Consumption of spirits associated with increased risk of ventricular arrhythmias

Only increased consumption of spirits was found to be associated with a higher risk of ventricular arrhythmias in regular drinkers.

Increased alcohol consumption is associated with an increased risk of ventricular arrhythmia, but this high risk is absent with other forms of alcoholic beverages. This is a key finding from a retrospective analysis carried out by a team from the Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Australia.

Higher alcohol consumption is generally considered to be cause damage the cardiovascular system, although light to moderate alcohol consumption appears to be protective. The term ‘holiday heart syndrome‘was invented to describe any alcohol-induced atrial arrhythmia and / or conduction disorder associated with heavy drinking in a person without other clinical signs of heart disease. While the relationship between atrial arrhythmias and alcohol has become well known, there is little evidence linking alcohol consumption to ventricular arrhythmias (VA). In fact, the available evidence is inconsistent, with some data showing a not significant association while other studies suggest that heavy alcohol consumption is an important factor. Furthermore, the influence of the type of alcoholic drink on VA or even sudden cardiac death (SCD) is also uncertain.

For the present study, the researchers used information held in the UK Biobank which provides data on around half a million people living in the community aged 40 to 69 across the UK. For their analysis, the researchers focused on incident cases of VA but excluded those with a history of the disease and former drinkers. The amount of alcohol consumed was reported in terms of standard drink, defined as 8 g of alcohol and the average number of standard drinks consumed per week. For alcohol consumption, the team also took into account the type of each drink consumed and created fitted regression models for several covariates such as age, sex, race, education.

Results

Data for a total of 408,712 individuals with a mean age of 58.3 years (52.1% female) were included in the analysis and who were followed for a median of 11.5 years. Median alcohol consumption for the entire cohort was 8 drinks per week, although 5.5% of the group reported never having consumed alcohol.

There were a total of 1733 incident VA events and 2044 SCD that occurred during the follow-up period. Overall, there was no statistically significant association between total alcohol consumption and risk of VA. However, when considered by type of alcoholic beverage, only alcohol consumption was linearly related to an increased risk of VA in people consuming more than 14 drinks per week (risk ratio, HR = 1.15, CI 95% 0.98 – 1.34) and this became statistically significant with more than 28 drinks per week (HR = 1.33, 95% CI 1.03 – 1.73).

For SCD, there was a U-shaped risk distribution with the lowest risk at about 7 drinks per week.

The authors concluded that they could not find an association between the total consumption of beer, cider and wine and VA and that only an increase in the consumption of spirits was linked to a higher risk. In fact, wine consumption was associated with a lower risk of sickle cell disease, although the authors suggested that these results require clarification from experimental studies.

Quote

Tu SJ et al. Alcohol consumption and the risk of ventricular arrhythmias and sudden cardiac death: an observational study of 408,712 people Heart rate 2021

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