time-updated, multivariable-adjusted Cox proportional hazards models.ResultsMean age (± standard deviation) was 71 ± 10 years (28% were women and 84% were on oral anticoagulants). We observed 136 confirmed strokes or systemic emboli. Compared with nondrinkers, adjusted hazard ratios for the primary outcome event were 0.87, 95% confidence interval (CI) 0.55-1.37 for > 0 to < 1 drinks/d; 0.70, 95% CI 0.39-1.25 for 1 to < 2 drinks/d; and 0.96, 95% CI 0.56-1.67 for ≥ 2 drinks/d (p for linear [quadratic] trend 0.71 [0.22]). There was no significant association between alcohol consumption and bleeding, but there was a nonlinear association with heart failure (p for quadratic trend 0.01) and myocardial infarction (p for quadratic trend 0.007).InterpretationIn patients with AF, we did not find a significant association between low to moderate alcohol intake and risk of stroke or other cardiovascular events. Our findings do not support special recommendations for patients with established AF with regard to alcohol consumption.Trial RegistrationClinicalTrials.gov, no. NCT02105844.© 2021 Joule Inc. or its licensors.

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