Table 1.
Selected characteristics of published studies evaluating the association of alcohol intake with atrial fibrillation
| Source | Study Population | Study Design | Alcohol Assessment | AF Ascertainment | Follow-up | Total N | AF Events | Main Results | Adjustment Variables |
|---|---|---|---|---|---|---|---|---|---|
| Rich 198511 | Both sexes; US subjects; patients hospitalized for acute idiopathic AF and 1:1 age, sex matched inpatient controls | Matched Case- control | Medical record reviews; heavy drinker was ≥70 ml alcohol/day, documented alcohol abuse, or obvious intoxication at admission; not heavy drinker was <70 mL alcohol/day or former alcohol abuser | Incident AF (acute idiopathic AF) as ascertained via discharge diagnoses - most patients had ECGs | N/A | 128 | 64 | 62% of AF cases reported heavy alcohol use compared to 33% of controls | Age, sex |
| Koskinen 198720 | Both sexes; Finnish subjects; average age = 48; hospitalized cases of AF and age/sex matched acute, hospitalized controls | Matched case- control | Interview regarding amount of alcohol in prior week (grams) and if different from previous weeks; categorized into abstainers, 1–30 g/day, and >30 g/day | Incident AF (idiopathic and known etiology) diagnosed by cardiologist (85% had ECGs) | N/A | 200 | 100 | Higher alcohol intake associated with higher risk of lone AF (p<0.05) but not AF associated with comorbidities | Age, sex |
| Koskinen 199019 | Both sexes; Finnish subjects; average age 51.5 years; patients hospitalized with recurrent AF, age/sex matched ER controls and age/sex frequency matched community controls | Matched Case- control | Interview regarding amount of alcohol in prior week (grams) and CAGE exam; weekly alcohol categorized into 0, 1–210 grams, and >210 g | Recurrent AF as ascertained by clinical evaluation | None | 246 | 98 | No association in women; in men, multivariate analyses showed that cases had higher odds of alcohol abuse (OR=3.25, p<0.05) compared with all controls | Age, sex, potassium levels, heart disease, stress/lack of sleep |
| Koskinen 199118 | Both sexes; Finnish subjects; average age 48 years; patients with new onset AF | Cohort | Interview regarding amount of alcohol in prior week, if different from previous weeks, and CAGE exam | Recurrent or chronic AF | 4 years | 98 | 39 subjects with recurrences and an additional 7 transitioned to chronic. | No association | None |
| Wilhelmsen 200121 | Men only; Swedish subjects; 47–55 at baseline; population based sample | Cohort | Alcohol abuse data were obtained via registries (yes/no) | Incident AF - Outpatient and Hospitalized AF via ICD-9 codes | 25.2 years | 7,495 | 754 | Alcohol abuse was associated with increased risk (RR=1.21, 95% CI 1.02–1.42) | Age |
| Djousse 200412 | Both sexes; U.S. subjects; average age 42–50 at baseline; Framingham cohort cases of AF and 1: ≥5 controls matched on age, sex, age at baseline, cohort, HTN, baseline CHF, and MI | Matched case- control of cohort data | Repeated questionnaires; frequency of alcohol intake; g/day averaged from baseline until visit prior to AF onset categorized into 0, 0.1–12, 12.1–24, 24.1–36, >36 | Incident AF obtained at study visit or by medical records - all confirmed with ECG | > 50 years | 10,333 | 1,055 | No effect with moderate intake. OR of AF in >36 g alcohol/day 1.33 (95% CI 1.01–1.78) | Multivariable |
| Frost 200413 | Both sexes; Danish subjects; average age 56 years; healthy population- based sample | Cohort | FFQ addressing amount (g/day), type (beer, wine, etc.), and frequency (times/week) of alcohol consumption. Broken out into sex-specific quintiles | Incident AF as identified by hospitalization discharge ICD-8 and ICD-10 codes, outpatient discharge codes after 1/1/95 | 5.7 years | 47,949 | 556 | No association in women. In men, 40% higher risk among those in quintiles 3–5 compared to quintile 1 (p for trend=0.04). | Multivariable |
| Mukamal 200514 | Both sexes; Danish subjects; median age 48–56; healthy, population-based sample | Cohort | Structured questionnaire given at three different time points | Incident AF from 1 of 3 exam visits (ECG) or nationwide hospitalization registries (ICD-9 codes) | >20 years | 1,645 | 1,071 | No association in women. In men higher risk among those taking ≥5 drinks/day (HR 1.45, 95% CI 1.02–2.04) | Multivariable |
| Mukamal 200715 | Both sexes; U.S. subjects; age > 65; population-based sample | Cohort | Yearly quantity/frequency questionnaire (until 1999) and then validated FFQ. Both had questions about frequency and amount of beer, wine, and spirits | Incident AF per annual visit or hospital discharge ICD-9 codes | 9.1 years | 5,609 | 1,232 | No association | Multivariable |
| Conen 200816 | Women only; U.S. subjects; >45 years at baseline; initially healthy | Cohort | FFQ measured at two time points; questions on alcohol intake amount and type; categorized into none, <1/day, 1-<2, and ≥2 | Incident AF via self-report and confirmed via ECG or medical report | 12.4 years | 34,715 | 653 | Increased risk if ≥2 drinks/day versus no alcohol (HR 1.49, 95% CI: 1.05–2.11) | Multivariable |
| Marcus 200817 | Both sexes; US subjects; AF/AFL cases; controls were patients with other arrhythmia and healthy controls | Matched case- control | Structured interview asking average amount and frequency of alcohol consumption (categorized into daily drinker vs. not daily drinker) | All AF/AFL patients reporting for ablation or cardioversion | None | 381 | 125 with AF, 70 with AFL | Increased risk of AFL in younger <60 daily drinkers vs. non-drinkers (OR 17, 95% CI 1.6–192.0) | Multivariable |
AF, atrial fibrillation; AFL, atrial flutter; CI: confidence interval; ECG, electrocardiogram; FFQ, food frequency questionnaire; N/A: not applicable; OR, odds ratio; RR: risk ratio