Alcohol Abuse and Cardiac Disease

Abstract

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.

Keywords: alcohol abuse; atrial fibrillation; congestive heart failure; epidemiology; myocardial infarction.

Central Illustration. Alcohol Abuse and Cardiac Disease: Risk, Patient Characteristics, and Population Attributable Risk

Absolute Risk of Atrial Fibrillation, Myocardial Infarction, or Congestive Heart Failure, Stratified by Presence or Absence of Risk Factors and Presence or Absence of Alcohol Abuse. CAD, coronary artery disease; CHF, congestive heart failure; CKD, chronic kidney disease; DL, dyslipidemia; DM, diabetes; OSA, obstructive sleep apnea; Smoking, current cigarette smoking; VHD, valvular heart disease. Age dichotomized to Age < 60 versus ≥ 60, and race dichotomized to White Race versus Non-White Race for analysis.

Figure 1. Cumulative Probability of Atrial Fibrillation, Myocardial Infarction, and Congestive Heart Failure by Presence or Absence of Alcohol Abuse

These curves were generated under a proportional hazards assumption. Each model is adjusted for age, sex, race, hypertension, diabetes, coronary artery disease (for the AF and CHF outcomes), congestive heart failure (for the AF and MI outcomes), chronic kidney disease, valvular heart disease (for the AF and CHF outcomes), dyslipidemia, obesity, obstructive sleep apnea, cigarette smoking, and income.

Figure 2. Association of alcohol abuse and known risk factors for Atrial Fibrillation, Myocardial Infarction, and Congestive Heart Failure

CAD, coronary artery disease; CHF, congestive heart failure; CKD, chronic kidney disease; DL, dyslipidemia; DM, diabetes; OSA, obstructive sleep apnea; Smoking, current cigarette smoking; VHD, valvular heart disease. White race is the referent for other racial hazard ratios. Other Race denotes patients self-identified as Asian, Pacific Islander, Native American, or Other. Patient characteristics ordered by strength of association for each given outcome, followed by race. Error bars denote 95% confidence intervals.

Figure 3. Association between Alcohol Abuse and Atrial Fibrillation, Myocardial Infarction, or Congestive Heart Failure, Stratified by Patient Characteristics

CAD, coronary artery disease; CHF, congestive heart failure; CKD, chronic kidney disease; DL, dyslipidemia; DM, diabetes; OSA, obstructive sleep apnea; Smoking, current cigarette smoking; VHD, valvular heart disease. Age dichotomized to Age < 60 versus ≥ 60, and race dichotomized to White Race versus Non-White Race for analysis. Error bars denote 95% confidence intervals.

Figure 4. Population attributable risk of alcohol abuse and other modifiable risk factors for Atrial Fibrillation, Myocardial Infarction, and Congestive Heart Failure

Patient characteristics with negative hazard ratios in the Cox proportional hazard adjusted model were excluded from the figure: obstructive sleep apnea (from MI), dyslipidemia (from CHF).