Levels of alcohol consumption currently considered safe by some countries are linked to development of heart failure, according to research presented at Heart Failure 2022, a scientific congress of the European Society of Cardiology in Spain.
“This study adds to the body of evidence that a more cautious approach to alcohol consumption is needed,” said study author Dr Bethany Wong of St Vincent’s University Hospital, Dublin, Ireland.
“To minimise the risk of alcohol causing harm to the heart, if you don’t drink, don’t start. If you do drink, limit your weekly consumption to less than one bottle of wine or less than three-and-a-half 500 ml cans of 4.5% beer.”
According to the World Health Organisation, the European Union is the heaviest-drinking region in the world. While it is well recognised that long-term heavy alcohol use can cause a type of heart failure called alcoholic cardiomyopathy, evidence from Asian populations suggests that lower amounts may also be detrimental.
“As there are genetic and environmental differences between Asian and European populations this study investigated if there was a similar relationship between alcohol and cardiac changes in Europeans at risk of heart failure or with pre-heart failure,” said Wong.
“The mainstay of treatment for this group is management of risk factors such as alcohol, so knowledge about safe levels is crucial.” This was a secondary analysis of the STOP-HF trial.
The study included 744 adults over 40 years-old either at risk of developing heart failure due to risk factors (e.g. high blood pressure, diabetes, obesity) or with pre-heart failure (risk factors and heart abnormalities but no symptoms).
The average age was 66.5 years and 53% were women. The study excluded former drinkers and heart failure patients with symptoms (e.g. shortness of breath, tiredness, reduced ability to exercise, swollen ankles). Heart function was measured with echocardiography at baseline and follow-up.
The study used the Irish definition of one standard drink (i.e. one unit), which is 10g of alcohol. Participants were categorised according to their weekly alcohol intake: 1) none; 2) low (less than seven units; up to one 750ml bottle of 12.5% wine or three-and-a-half 500ml cans of 4.5% beer); 3) moderate (7-14 units; up to two bottles of 12.5% wine or seven 500ml cans of 4.5% beer); 4) high (above 14 units; more than two bottles of 12.5% wine or seven 500ml cans of 4.5% beer).
The researchers analysed the association between alcohol use and heart health over a median of 5.4 years. The results were reported separately for the at-risk and pre-heart failure groups.
In the at-risk group, worsening heart health was defined as progression to pre-heart failure or to symptomatic heart failure. For the pre-heart failure group, worsening heart health was defined as deterioration in the squeezing or relaxation functions of the heart or progression to symptomatic heart failure. The analyses were adjusted for factors that can affect heart structure including age, gender, obesity, high blood pressure, diabetes, and vascular disease.
A total of 201 (27%) patients reported no alcohol usage, while 356 (48%) were low users and 187 (25%) had moderate or high intake. Compared to the low intake group, those with moderate or high use were younger, more likely to be male, and had a higher body mass index.
In the pre-heart failure group, compared with no alcohol use, moderate or high intake was associated with a 4.5-fold increased risk of worsening heart health. The relationship was also observed when moderate and high levels were analysed separately. In the at-risk group, there was no association between moderate or high alcohol use with progression to pre-heart failure or to symptomatic heart failure. No protective associations were found for low alcohol intake.
Wong said: “Our study suggests that drinking more than 70g of alcohol per week is associated with worsening pre-heart failure or progression to symptomatic heart failure in Europeans. We did not observe any benefits of low alcohol usage. Our results indicate that countries should advocate lower limits of safe alcohol intake in pre-heart failure patients.
“In Ireland, for example, those at risk of heart failure or with pre-heart failure are advised to restrict weekly alcohol intake to 11 units for women and 17 units for men. This limit for men is more than twice the amount we found to be safe. More research is needed in Caucasian populations to align results and reduce the mixed messages that clinicians, patients and the public are currently getting.”
Study details
Moderate alcohol consumption is associated with progression of left ventricular dysfunction in a European stage B heart failure population.
B Wong, A Radhakrishna, K Mcdonald, M Ledwidge, St Vincent's University Hospital Dublin, University College Dublin,
Presented at the ESC Heart Failure Congress on 22 May
Background
There is limited evidence of the longitudinal impact of alcohol dose and progression of structural cardiac changes amongst European populations with pre-heart failure (Stage A/B HF). Furthermore, current guidelines describe beneficial effects in the general population of light alcohol usage on risk of HF{1}, despite emerging evidence to the contrary{2}.
Aim
To understand the dose-response relationship between alcohol consumption and progression of stage B/C HF in a European population.
Methods
This is a secondary analysis of the St Vincent’s Screening TO-Prevent Heart Failure (STOP-HF) trial{3} among patients with Stage A/B HF, with documented alcohol intake and echocardiography at both baseline and follow up ≥18 months. Excluded were former-drinkers and patients with symptomatic (stage C) HF. The main outcome measure was the relationship between progression of stage B/C HF, stratified according to whether patients were stage A or B at baseline, and 3 categories of alcohol dose: no alcohol usage; low alcohol usage (1 unit daily or 70g/week); moderate-high alcohol usage (>1 unit daily or >70g/week). Progression of stage B HF was defined as follow up left ventricular dysfunction (EF <50%) and a decline of at least 5% and/or lateral E/e’ >13 increase of at least 2 units. Prespecified covariate adjustment included age, gender, obesity, hypertension, diabetes, vascular disease.
Results
Of 744 patients included in the analysis (mean age 66.5 ±9.8 years), 395 (53.1%) were female, 556 (74.7%) had hypertension, 145 (19.5%) had diabetes and 260 (34.9%) had stage B HF at baseline. Overall, a total of 201 (27.0%) patients reported no alcohol usage, 356 (47.8%) reported low (70g/ wk) alcohol intake and n=187 (25.1%) reported moderate-high alcohol usage with >70g/ wk alcohol intake. There was no difference in alcohol usage between stage A and stage B patients. Compared to low alcohol use, those with moderate-high alcohol usage were younger, more likely to be male and had a higher body mass index. Over a median follow up period of 5.44 [IQR 4.33;6.73] years, 84 (11.3%) patients had progression of stage B/C HF. Moderate-high alcohol usage was associated with an adjusted 4.5 fold (95% CI 1.7- 15.9, p=0.004) increased risk of progression of stage B/C HF amongst those with stage B at baseline. Increased progression of stage B/C HF was also evident in moderate (70-140g/week) and high (>140g/week) alcohol use subgroups. Finally, there was no protective associations of low alcohol usage (<70g/week) and progression of HF in any patient group. Conclusion Moderate alcohol (>70g/week) usage appears to be associated with progression of stage B/C HF in European patients in the STOP-HF study and we did not observe protective benefits of low alcohol usage. These data are in accordance with recent evidence from Asian populations{4}. European HF guidelines should reconsider advice suggesting any protective effects of alcohol on risk of heart failure.
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Moderate alcohol use can be good for the heart if rich, fatal if poor
Major study: Drinking less alcohol improves heart health
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