Every December and January, emergency room doctors see patients with Holiday Heart Syndrome, a bout of atrial fibrillation produced by heavier-than-normal drinking.
Now, there is growing concern that even moderate alcohol consumption can trigger episodes of atrial fibrillation—commonly called AFib—fast and chaotic beating of the heart that can lead to stroke and other health problems.
“The data for alcohol [and AFib] are quite strong,” says Dr. James Freeman, a cardiologist at the Yale School of Medicine.
People who had previous incidents of AFib are most at risk. A 2021 study by the University of California at San Francisco found that a single alcoholic drink doubled the risk of atrial fibrillation within four hours, while two or more drinks tripled it. A separate UCSF study found that as blood alcohol levels rose, electrical properties of the heart changed in a way that made it more prone to AFib
AFib is a common malady, but it can be quite dangerous. Because the heart pumps erratically during AFib, blood can pool and clot more easily. Those clots can go anywhere in the body, causing stroke, heart attacks, or organ problems.
“People with AFib are at high risk of stroke, high risk of heart attack, high risk of kidney problems,” says Dr. Gregory Marcus, the UCSF cardiologist who conducted the alcohol studies. People with AFib also appear to be at higher risk of dementia, possibly because small clots lodge in their brain, Dr. Marcus says.
Sometimes AFib comes and goes. Other times it can persist for days, months, or even years, causing discomfort and elevated heart rate. “Some people feel very uncomfortable,” Marcus says. “Others may not have any symptoms.”
Doctors sometimes perform a procedure called an ablation to treat AFib, threading catheters through a vein into the heart, and then using heat or cold to create scars in the heart to block the faulty electrical signals and restore a normal heartbeat.
Alcohol use is by no means the only risk factor for AFib. Hypertension, coronary disease, and diabetes also make the condition more likely. But alcohol consumption—along with sleep apnea and obesity—is one of the more modifiable risk factors, says Yale’s Freeman.
“One of the easiest things we can do is lose weight or stop drinking,” he says. “We know that reducing use of alcohol, or eliminating it completely, can be a potent treatment.”
What about people who don’t already have AFib? Is drinking alcohol safe for them? Doctors Freeman and Marcus say that heavy drinking appears to contribute to onset of AFib, and older Americans should be even more cautious about alcohol use. That’s because AFib rates rise with age. The rate is around 4% for those in their 60s, but can be as high as 10% to 17% in those over age 80.
It’s less clear whether alcohol causes AFib in light to moderate drinkers. Some studies have found links, but at least one well-regarded study found that low levels of alcohol—as long you weren’t drinking beer or cider—were associated with the lowest level of AFib risk.
“We really don’t know, there could even be benefits,” says Marcus, who doesn’t have AFib and drinks a glass of red wine at times with his dinner.
But for people who have had an incident of AFib, there is now little doubt that alcohol can help bring on more episodes. A 2020 study in Australia took 70 regular drinkers with AFib and divided them into two groups. One group continued to drink and AFib recurred in 73% of them during a 6-month study period. The other group largely abstained, and 53% experienced AFib.
“If someone has ever had an episode with AFib, and wants to do everything possible to minimize AFib,” Marcus says, “it would be to cut out all alcohol.”
Write to Neal Templin at [email protected]
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