Life overflows with choices. And consequences. You can choose to smoke and then not be surprised to die a difficult death from cancer. You can choose to eat more calories than you burn and then buy bigger belts. You can choose to “need” more stuff and then, surely, remain unfulfilled.
The more we learn about atrial fibrillation the more it looks like a consequence of our choices. The notion that AF is (mostly) not a mysterious fluke of nature but a result of simple lifestyle choices represents a big shift in thinking, which, like most things in medicine, will take some time to become mainstream. It’s very early in the process of understanding that AF may be unnecessary.
One of the choices we make in our daily life is whether to drink alcohol. And if we decide to drink, we also decide the dosage. These choices, too, come with consequences. And one of them may be to disrupt the heart’s rhythm.
It has long been known that excessive alcohol intake can lead to the “holiday heart,” a disorder in which AF occurs and then passes. Fast (intuitive) thinking holds that it was just too much alcohol at one time, and, no worries, just don’t do that dose again and all will be well.
New studies, however, tell a different story. In recent years, researchers who study populations have found linear (not u-shaped) relationships of alcohol intake and AF incidence. What this means is that one drink daily increases the risk of AF a little. Two drinks daily increases AF risk a little more. And so on. This is different than the old idea that mild-to-moderate alcohol intake is protective (u-shaped curve).
A new study published this week in the Journal of the American College of Cardiology strengthens the idea that alcohol intake increases the risk of having AF in a dose-dependent way. Although the study was observational, the Swedish researchers provided compelling evidence that alcohol intake is indeed an important lifestyle choice, one that comes with potential consequences for the heart’s electrical system. (Recall that the heart beats 100,000 times daily. And that once AF starts, it sometimes doesn’t just stop so easily.)
In my column over at Trials and Fibrillations on theHeart.org, I summarized this study, and then expanded on four thoughts that came to mind when thinking about alcohol and AF risk. The areas I wrote about included the biology, statistics, ethics and philosophy of alcohol use.
If you want to read more, the title and link to the post is here: Alcohol and AF: More Data, More Questions, and Some Philosophy.
JMM
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