An analysis of data from the large Atherosclerosis Risk in Communities (ARIC) study evaluated the effects of alcohol consumption at baseline, and the cumulative average intake based on several later assessments during a 24 year follow-up period, on the risk of the development of heart failure (HF). The authors conclude: “In this community, alcohol consumption of up to 7 drinks/week at early-middle age is associated with lower risk for future HF, with a similar but less definite association in women than in men. These findings suggest that despite the dangers of heavy drinking, modest alcohol consumption in early-middle age may be associated with a lower risk for HF.” The authors reported further that the risk of total mortality was higher than that of abstainers for former drinkers and for the heaviest drinkers, but did not demonstrate a “J-shaped” curve for total mortality (i.e., a lower risk for moderate drinkers in comparison with abstainers).
Forum members considered this to be a well-done analysis, with findings for a lower risk of HF among light-to-moderate drinkers consistent with many earlier reports. They noted that these findings may be somewhat affected by the inability of the investigators to include data on the pattern of alcohol consumption (regular moderate intake versus periodic binge drinking of similar total amounts) to disease. It would be expected that the relations between alcohol intake and HF (as well as with total mortality) would be stronger for regular moderate drinkers than for those who consumed their alcohol in binges (even if the total weekly average intake was the same). This could be one reason why a “J-shaped” curve was not seen for the relation of alcohol intake to total mortality in this study.
While coronary artery disease (CAD) is known to be a major precursor of HF, it is not clear from the data presented if the alcohol-HF relation may have differed between subjects with and those without CAD. For the effects of current heavy drinking, the implications from this study are limited because of the small number of such drinkers in this cohort; this was especially the case for women. The authors do not discuss the potential effects on their results of under-reporting of alcohol intake among their subjects; other studies have suggested means for identifying such subjects and ways of adjusting for such.
This study adds support to other large studies, including one just released as a pre-publication (see Addendum), that suggest that moderate alcohol consumption may reduce the risk of the development of heart failure. Some of this putative protective effect surely relates to a decrease in the risk of coronary artery disease among moderate drinkers. Heavy alcohol intake, especially among alcoholics, may increase the risk of both heart disease and heart failure.
Reference: Gon?alves A, Claggett B, Jhund PS, Rosamond W, Deswal A, Aguilar D, Shah AM, Cheng S, Solomon SD. Alcohol consumption and risk of heart failure: the Atherosclerosis Risk in Communities Study. European Heart Journal, 2015, pre-publication; doi:10.1093/eurheartj/ehu514.
Addendum Following the preparation of this critique, the pre-publication version of another paper has appeared: Larsson SC, Orsini N, Wolk A. Alcohol consumption and risk of heart failure: a dose–response meta-analysis of prospective studies. European Journal of Heart Failure 2015; January, 2015. 10.1002/ejhf.228. According to its abstract, this paper is based on “a meta-analysis that included eight prospective studies, with a total of 202,378 participants and 6,211 cases of HF.” While the Forum has not yet had an opportunity for a careful review of this new paper, the authors’ conclusions appear to provide strong support for the paper by Gon?alves et al. The authors of the Larsson et al paper conclude their abstract by stating that when carrying out a dose-response meta-analysis, they “observed a non-linear relationship between alcohol consumption and risk of HF. Compared with non-drinkers, the RRs (95% CI) across levels of alcohol consumption were 0.90 (0.84–0.96) for 3 drinks/week, 0.83 (0.73–0.95) for 7 drinks/week, 0.84 (0.72–0.98) for 10 drinks/week, 0.90 (0.73–1.10) for 14 drinks/week, and 1.07 (0.77–1.48) for 21 drinks/week. Alcohol consumption in moderation is associated with a reduced risk of HF.”