Eur Heart J. 2021;42(46):4759-4768.

Lower risk of stroke after alcohol abstinence in patients with incident atrial fibrillation: a nationwide population-based cohort study.

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제1저자 이소령 · 교신저자 최의근

PMID 34097040 PMC8651176 DOI 10.1093/eurheartj/ehab315 IF 45.3 순환기내과

소속 (6)

Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Department of Medical Statistics, College of Medicine, Catholic University of Korea, 222 Banpo-daero, Seoucho-gu, Seoul 06591, Republic of Korea.
Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul 06978, Republic of Korea.
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, Thomas Dr, Liverpool L14 3PE, UK.
Department of Clinical Medicine, Aalborg University, Aalborg 9000, Denmark.

Abstract

AIMS The aim of this study was to evaluate the association between alcohol consumption status (and its changes) after newly diagnosed atrial fibrillation (AF) and the risk of ischaemic stroke.

METHODS AND RESULTS Using the Korean nationwide claims and health examination database, we included subjects who were newly diagnosed with AF between 2010 and 2016. Patients were categorized into three groups according to the status of alcohol consumption before and after AF diagnosis: non-drinkers; abstainers from alcohol after AF diagnosis; and current drinkers. The primary outcome was incident ischaemic stroke during follow-up. Non-drinkers, abstainers, and current drinkers were compared using incidence rate differences after the inverse probability of treatment weighting (IPTW). Among a total of 97 869 newly diagnosed AF patients, 51% were non-drinkers, 13% were abstainers, and 36% were current drinkers. During 310 926 person-years of follow-up, 3120 patients were diagnosed with incident ischaemic stroke (10.0 per 1000 person-years). At 5-year follow-up, abstainers and non-drinkers were associated with a lower risk for stroke than current drinkers (incidence rate differences after IPTW, -2.03 [-3.25, -0.82] for abstainers and -2.98 [-3.81, -2.15] for non-drinkers, per 1000 person-years, respectively; and incidence rate ratios after IPTW, 0.75 [0.70, 0.81] for non-drinkers and 0.83 [0.74, 0.93] for abstainers, respectively).

CONCLUSION Current alcohol consumption was associated with an increased risk of ischaemic stroke in patients with newly diagnosed AF, and alcohol abstinence after AF diagnosis could reduce the risk of ischaemic stroke. Lifestyle intervention, including attention to alcohol consumption, should be encouraged as part of a comprehensive approach to AF management to improve clinical outcomes.

Keywords

AlcoholAlcohol abstinenceAtrial fibrillationStroke

Figures

Alcohol abstinence after atrial fibrillation diagnosis could reduce the risk of ischaemic stroke. Lifestyle intervention, including attention to alcohol consumption, should be encouraged as part of a comprehensive approach to atrial fibrillation management to improve clinical outcomes.

**Figure 1** Study design. AF, atrial fibrillation.

**Figure 2** Flowchart of enrolment of the study population. AF, atrial fibrillation.

**Figure 3** Weighted cumulative incidence curves of non-drinkers, abstainers, and current drinkers after inverse probability of treatment weighting. Incidence rate and incidence rate difference, per 1000 person-years. *Time after the second health examination (within 2-year after the date of AF diagnosis). CI, confidence interval; HR, hazard ratio; IPTW, inverse probability of treatment weighting; IR, incidence rate; IRD, incidence rate difference; IRR, incidence rate ratio.

**Figure 4** The risk of incident ischaemic stroke according to alcohol consumption status. (A) The risk of incident ischaemic stroke in abstainers and current drinkers compared to non-drinkers. *With current drinkers as the reference group. Incidence rate, per 1000 person-years. (B) Stratifying current drinkers according to the amount of alcohol consumed per week. (C) Stratifying current drinkers according to the number of drinking sessions per week. (D) Stratifying current drinkers according to the alcohol consumed per each drinking session adjusted for age, sex, baseline body mass index, heavy drinker, regular exercise, low income, comorbidities including hypertension, diabetes mellitus, dyslipidaemia, heart failure, prior myocardial infarction, peripheral artery disease, chronic kidney disease, chronic obstructive pulmonary disease, cancer, CHA₂DS₂-VASc score, baseline medications including oral anticoagulants (warfarin or DOAC), anti-platelet agents (aspirin or P₂Y₁₂ inhibitor) and statin. CI, confidence interval; DOAC, direct oral anticoagulant; HR, hazard ratio; IR, incidence rate.

**Figure 5** Cumulative incidence curves in the propensity score matched cohort. Incidence rate and incidence rate difference, per 1000 person-years. *Time after the second health examination (within 2 years after the date of atrial fibrillation diagnosis). CI, confidence interval; HR, hazard ratio; IR, incidence rate; IRD, incidence rate difference; IRR, incidence rate ratio.

그림 출처: PubMed Central 공개 논문 (PMC8651176)

Comment · 정정

Comment in Eur Heart J. 2021 Dec 7;42(46):4769-4771. doi: 10.1093/eurheartj/ehab657.

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