Author + information
- Received July 23, 2016
- Revision received September 23, 2016
- Accepted October 4, 2016
- Published online January 2, 2017.
- Isaac R. Whitman, MDa,
- Vratika Agarwal, MDb,
- Gregory Nah, MAa,
- Jonathan W. Dukes, MDc,
- Eric Vittinghoff, PhDd,
- Thomas A. Dewland, MDe and
- Gregory M. Marcus, MD, MASa,∗ ()
- aUniversity of California-San Francisco, Division of Electrophysiology, San Francisco, California
- bDivision of Cardiology, Staten Island University Hospital, Staten Island, New York
- cCardiology Associates Medical Group, Ventura, California
- dDepartment of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California
- eKnight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- ↵∗Reprint requests and correspondence:
Dr. Gregory M. Marcus, Division of Electrophysiology, University of California-San Francisco, 505 Parnassus Avenue, M-1180B, Box 0124, San Francisco, California 94143-0124.
Background Understanding the relationship between alcohol abuse, a common and theoretically modifiable condition, and the most common cause of death in the world, cardiovascular disease, may inform potential prevention strategies.
Objectives The study sought to investigate the associations among alcohol abuse and atrial fibrillation (AF), myocardial infarction (MI), and congestive heart failure (CHF).
Methods Using the Healthcare Cost and Utilization Project database, we performed a longitudinal analysis of California residents ≥21 years of age who received ambulatory surgery, emergency, or inpatient medical care in California between 2005 and 2009. We determined the risk of an alcohol abuse diagnosis on incident AF, MI, and CHF. Patient characteristics modifying the associations and population-attributable risks were determined.
Results Among 14,727,591 patients, 268,084 (1.8%) had alcohol abuse. After multivariable adjustment, alcohol abuse was associated with an increased risk of incident AF (hazard ratio [HR]: 2.14; 95% confidence interval [CI]: 2.08 to 2.19; p < 0.0001), MI (HR: 1.45; 95% CI: 1.40 to 1.51; p < 0.0001), and CHF (HR: 2.34; 95% CI: 2.29 to 2.39; p < 0.0001). In interaction analyses, individuals without conventional risk factors for cardiovascular disease exhibited a disproportionately enhanced risk of each outcome. The population-attributable risk of alcohol abuse on each outcome was of similar magnitude to other well-recognized modifiable risk factors.
Conclusions Alcohol abuse increased the risk of AF, MI, and CHF to a similar degree as other well-established risk factors. Those without traditional cardiovascular risk factors are disproportionately prone to these cardiac diseases in the setting of alcohol abuse. Thus, efforts to mitigate alcohol abuse might result in meaningful reductions of cardiovascular disease.
Research reported in the article was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under Award Number R01AA022222 (to Dr. Marcus) and 1F32HL129759-01 (to Dr. Whitman). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 23, 2016.
- Revision received September 23, 2016.
- Accepted October 4, 2016.
- American College of Cardiology Foundation