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Chronic heavy drinkers in middle age had better chances of dodging atrial fibrillation (Afib or AF) if they quit alcohol instead of drinking less of it, a retrospective study suggested.

In a nationwide population-based cohort from South Korea, former heavy drinkers who switched to absolute abstinence had a significantly lower long-term risk of new-onset Afib compared with peers who sustained heavy drinking (HR 0.379, 95% CI 0.169-0.853), reported Dae-In Lee, MD, of Korea University Medical Center in Seoul, and colleagues.

No such risk reduction generally applied to people who practiced harm reduction, or reduced drinking (HR 0.940, 95% CI 0.806-1.097) -- although people with CHA₂DS₂-VASc scores under 3 did appear to have reduced incident Afib after drinking less (HR 0.795, 95% CI 0.642-0.985), they noted in the .

"Our findings indicate that mitigating measures targeting healthier and younger individuals would be more beneficial in preventing alcohol-attributable AF," the group wrote, advocating for alcohol regulation policies such as beverage taxes and other ways to limit accessibility to drinking.

"Given the high prevalence of heavy alcohol consumption in most countries, comprehensive clinical measures and public health policies are required to prevent incident AF in heavy drinkers," the authors stressed.

American suggest no more than two drinks a day for men and one drink a day for women. The CDC defines as eight or more drinks per week for a woman or 15 or more drinks per week for a man.

Between absolute abstinence and the harm reduction approach, the latter is thought to be more acceptable and feasible to heavy drinkers seeking to lower their alcohol-related risks (e.g., heart disease, liver disease, cancer, and poor pregnancy outcomes).

However, research has shown that drinking even small amounts can be a risk factor for Afib.

The present study extends the known Afib-limiting benefit of alcohol abstinence, evident in reduced recurrent Afib episodes in people with a history of Afib, to a primary prevention cohort with no baseline Afib.

"AF is a multi-faceted disease resulting from a combined interaction of multiple risk factors, including sex, genetic vulnerability, environmental factors, unhealthy lifestyle factors, cardiovascular risk factors, and metabolic or systemic comorbidities," Lee's team noted.

"Accordingly, the effect of alcohol on incident AF needs to be interpreted in the context of the inter-individual variability of several predisposing factors, including hypertension, obesity, diabetes mellitus, cardiomyopathy, and obstructive sleep apnea," the group cautioned.

The retrospective study included 19,425 people, all free of baseline Afib, with heavy drinking logged in the Korean National Health Insurance Service database in 2005-2008. The definition of heavy drinking corresponded with the World Health Organization's risk thresholds of 60 g per day of alcohol for men and 40 g per day for women.

The cohort was divided into three groups based on subsequent changes in alcohol consumption in 2009-2012:

• Sustained heavy drinking (n=10,629; average age at baseline 55.3 years, 91.7% men)
• Reduced drinking (n=8,419; 57.2 years, 88.9% men)
• Absolute abstinence (n=377; 59.7 years, 59.2% men)

After inverse probability of treatment weighting, baseline patient variables were mostly balanced except for creatinine level among the three groups.

Follow-up lasted from 2013 to 2019, during which incident Afib was captured from hospitalization and outpatient records.

Lee and colleagues acknowledged that all alcohol consumption patterns were self-reported by patients, and that the investigators could only assume that participants kept their drinking habits from 2009-2012 during the follow-up period.

Furthermore, the study only included people in South Korea, limiting its generalizability to other populations.

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